Changes in the availability of medical oxygen and its clinical practice in Ethiopia during a national scale-up program: a time series design from thirty-two public hospitals

Abstract

Background Oxygen therapy is a lifesaving treatment, however, in Ethiopia, oxygen is not readily available in many healthcare facilities. In 2015, the Federal Ministry of Health launched a national roadmap to increase access to oxygen. This study aims to evaluate whether availability of oxygen and its clinical practice in public hospitals of Ethiopia changed during the time the roadmap was being implemented. Methods Between December 2015 and December 2019, a multifaceted approach was undertaken to increase access to oxygen in public facilities in Ethiopia. The activities included formation of new policies, development of guidelines, procurement and maintenance of oxygen equipment, and training of healthcare workers. To evaluate whether access and use of oxygen changed during this period, facility-based surveys were conducted between December 2015 to December 2019. Primary data, including medical record reviews, were collected from 32 public hospitals bi-annually. A chi-square test that claimed P < 0.05 used to assess the statistical significance differences. Results The study was conducted in 32 public hospitals of Ethiopia, where capacity building and technical support interventions implemented. Of these 32 facilities, 15 (46.9%) were general hospitals, 10 (31.2%) were referral hospitals, and 7 (21.9%) were primary hospitals. Functional availability of oxygen has shown a statistically significant increase from 62 to 100% in the pediatric in-patient departments of general and referral hospitals (p-value < 0.001). Similarly, functional availability of pulse oximetry has shown a statistically significant increase from 45 to 96%. With regard to clinical practices, the blood oxygen saturation (SpO2) measurement at diagnosis increased from 10.2 to 75%, and SpO2 measurement at admission increased 20.5 to 83%. Conclusions Based on the intervention results, we conclude that multifaceted approaches targeting policy, healthcare workers’ capacity, increased device procurement, and device maintenance programs with on-site mentorship, can improve the availability of medical oxygen and pulse oximetry, as well as clinical practice of oxygen therapy in health facilities. Therefore, ensuring device availability along with regular technical support and close follow-up of healthcare workers and facilities are critical, and these interventions should be scaled further.

Pulse oximetry: why oxygen saturation is still not a part of standard pediatric guidelines in low-and-middle-income countries (LMICs)

“…One component of this five-year strategy was pressing for a new policy on oxygen and pulse oximetry scale-up. The results from this wide-scale approach lead to functional oxygen availability from 62 to 100% in pediatric wards, and increasing the availability of pulse oximetry from 45 to 96% [ 39 ]. Adoption of pulse oximetry in Nigerian centers indicated swift implementation, with reporting on > 90% of admitted children within 6 to 12 months of commencement [ 40 ].…”

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

“…Oxygen therapy is used to treat many diseases which present with hypoxemia, a serious condition caused by low levels of oxygen in the blood [2]. Pneumonia is the largest infectious cause of death in children worldwide, claiming the lives of an estimated 800,000 children under the age of five, which is equivalent to around 2200 children every day [3]. Supplemental oxygen is among the most administered medical therapies in hospitalized patients [4].…”

“…In many hospitals, supplemental oxygen can be administered and titrated without a physician order, in contrast to most medications [5]. New hypoxemia is a cardinal bedside sign of acute or impending decompensation as well as a marker of disease severity for several chronic comorbidities [3]. Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully [4].…”

“…Oxygen therapy is defined as oxygen given at concentrations greater than that found in the surrounding air [2]. It is used as a treatment for respiratory failure, itself defined as an inability of the lungs and respiratory apparatus to ensure adequate systemic oxygenation and/or carbon dioxide excretion [3]. This is further classified by whether there is a failure of oxygenation (a low partial pressure of oxygen [PaO2]) with a normal partial pressure of carbon dioxide (PaCO2, "type 1" respiratory failure), or whether the PaCO2 is high ("type 2," or hypercapnic, respiratory failure) [6]…”

Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study

“…A study of 32 national hospitals indicated that during this time, the functional availability of pulse oximetry increased from 45%-86%. 21 In addition, the Ethiopian government implemented the Acute Respiratory Infection Diagnostic Aids (ARIDA) initiative supported by United Nations Children’s Emergency Fund (UNICEF). The aim of the ARIDA initiative was to identify and test innovative diagnostic tools to improve the identification, classification and management of children with pneumonia.…”