A retrospective cohort assessing practices of hypoxemia management for inpatients of Rwandan public hospitals

Hypoxemia, low blood oxygen levels, poses significant risks to inpatients. Effective management relies on pulse oximetry diagnosis and prompt, high-quality oxygen therapy. In Rwanda, following recent national investments in medical oxygen systems, we aimed to evaluate hypoxemia management for inpatients in hospital settings. A retrospective cohort was conducted in public hospitals in Rwanda from July to September 2022, using data extracted from medical records for all inpatient admissions to examine pulse oximetry use, hypoxemia prevalence and oxygen administration on the day of admission, and subsequent patient outcomes. Pulse oximetry on admission was documented for 87.7% (5025/5731, 95% CI 86.8–88.5%) of patients who were admitted to 39 Rwandan hospitals. Of patients that had a following day of admission, this fell to 75.3% (3702/4919, 95% CI 74.0-76.5%). The prevalence of hypoxemia (SpO 2 <90%) amongst those screened on admission was found to be 9.4% (472/5025, 95% CI 8.6–10.2%), particularly affecting neonates at 27.9% (163/585, 95% CI 24.4–31.6%). 21.0% of patients hypoxemic on admission died (99/472, 95% CI 17.5–24.9), compared to 1.7% of those not found to be hypoxemic (78/4538, 95% CI 1.4–2.1%). Among patients identified as hypoxemic on admission, 93.4% (441/472, 95% CI 90.8–95.4%) received oxygen therapy. Pulse oximetry and oxygen therapy use, was common on admission to hospital in Rwanda. There were some disparities across wards, especially maternity. While most patients found to be hypoxemic received oxygen the same day, improvements in use of pulse oximetry to monitor patients throughout the course of the admission are required.