 This study found that hyposemia is common among acutely unwell children under five years of age presenting to gondon primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials, including economic analysis from health system and societal perspectives. This article was authored by Hamish R. Graham, Yawanda Kamuntu, Jasmine Miller and others.