Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review

Abstract

Background Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in sub-Saharan Africa is not well-described. We aim to identify and describe existing data around oxygen availability and provision for adults in sub-Saharan Africa, determine knowledge or research gaps, and make recommendations for future research and capacity building. Methods We systematically searched four databases for articles on April 22, 2020, for variations of keywords related to oxygen with a focus on countries in sub-Saharan Africa. Inclusion criteria were studies that included adults and addressed hypoxemia assessment or outcome, oxygen delivery mechanisms, oxygen availability, oxygen provision infrastructure, and oxygen therapy and outcomes. Results 35 studies representing 22 countries met inclusion criteria. Availability of oxygen delivery systems ranged from 42%-94% between facilities, with wide variability in the consistency of availability. There was also wide reported prevalence of hypoxemia, with most studies focusing on specific populations. In facilities where oxygen is available, health care workers are ill-equipped to identify adult patients with hypoxemia, provide oxygen to those who need it, and titrate or discontinue oxygen appropriately. Oxygen concentrators were shown to be the most cost-effective delivery system in areas where power is readily available. Conclusions There is a substantial need for building capacity for oxygen delivery throughout sub-Saharan Africa. Addressing this critical issue will require innovation and a multi-faceted approach of developing infrastructure, better equipping facilities, and health care worker training.

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“…Another 65% had pulse oximeters but the quantities were inadequate and 20% had none [32]. In addition, a recent review of available studies involving adults also demonstrated a dire lack of access to oxygen delivery systems across sub-Saharan Africa with most facilities ill-equipped to identify adult patients with hypoxemia [33]. WHO guidelines on the clinical use of oxygen and technical specifications for oxygen equipment are available but emphasis is on children with specifications for adults conspicuously lacking [34].…”

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“…The outlets of the valve were connected to a zeolite column (5) each. The columns in turn were connected to the check needle valves (6). Both check needle valves were connected to the storage tank (7), which in turn was connected to the needle valve (8).…”

“…The spiking demand for supplemental oxygen during this health crisis critically exposed the problem of its availability . Studies have shown that many patients in low-resource settings (LRSs) do not have access to supplemental oxygen even in hospitals. , …”

“…5 Studies have shown that many patients in low-resource settings (LRSs) do not have access to supplemental oxygen even in hospitals. 6,7 The pandemic has impacted not only people's health but also societies and economies. COVID-19 increased social imbalance, restricted international mobility, and caused delays in supply chains, thus creating shortages of many resources.…”

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“…Moreover, some donations such as those related to oxygen supply require a longerterm plan to ensure infrastructure and systems are in place for proper use and management. 30 Strengthening supply chain systems to improve the process of equipment donation to and at the district level and establishing longer-term plans for certain donations will be necessary for the mutual benefit of donors and recipients alike.…”