The prevalence of hypoxaemia in paediatric and adult patients in health-care facilities in low-income and middle-income countries: a systematic review and meta-analysis.

Summary

Across 213 studies with 601,757 participants from LMICs, pooled hypoxaemia prevalence was 24.5% in neonates, 12.1% in children, and 10.8% in adults, and hypoxaemia was associated with 4.84-fold higher odds of death. Burden was highest in neonatal and respiratory conditions but remained substantial across other illnesses.

Key Findings

• Pooled hypoxaemia prevalence: neonates 24.5% (95% CI 19.9–29.4), children 12.1% (10.0–14.4), adults 10.8% (4.9–18.7).
• Hypoxaemia increased odds of death by 4.84 (95% CI 4.11–5.69).
• Highest burden in neonatal and primary respiratory conditions, but hypoxaemia was common across many other diagnoses.

Clinical Implications

Integrate pulse oximetry screening and reliable oxygen therapy across all levels of care, prioritize neonatal and respiratory conditions, and embed hypoxaemia assessment into triage and quality-of-care metrics.

Limitations

• Heterogeneity across studies and settings; variable SpO2 thresholds and measurement protocols
• Geographic concentration in sub-Saharan Africa and South Asia may limit generalizability

Future Directions

Develop and evaluate scalable oxygen systems (supply, pulse oximetry, automated titration), define context-specific SpO2 thresholds, and implement quality improvement programs to reduce hypoxaemia-related mortality.