Experience with Implementation of Pulse Oximetry Screening for Critical Congenital Heart Disease in a Low–Middle-Income Country

The adoption of pulse oximetry screening (POS) in low- and middle-income countries remains limited. We describe the development, implementation, and evaluation of a POS program at two of the leading tertiary centers in Accra, Ghana, based on a modified American Academy of Pediatrics protocol. Screening was conducted by trained research assistants. Operational experiences of research assistants were evaluated using a mixed-methods approach, including post-implementation surveys (n = 14) and focus group discussions (n = 10). Although participants felt comfortable with the level of instruction, they recommended incorporating simulation exercises to strengthen management of failed screens. Key challenges included difficulty locating newborns due to fragmented wards and paper-based records, equipment durability issues, and complex coordination for echocardiography following failed screens. Early discharge practices and high neonatal intensive care unit admissions reduced screening coverage among high-risk infants. Despite limited referral systems and surgical capacity, the POS pilot increased provider awareness, improved diagnostic clarity and demonstrated feasibility. Sustainable expansion will require more efficient referral networks as well as investment in pediatric cardiology training and cardiac surgical infrastructure.