Oxygen saturation among under-five children living at moderate altitude, Addis Ababa, Ethiopia


  • amha mekasha addis ababa university
  • Segen Yohanes Menelik II Hospital, Department of Pediatrics


• Moderate altitude, oxygen saturation, children under-five-year




Acute lower respiratory infections (ALRI) is a major cause of deaths in children worldwide. In ALRI hypoxemia is the most common fatal complication. The WHO definition of hypoxemia  does not take into account the altitude The objective of this study is to determine the oxygen saturation value in apparently healthy under-five children who permanently reside at moderate altitude, Addis Ababa, Ethiopia using pulse oximetry. 


The study was a cross sectional design. The location of the study was at 2 health facilities in Addis Ababa. The SpO2 was measured among apparently healthy under-five year children using Nellcor N-10 self-calibrating pulse oximetry between May and July, 2017. A structured questionnaire was used to collect socio-demographic and clinical data. Data were entered and analyzed using SPSS version 20 statistical software.


The mean SpO2 was 93.59% (95% CI 93.06%, 94.11%) with a median of 94.67%.  The 2.5th centile threshold of SpO2 for hypoxemia is 82%. Using suggested formula for hypoxemia threshold for the altitude of Addis Ababa is 90%. A significant difference was observed in SpO2 between infants and older children, although the difference was not demonstrable when sleeping subjects were excluded. Activities affect SpO2 whereby sleep and bottle or breast feeding had a lowering effect on SpO2.


This study provided a reference range of SpO2 values for healthy children under-five years of age. To determine the threshold for hypoxemia needs further clinically relevant cutoff.

Key words:

  • Moderate altitude, oxygen saturation, children under-five-year


1. GBD 2016 collaborators. Estimates of global, regional and national morbidity, mortality and etiologies of lower respiratory infections in 195 countries, 1009-2016: A systematic analysis for Global Burden of Diseases Study 2016. Lancet Infec Dis . 2018; 18: 1191-210.
2. Junge S, Palmer A, Greenwood BM, Mulholland K, Weber M. The spectrum of hypoxemia in children admitted to hospital in the Gambia, West Africa. Trop Med Int health. 2006; 11(3): 367-72
3. Lozano JM. Epidemiology of hypoxemia in children with acute lower respiratory infections. Int J Tuberc Lung Dis. 2001; 5 (6): 496-504.
4. Duke T, Mgone J, Frank D. Hypoxaemia in children with severe pneumonia in Papua
New Guinea. Int J Tuberc Lung Dis 2001; 5:511–19
5. WHO 2004. Informal consultation on clinical use of oxygen. Meeting report 2-3 October 2003.
6. Subhi R, Smith K, Duke T. when should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxemia. Arch Dis Child.2009; 94:6-10
7. Beall CM. Andean, Tibetan, and Ethiopian patterns of adaptation to high-altitude hypoxia. Integrative and Comparative Biology. 2006;46 (1):18–24. doi:10.1093/icb/icj004,
8. Niermeyer S, Yang P, Shanmina, et al. Arterial oxygen saturation in Tibean and Han infants born in Lhasa, Tibet. New Engl J Med 1995;333:1248-52
9. Lozano JM, Duque OR, Buitrago T, Behaine S. Pulse oximetry reference value at high altitude. Arch Dis child.1992;67(3):299-301
10. Reuland DS, Steinhoff MC, Gilman RH, et al. Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes. J Pediatr 1991;119:900–6.
11. Nicholas R, Yaron M, Reeves J. Oxygen saturation in children living at moderate altitude. J Am Board Fam Pract 1993;6:452–6.
12. Gamponia MJ, Babaali H, Yugar F, Gilman RH. Reference values for pulse oximetry at high altitude. Arch Dis Child 1998;78:461–465
13. Stradling JR, Chadwick GA, Frew AJ. Changes in ventilation and its components in normal subjects during sleep. Thorax 1985;40:364-370