Two new international studies show that simple digital tools – such as pulse oximeters – can improve clinical outcomes for children at primary healthcare facilities, especially in low-resource settings like Tanzania. 

Pulse oximeters, small devices that measure oxygen levels in the blood, enable health workers to quickly assess a child’s oxygen saturation—an important sign of serious illness—helping them make faster, more accurate treatment decisions.

Together, the studies present a clearer picture of how such technology works in real-world clinics, highlighting both the potential benefits and the challenges, including costs.

Researchers from the Ifakara Health Institute, in collaboration with partners from Switzerland, India, Canada, Senegal, and Kenya, played a central role in both studies.

Study 1: Measuring costs and savings

The first study, published on PLOS Global Public Health, looked at how much it costs to use pulse oximetry combined with a digital clinical decision tool when treating children under five. This study was conducted in Tanzania, India, Kenya, and Senegal.

The results show wide differences in cost depending on the country and healthcare setting. In Tanzania, for example, it costs about $70 per 100 children to use the technology in dispensaries, which is cheaper than the standard care. In contrast, in Senegal, the same approach costs up to $385, making it far less affordable.

Using pulse oximetry also helped reduce unnecessary lab tests and antibiotic use in some places, which could save money, while in other settings, it led to more hospital referrals, increasing costs.

"Scaling up PO use at the primary care level nationally could have an important budgetary impact; however, there are ways to reduce costs, for example, by targeting facilities with greater volumes of sick child visits," noted the authors.

Dr. Honorati Masanja and Susan Makawia from the Ifakara Health Institute were part of the research team that carried out this study in Tanzania as part of the Tools for Integrated Management of Childhood Illness (TIMCI) project. Their work helped assess how such tools can fit into real-life clinic settings and inform decisions by health policymakers.

Study 2: Do these tools save lives?

The second study, published on The Lancet’s eClinicalMedicine, focused on the impact of using pulse oximetry and decision support tools to see if they reduce hospital admissions and deaths among sick children under five years. 

While the tools helped health workers better identify seriously ill children, the study didn’t find strong evidence that this led to fewer deaths or hospitalizations. In other words, early detection alone isn’t enough—other parts of the system must also work well. This includes strengthening health systems, training workers, and ensuring timely treatment after diagnosis.

“Pulse oximetry and decision tools must be embedded in wider efforts to implement active follow-up of children with severe illness,” the authors wrote. "These efforts should also aim to strengthen quality as a continuum from primary to hospital care and address the socio-economic determinants of access to care."

Dr. Grace Mhalu and Dr. Honorati Masanja (who was joint last author) were key contributors from the Ifakara, alongside other international collaborators. 

What these studies tell us

Together, these studies offer important lessons for child healthcare in Tanzania and beyond:

• Yes, technology can help, especially in rural areas with few resources.
• It’s not always cheaper—costs vary by country, clinic type, and patient flow.
• Introducing tools alone isn’t enough—to save lives, we also need better training, stronger health systems, and follow-up care.
• Smarter investment matters—directing resources where they’ll have the most impact is key.

Global collaboration, local impact

These studies were made possible through close collaboration between the Ifakara Health Institute and research institutions in Switzerland, India, Canada, Senegal, and Kenya. The team was able to explore how digital tools can work in different health systems and guide smarter investments in child health.

The findings will help shape future decisions on how to improve child healthcare not just in Tanzania, but in other countries facing similar challenges.