Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study.



Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya, with a focus on chronic hypoxaemia.


Single-centre, prospective cohort study.


National tertiary referral hospital in Eldoret, Kenya between September 2019 and April 2022.


Adults (age ≥18 years) admitted to general medicine wards.

Primary and secondary outcome measures

Our primary outcome was proportion of patients who were hypoxaemic (oxygen saturation, SpO2 ≤88%) on admission. Secondary outcomes were proportion of patients with hypoxaemia on admission who had hypoxaemia resolution, hospital discharge, transfer, or death among those with unresolved hypoxaemia or chronic hypoxaemia. Patients remaining hypoxaemic for ≤3 days after admission were enrolled into an additional cohort to determine chronic hypoxaemia. Chronic hypoxaemia was defined as an SpO2 ≤ 88% at either 1-month post-discharge follow-up or, for patients who died prior to follow-up, a documented SpO2 ≤88% during a previous hospital discharge or outpatient visit within the last 6 months.


We screened 4104 patients (48.5% female, mean age 49.4±19.4 years), of whom 23.8% were hypoxaemic on admission. Hypoxaemic patients were significantly older and more predominantly female than normoxaemic patients. Among those hypoxaemic on admission, 33.9% had resolution of their hypoxaemia as inpatients, 55.6% had unresolved hypoxaemia (31.0% died before hospital discharge, 13.3% were alive on discharge and 11.4% were transferred) and 10.4% were lost to follow-up. The prevalence of chronic hypoxaemia was 2.1% in the total screened population, representing 8.8% of patients who were hypoxaemic on admission. Chronic hypoxaemia was determined at 1-month post-discharge among 59/86 patients and based on prior documentation among 27/86 patients.


Hypoxaemia is highly prevalent among adults admitted to a general medicine ward at a national referral hospital in Kenya. Nearly 1 in 11 patients who are hypoxaemic on admission are chronically hypoxaemic.





Published Version (Please cite this version)


Publication Info

Navuluri, Neelima, David K Lagat, Elcy Birgen, Sylvia Kitur, Peter S Kussin, David M Murdoch, Nathan M Thielman, Alice Parish, et al. (2023). Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study. BMJ open, 13(9). p. e072111. 10.1136/bmjopen-2023-072111 Retrieved from

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Neelima Navuluri

Assistant Professor of Medicine

Peter Samuel Kussin

Professor of Medicine

The majority of my effort is devoted to clinical care of patients with advanced lung disease and teaching.

I spend four months a year in Eldoret Kenya working at Moi Teaching and Referral Hospital as part of The Duke Hubert Yeargan Institute for Global Health and AMPATH- a consortium of North American Medical Schools collaborating with Moi University School of Medicine and Moi Teaching and Referral Hospital. I work primarily in the intensive care unit and medicine wards. I am involved in broad range of research efforts in critical care and pulmonary medicine  in resource limited countries.


David Martin Murdoch

Associate Professor of Medicine

As a physician and researcher, my career has been driven by a passion for linking the basic and clinical sciences with the primary goal of understanding the disease pathogenesis. Through my training in epidemiology, basic science immunology, and clinical medicine, I have acquired a breadth of experience, knowledge, collaborators, and an adaptability which has culminated in a research focus on the reconstitution of immune responses and systemic inflammation in immunocompromised patients and vulnerable populations. My research focuses on T cell immunology utilizing a variety of platforms including polychromatic flow cytometry, cytokine multiplexing, and novel single cell assays. My initial research centered on the immune reconstitution syndrome (IRIS), with a focus on the mycobacterial precipitants of the disease, its epidemiology, and research efforts into elucidating the pathogenesis of the syndrome. Recently, I have translated my interest in co-infection immunology in the immunocompromised transplant population. With a career long interest in contrasting compartmental and peripheral immune responses, I have partnered with engineers in the Duke Pratt School of Engineering in order to develop novel single cell immune assays in order to comprehensively profile the immune response on limited specimens.


Nathan Maclyn Thielman

Professor of Medicine

Broadly, my research focuses on a range of clinical and social issues that affect persons living with or at risk for HIV infection in resource-poor settings. In Tanzania, our group is applying novel methods to optimize HIV testing uptake among high-risk groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying (a) which characteristics of HIV testing options are most preferred by different populations and (b) which tradeoffs individuals make in evaluating testing options. Building on more than a decade of productive HIV testing research in the Kilimanjaro Region, the next phase of our NIMH funded project will test the hypothesis that DCE-derived HIV testing options significantly increases rates of testing among groups at high risk for HIV infection. This work holds promise not only for optimizing HIV testing uptake in the Kilimanjaro Region, but also for applying novel tools in the service of translational epidemiology and implementation research.


Alice Parish

Biostatistician III

Education: Master of Science in Public Health, Biostatistics-  Emory University Rollins School of Public Health.  

Overview: Alice collaborates with researchers and clinicians with the Division of Gastroenterology on many observational studies using data from EHR as well as large national databases such as HCUP, UNOS, and Medicare 5% LDS.  Additionally, Alice collaborates with the Division of Pulmonary on palliative care RCTs and various retrospective studies.  Alice works with the Pharmacy residents on their PGY1 studies.  In the past Alice has had the opportunity to work with investigators in Heart Center and Epicenter.  Alice has experience working with zero inflated count outcomes, among many other statistical methodologies.


Cynthia Lea Green

Associate Professor of Biostatistics & Bioinformatics

Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods


Neil Ross MacIntyre

Professor of Medicine
  1. Mechanical Ventilation and respiratory failure. Current projects involve studying patient-ventilator interactions during modes of support that require patient activity. The focus is on ventilatory muscle function during these assisted modes. Other projects include evaluating respiratory system mechanics in acute respiratory failure and the role of ECMO in the adult. Duke is also one of several institutions in the NIH ARDS Network, a consortium designed to perform multi-center trials.

    2) Diffusing capacity of the lung for carbon monoxide. Current projects involve using a rapidly responding gas analyzer to measure lung diffusing capacity in discrete regions of the lung. These analyses are being extended into mechanically ventilated patients.

    3) COPD. Current projects involve studying the physiology of cardio-respiratory conditioning in patients with obstructive lung disease and the role of pulmonary rehabilitation in improving COPD outcomes. Duke is also a member of two NIH sponsored multicenter programs: the COPDgene project correlating genetic profiles with physiologic/clinical phenotypes; and the NIH LOTT project evaluating the role of oxygen therapy in exercise and sleep hypoxemia.

    4) Aerosol delivery systems. The current project is the development of a prototype aerosol generating catheter that can be directly inserted into the airways. Studies are being conducted in both ex vivo animal lungs and in mechanically ventilated patients.

Loretta Georgina Que

Professor of Medicine

My research interests focus on studying the role of nitric oxide and related enzymes in the pathogenesis of lung disease, specifically that caused by nitrosative/oxidative stress. Proposed studies are performed in cell culture and applied to animal models of disease, then examined in human disease where relevant. It is our hope that by better understanding the role of NO and reactive nitrogen species in mediating inflammation, and regulating cell signaling, that we will not only help to unravel the basic mechanisms of NO related lung disease, but also provide a rationale for targeted therapeutic use of NO.

Key words: nitrosative defense, lung injury, nitric oxide

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