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Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi
Penny Enarson1, Sophie La Vincente, Robert Gie
1International Union Against Tuberculosis and Lung Disease, Paris, France. penarson@iuatld.org
Insights
Implementing oxygen concentrators in Malawi
Area of Science:
- Pediatric critical care
- Respiratory medicine
- Global health initiatives
Background:
- Hypoxemia in children with severe pneumonia predicts mortality.
- Oxygen was largely unavailable in Malawian pediatric wards.
Purpose of the Study:
- To assess the feasibility of implementing an oxygen system using concentrators in Malawi.
- To improve oxygen availability in pediatric wards.
Main Methods:
- The Child Lung Health Programme supplied oxygen concentrators and supplies to 22 district and 3 regional hospitals.
- A five-step training program was implemented for staff and biomedical engineers.
- High-dependency areas were established for severely ill children.
Main Results:
- Oxygen sources were established in all district hospital pediatric wards.
- Healthcare and biomedical personnel received training on oxygen concentrator use, maintenance, and repair.
- High-dependency units were created for administering oxygen to critically ill children.
Conclusions:
- Implementing oxygen concentrator systems is feasible in low-income countries.
- Trained personnel, equipment, and supplies are crucial for effective oxygen delivery.
- Consistent maintenance and supervision are vital for sustained optimal use.
Problem:
Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, yet oxygen was not available in most paediatric wards in Malawi.
Approach:
The Child Lung Health Programme in Malawi made oxygen available by supplying oxygen concentrators and essential supplies to 22 district and 3 regional hospitals' paediatric wards. Five key steps were taken to introduce concentrators: (1) develop a curriculum and training materials; (2) train staff on use and maintenance; (3) retrain electromedical departments on maintenance and repair; (4) conduct training once concentrators arrived in the country; and (5) distribute concentrators once staff had been trained.
Local Setting:
The paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in Malawi.
Relevant Changes:
Main changes were: (1) provision of a source of oxygen in every paediatric ward in all district hospitals; (2) training of electrical engineering and health personnel in the use, maintenance and repair of oxygen concentrators; and (3) setting-up of high-dependency rooms or areas for severely ill children where oxygen is administered.
Lessons Learned:
It is feasible to implement an oxygen system using concentrators throughout a low-income country. Oxygen delivery requires trained staff with necessary equipment and supplies. Regular maintenance and supervision are essential to ensure optimal utilization.
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