Oxygen insecurity and mortality in resource‐constrained healthcare facilities in rural Kenya

Abstract

Introduction Pneumonia is the leading cause of death globally in children. Supplemental oxygen reduces mortality but is not available in many low‐resource settings. Inadequate power supply to drive oxygen concentrators is a major contributor to this failure. The objectives of our study were to (a) assess the availability of therapeutic oxygen; (b) evaluate the reliability of the electrical supply; and (c) investigate the effects of suboptimal oxygen delivery on patient outcomes in selected healthcare facilities in rural Kenya. Materials and Methods A cross‐sectional descriptive study on oxygen availability and descriptive case series of Kenyan children and youth hospitalized with hypoxemia. Results Two of 11 facilities had no oxygen equipment and nine facilities had at least one concentrator or cylinder. Facilities had a median of seven power interruptions per week (range: 2‐147). The median duration of the power outage was 17 minutes and the longest was more than 6 days. The median proportion of time without power was out 7% (range: 1%‐58%). Fifty‐seven patients hospitalized with hypoxemia (median oxygen saturation 85% [interquartile range {IQR}: 82‐87]) were included in our case series. Patients received supplemental oxygen for a median duration of 4.6 hours (IQR: 3.0‐7.8). Eighteen patients (32%) faced an oxygen interruption of the median duration of 11 minutes (IQR: 9‐20). A back‐up cylinder was used in 5/18 (28%) cases. The case fatality rate was 11/57 (19%). Conclusion Mortality due to hypoxemia remains unacceptably high in low‐resource healthcare facilities and may be associated with oxygen insecurity, related to lack of equipment and/or reliable power.

Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda

“…Lower access to intensive care, and particularly to oxygen, may reduce recovery rates for severe cases in Uganda and more broadly in this region in DALYs lost and mortality. 37,38 We also make no adjustments for the impact of age structure on underlying transmission, but compare the age-based predicted mortality for a hypothetical equivalent transmission uniformly across each age-group. To address these uncertainties, this article has taken a conservative approach to comparing COVID-19 impact with that of lockdown-related program deterioration, assuming a very high transmission of COVID-19 (a 20% detectable infection rate) across Uganda.…”

“…Lower access to intensive care, and particularly to oxygen, may reduce recovery rates for severe cases in Uganda and more broadly in this region in DALYs lost and mortality. 37 , 38 We also make no adjustments for the impact of age structure on underlying transmission, but compare the age-based predicted mortality for a hypothetical equivalent transmission uniformly across each age-group.…”

Improving Hospital Oxygen Systems for COVID-19 in Low-Resource Settings: Lessons From the Field

“…We, and others, have reported similar findings in Kenya, Uganda, Papua New Guinea, and other African and Asia-Pacific contexts. [7][8][9][10][11] Indeed, unreliable oxygen supplies and deficiencies in oxygen use are consistent and persisting problems for many hospitals in these regions, particularly in rural and remote settings.…”

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

“…These surveys showed a lack of basic equipment such as pulse oximeters and oxygen delivery systems, eg, cylinders or concentrators. Availability of oxygen delivery systems ranged from 42%-94% between facilities, with wide variability in the consistency of availability [ 13 - 15 , 18 , 20 , 22 , 24 , 25 , 28 , 30 , 33 ]. For example, the highest reported availability was in a study of private and public facilities in Uganda which showed that 15 of 16 facilities had access to oxygen at least half of the time.…”