In Developing Nations, Improved Oxygen Systems Can Improve Child Pneumonia Mortality

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Main Category: Respiratory / Asthma
Also Included In: Public Health;  Medical Devices / Diagnostics
Article Date: 19 Aug 2008 - 0:00 PDT

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Child pneumonia mortality is decreased by the implementation of various improved oxygen systems, including pulse oximeters and oxygen concentrators, in the developing world. Additionally, this is cost effective when compared to other interventions, according to an article released on August 18, 2008 in The Lancet.

Acute respiratory infections, such as pneumonia, are a major health issue for children in developing countries. Hypoxemia, a deficiency in blood oxygen, is an important complication of pneumonia that can be difficult to detect without equipment. This is particularly true in the rural hospitals of developing nations, where factors such as poor lighting or patients with darker skin may prevent the observation of cyanosis. Pulse oximeters and other devices could help detection and treatment of such complications, but according to the authors, need to be further investigated in the developing world.

To this end, Dr Trevor Duke, Centre for International Child Health at the University of Melbourne, and colleagues from the Department of Health in Papua New Guinea, performed a study to determine the effect of access to oxygen concentrators and pulse oximeters on the outcome of young pneumonia patients. They examined the case fatality rate for more than 11,000 children with pneumonia were included from five rural hospitals in Papua New Guinea which were updated with improved oxygen systems in 2005, including a training program for clinicians and engineers in equipment maintenance and oxygen use guidelines.

The children formed two comparison groups: the "pre-intervention" group, treated between 2001 and 2004, before the improved system was installed; and the "post-intervention" group, treated between 2005 and 2007, who were treated with access to oxygen concentrators and pulse oximeters. In the latter group, those children with blood oxygen saturation less than 90% were supplied with oxygen via nasal prongs and an oxygen concentrator. In addition to patient outcomes, all costs associated with the systems were recorded.

It was found that, for child pneumonia, the case-fatality rate fell from 4.97% in the pre-intervention group to 3.22% in the post-intervention group. Though mortality rates varied across the five associated hospitals, the children with access to improved care had a risk of death 35% lower than those without. The costs of the improved oxygen systems, in different contexts, were, in USD: $51 per patient treated, $1,673 per life saved, and $50 per disability-adjusted life-year (DALY) prevented.

In conclusion, the authors show the relative benefits of this strategy. "Pulse oximetry and oxygen concentrators can alleviate oxygen shortages, reduce mortality, and improve quality of care for children with pneumonia in developing countries. The cost-effectiveness of this system compared favourably with that of other public-health interventions."

Dr Andre Cantin, University of Sherbrooke, Quebec, Canada, contributed an accompanying comment indicating that these are positive developments. "The substantial decrease in mortality that was seen in some Papua New Guinea hospitals suggests that oxygen treatment and monitoring is a key step forward in the fight against childhood pneumonia."

Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea
Trevor Duke, Francis Wandi, Merilyn Jonathan, Sens Matai, Magdalene Kaupa, Martin Saavu, Rami Subhi, David Peel
Published Online Lancet, August 18, 2008
DOI:10.1016/S0140-6736(08)61164-2
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Written by Anna Sophia McKenney
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