Abstract
ObjectiveTo identify and describe interventions to improve oxygen therapy in hospitals in low-resource settings, and to determine the factors that contribute to success and failure in different contexts.MethodsUsing realist review methods, we scanned the literature and contacted experts in the field to identify possible mechanistic theories of how interventions to improve oxygen therapy systems might work. Then we systematically searched online databases for evaluations of improved oxygen systems in hospitals in low- or middle-income countries. We extracted data on the effectiveness, processes and underlying theory of selected projects, and used these data to test the candidate theories and identify the features of successful projects.FindingsWe included 20 improved oxygen therapy projects (45 papers) from 15 countries. These used various approaches to improving oxygen therapy, and reported clinical, quality of care and technical outcomes. Four effectiveness studies demonstrated positive clinical outcomes for childhood pneumonia, with large variation between programmes and hospitals. We identified factors that help or hinder success, and proposed a practical framework depicting the key requirements for hospitals to effectively provide oxygen therapy to children. To improve clinical outcomes, oxygen improvement programmes must achieve good access to oxygen and good use of oxygen, which should be facilitated by a broad quality improvement capacity, by a strong managerial and policy support and multidisciplinary teamwork.ConclusionOur findings can inform practitioners and policy-makers about how to improve oxygen therapy in low-resource settings, and may be relevant for other interventions involving the introduction of health technologies.
Highlights
Oxygen is an essential medical therapy that has been saving lives for over 100 years.[1]
Oxygen therapy is used for pneumonia and other primary lung diseases and many other conditions that result in hypoxaemia, such as sepsis, severe malaria, status epilepticus, trauma, obstetric and neonatal conditions, surgical care and anaesthesia
A systematic review estimated that, globally, hypoxaemia affects about 13% of children admitted to hospital with pneumonia, about 20% of sick neonates and 10–15% of children admitted with conditions such as malaria, meningitis or convulsions.[2]
Summary
Oxygen is an essential medical therapy that has been saving lives for over 100 years.[1]. A systematic review estimated that, globally, hypoxaemia affects about 13% of children admitted to hospital with pneumonia, about 20% of sick neonates and 10–15% of children admitted with conditions such as malaria, meningitis or convulsions.[2] Given that hypoxaemia is a major risk factor for death,[2,3] oxygen therapy is important for improving child health outcomes. Effective oxygen therapy requires prompt and accurate detection of hypoxaemia and appropriate administration of oxygen, combined with good clinical evaluation and management of the underlying condition.[4] Improvements in the technology and affordability of pulse oximetry ‒ the standard method for detecting hypoxaemia ‒ are enhancing its accessibility for hospitals in low-resource settings.[1] Oxygen may be supplied by oxygen cylinders, oxygen concentrators or larger oxygen plants, each of which have unique advantages and disadvantages, when used in hot, humid or dusty environments.[1,5] The World Health Organization (WHO) has produced guidelines on the clinical use of oxygen[6,7,8] and oxygen equipment.[9]
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