Health Feature — For decades, the pulse oximeter; a small clip-on device used to measure oxygen levels in the blood has been considered a universal lifesaver. From surgery theatres to neonatal wards, it’s a frontline tool guiding critical interventions. Yet, recent evidence suggests it doesn’t serve all patients equally.
A 2020 study published in The New England Journal of Medicine revealed that pulse oximeters were three times more likely to miss dangerously low oxygen levels in Black patients than in White patients. This discrepancy, linked to differences in skin pigmentation, has raised serious concerns about how medical devices are designed, tested, and approved and whose lives are most at risk when they fail.
Now, Uganda has become a key site in addressing that inequity. The Uganda Hypoxia Lab is the first independent medical device testing facility of its kind in East Africa and the only one globally operating in a low- or middle-income country.
In partnership with the University of California, San Francisco (UCSF) and Uganda’s Association of Anaesthesiologists (AAU), its purpose is to evaluate how pulse oximeters perform on darker-skinned populations, in real-world low-resource settings.
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Dr. Emmanuel Apore, an anaesthesiologist at the lab, says that most such devices have historically been tested in lighter-skinned populations in high-income countries; an oversight with clinical consequences.
“Many of these devices overestimate oxygen levels in people with darker skin,” Dr. Apore explains.
“That means a patient may appear stable when, in fact, they’re hypoxic. The result is delayed intervention, and in critical care, that delay can be fatal.”
The lab’s work builds on the Open Oximetry Project, a UCSF-led initiative launched in 2022 to make pulse oximetry more equitable and accurate across all populations.
For Dr. Apore, this is not just a scientific exercise, it’s a question of representation and accountability.
“For too long, regulatory standards like those of the U.S. FDA and ISO have been shaped almost entirely by data from high-income countries,” he says.
“The Uganda Hypoxia Lab gives Africa a voice in defining what accurate means for all patients.”
The lab’s first major research protocol, Accurate Pulse Oximetry with Profound Hypoxia, aims to test 50 pulse oximeter models on more than 400 volunteers. The data generated will inform manufacturers and regulators on how to calibrate future devices, ensuring their readings reflect the physiological realities of diverse populations.
The urgency of this work became evident during the COVID-19 pandemic, when pulse oximeters became central tools for diagnosis and home monitoring. In Africa and other low-resource regions, these devices guided critical decisions on oxygen therapy and hospital admission. Yet, their inaccuracy in darker-skinned patients likely contributed to under-diagnosis of severe cases.
“COVID-19 exposed how dependent we’ve become on technology that was never designed with everyone in mind,” says Dr. Apore.
“In Uganda, we saw patients whose readings appeared normal, yet they were severely hypoxic. By the time care escalated, outcomes were often poor.”
This experience has reinforced the argument for localised research and validation; especially as low- and middle-income countries increasingly rely on imported technologies whose performance may not have been evaluated in their populations.
The establishment of the Hypoxia Lab represents a significant shift in global health dynamics. For the first time, data from a low-income country could influence international device regulation not merely adapt to it.
“Africa’s contribution to medical device research has long been underrepresented,” notes Dr. Apore.
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“This lab allows Uganda not only to generate its own data but also to shape global safety standards. It’s a step toward equity in both science and patient care.”
In the long term, the lab will also serve as a regional training hub, mentoring Ugandan and East African researchers in medical device testing and regulatory science. It will support partnerships with local universities, including Makerere and Busitema to build capacity for evidence-based medical innovation.
The Uganda Hypoxia Lab is now setting a precedent for what equitable global health research should look like: collaborative, data-driven, and inclusive. Its findings are expected to inform not only pulse oximetry standards but also future testing protocols for other medical devices, from patient monitors to ventilators.
“Patient safety should never depend on skin colour. What we’re doing here is ensuring that the technology we use to save lives sees everyone clearly,” Dr Apore adds.
