Access to Oxygen Therapy| 29 May 2017 1 |

Availability and Use Oxygen in

district hospitals in low and

middle income countries

Dr Wilson Were

Department of Maternal, Newborn, Child and Adolescent Health

Access to Oxygen Therapy| 29 May 2017 2 |

Outline of Presentation

Burden of hypoxaemia

Availability of oxygen systems

Challenges in access to oxygen

Challenges

Conclusions

Access to Oxygen Therapy| 29 May 2017 3 |

Burden of Hypoxia

Every year 11–20M children are admitted with pneumonia

At least 13.3-37.5% (1.5–2.7M) have hypoxaemia

Hypoxia contributes to the over 1.5 M deaths due to

pneumonia

Other common causes of hypoxaemia

– Neonatal period - birth asphyxia, sepsis and low birth weight,

– Adults conditions- COPD, asthma, pneumonia, heart failure, major

trauma and obstetric emergencies, and anaesthesia.

Source: Subhi et al. Lancet Inf Dis 2009

Access to Oxygen Therapy| 29 May 2017 4 |

Oxygen Availability in Hospitals

Ghana (2016) – 11% Health Centre had oxygen supply

Sierra Leone (2009) – 40% of hospitals had no oxygen supply, 60% had interrupted supplies because

of shortages of power

Papua New Guinea (2006) – 22% of 1300 seriously ill children in 5 hospitals could not access oxygen at

admission

Kenya (2004) – 40% of children prescribed oxygen by a doctor did not receive it

South Africa – 39% of rural health clinics and 18% of district hospitals had no oxygen

Source: Nyarko et al. Pan Afr Med J. 2016; 25(Suppl 1): 16. Wandi F, et al. Ann Trop Paediatr 2006; 26(6):277-284; English M, et al. Lancet 2004; 363:1948-1953

Access to Oxygen Therapy| 29 May 2017 5 |

Oxygen Availability: Acute Surgical Care in Low

Resource Settings

12 Sub-Saharan African countries(2010): 231 health facilities

(38% PHC centres; 23% private/NGO hospitals; 23% district hospitals; 8% regional or

provincial hospitals; and 8% General hospitals)

– 44% (99) - access to an oxygen source

– 34% (75) - 1 face mask + tube set always available

– 29% (66) - regular access to at least 1 oxygen cylinder

– 25% (55) - fully functioning oxygen concentrator

Kenya (2012): A cross sectional survey in 22 internship training hospitals

– < 50% had all resources needed to provide oxygen

Source: 1) Belle J et al J Infect Dev Ctries 2010, 2) Mwinga et al . Trop Med Int Health. 2015 Feb; 20(2): 240–249

Access to Oxygen Therapy| 29 May 2017 6 |

Challenges: Poorly Maintained Equipment

Equipment:

– Unavailable

– non-functioning

– No maintenance

– Unsafe

Training skills

Access to Oxygen Therapy| 29 May 2017 7 |

Challenges: Access and use

Equipment and supplies

– Poor accessibility and availability of oxygen sources

– Lack of oxygen delivery supplies

– Systems are not safe and reliable

– Poor maintenance of equipment

Hypoxaemia is often not well recognized or managed in

settings where resources are limited.

Poor staff training on use of oxygen

Lack of funding and support required for sustainability

Access to Oxygen Therapy| 29 May 2017 8 |

How can we provide optimal

Oxygen Systems?

Appropriate equipment and supplies

– Reliable oxygen sources

– Continuous power supply

– Oxygen tubing and delivery mechanism

– Regular maintenance and spare parts

Pulse oximetry for detecting and

monitoring hypoxia

Clinical protocols on use of oxygen

Training and supervision

Access to Oxygen Therapy| 29 May 2017 9 |

WHO efforts to Improvement of Oxygen support

Development of guidelines and supportive tools – Oxygen therapy for children

– Oxygen training video

– Oxygen assessment tool

Development of specifications – Oxygen Concentrators

– Pulse oximeters?

Overall improvement in hospital quality of care – Improvement in the quality of essential surgical care

– Improvement of Quality of Care for children in referral hospitals

Field trials for different Oxygen supply models

Access to Oxygen Therapy| 29 May 2017 10 |

Conclusions

Hypoxaemia is a common and major cause of mortality, but a treatable

complication.

Access to regular oxygen supply is still limited.

Investment in oxygen systems to improve diagnosis and management of

hypoxaemia should be part of health system support.

Accurate detection of hypoxia will improve rational use of O2 and

improve quality of care.

Global awareness and improved technology is necessary.

Can advances in technology

improve availability and use

of oxygen?