Solar powered oxygen systems in remote health centers in Papua New Guinea: a large scale implementation effectiveness trial

Abstract

BackgroundPneumonia is the largest cause of child deaths in Papua New Guinea (PNG), and hypoxaemia is the major complication causing death in childhood pneumonia, and hypoxaemia is a major factor in deaths from many other common conditions, including bronchiolitis, asthma, sepsis, malaria, trauma, perinatal problems, and obstetric emergencies. A reliable source of oxygen therapy can reduce mortality from pneumonia by up to 35%. However, in low and middle income countries throughout the world, improved oxygen systems have not been implemented at large scale in remote, difficult to access health care settings, and oxygen is often unavailable at smaller rural hospitals or district health centers which serve as the first point of referral for childhood illnesses. These hospitals are hampered by lack of reliable power, staff training and other basic services.MethodsWe report the methodology of a large implementation effectiveness trial involving sustainable and renewable oxygen and power systems in 36 health facilities in remote rural areas of PNG. The methodology is a before–and after evaluation involving continuous quality improvement, and a health systems approach. We describe this model of implementation as the considerations and steps involved have wider implications in health systems in other countries.ResultsThe implementation steps include: defining the criteria for where such an intervention is appropriate, assessment of power supplies and power requirements, the optimal design of a solar power system, specifications for oxygen concentrators and other oxygen equipment that will function in remote environments, installation logistics in remote settings, the role of oxygen analyzers in monitoring oxygen concentrator performance, the engineering capacity required to sustain a program at scale, clinical guidelines and training on oxygen equipment and the treatment of children with severe respiratory infection and other critical illnesses, program costs, and measurement of processes and outcomes to support continuous quality improvement.ConclusionsThis study will evaluate the feasibility and sustainability issues in improving oxygen systems and providing reliable power on a large scale in remote rural settings in PNG, and the impact of this on child mortality from pneumonia over 3 years post–intervention. Taking a continuous quality improvement approach can be transformational for remote health services.

Solar-powered oxygen delivery for the treatment of children with hypoxemia: protocol for a cluster-randomized stepped-wedge controlled trial in Uganda

“…We will test this hypothesis in a stepped-wedge clusterrandomized study in Uganda. SPO 2 has a number of benefits that lend themselves to further scale-up: reliability in settings with poor access to electricity or O 2 cylinders [31]; abundance of solar radiation in target LMICs in the tropics [32]; minimal maintenance and training requirements [32]; and cost- Fig. 4 Computer simulation for sample size estimation.…”

“…Our study sample size was calculated via a computer simulation using real-world parameters using the Uganda DHIS [22,35], data from previous large-scale studies [31], and systematic reviews [22]. We applied our planned primary analysis to the simulated data for > 5000 trials to estimate a required sample size of 2400 patients from 20 sites, with 20 steps, recruited over two years to detect a mortality benefit estimated at 35% with 80% power (α = 0.05).…”

The Early Recognition and Management of Sepsis in Sub-Saharan African Adults: A Systematic Review and Meta-Analysis

“…As an additional point, the provision of oxygen has been described as an ‘entry point’ for improving quality of care in lower-middle income countries [ 57 ] and is a vital component of sepsis management [ 4 ]. However, availability is extremely limited in sub-Saharan Africa [ 11 , 13 , 58 , 59 ]: one study identified that only 44% of surveyed facilities (12 countries) had an uninterrupted supply of oxygen [ 30 ].…”

Use of bubble continuous positive airway pressure (bCPAP) in the management of critically ill children in a Malawian paediatric unit: an observational study

“…Installation and maintenance of these ‘oxygen systems’, however, remain a challenge in many health facilities in African countries 13. The combination of solar-powered energy systems and the use of oxygen concentrators can be an option to improve oxygen supply in health facilities in remote settings 14…”