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Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a
Hamish R Graham1,2, Adejumoke I Ayede3,4, Ayobami A Bakare3
1Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia. Hamish.Graham@rch.org.au.
Insights
Implementing improved oxygen systems in Nigerian hospitals significantly reduces childhood pneumonia and neonatal mortality. This study highlights effective strategies for oxygen delivery in resource-limited settings, crucial for child survival.
Area of Science:
- Pediatric critical care
- Health systems strengthening
- Implementation science
Background:
- Oxygen is a vital medicine for treating common childhood illnesses like pneumonia.
- Providing adequate oxygen is challenging in low-resource settings due to infrastructure and staffing limitations.
- Improved oxygen systems can substantially decrease childhood pneumonia mortality.
Purpose of the Study:
- To evaluate the implementation of improved oxygen systems in secondary-level hospitals in southwest Nigeria.
- To assess the effectiveness of a comprehensive oxygen system package, including equipment, training, and quality improvement.
- To provide evidence for scaling up oxygen delivery in resource-limited environments.
Main Methods:
- A stepped-wedge cluster randomized trial design was employed across multiple hospitals.
- The intervention involved a phased approach: pulse oximetry followed by a full oxygen system package.
- Mixed-methods evaluation assessed effectiveness, impact, sustainability, process, and fidelity, with primary outcomes of pneumonia case fatality and neonatal mortality rates.
Main Results:
- The study is designed to provide quality evidence on the effectiveness of improved oxygen systems.
- Primary outcomes include reductions in childhood pneumonia case fatality rate and inpatient neonatal mortality rate.
- Secondary outcomes encompass clinical, quality of care, technical, and health systems improvements.
Conclusions:
- The findings will offer crucial evidence on the effectiveness and implementation of improved oxygen systems.
- Results will inform policy-makers and healthcare organizations on scaling up oxygen delivery in resource-limited settings.
- This research has significant implications for improving child health outcomes globally.
Background:
Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity.
Methods/Design:
This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018.
Discussion:
Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally.
Trial Registration:
Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.
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