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The AIRE project (Améliorer l’Identification des détresses Respiratoires chez l’Enfant) demonstrated that a simple device—a pulse oximeter—can contribute to improving the management of severely ill children at primary care level in resource-limited settings. The data presented in this BMJ Global Health supplement confirm its usefulness and acceptability in detecting hypoxaemia, improving early recognition of severe cases and strengthening the quality of clinical decision-making.1 2 These findings are further informed by a realist evaluation conducted as part of the project, which explored how contextual and implementation factors shaped pulse oximetry adoption.3