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Oxygen insecurity and mortality in resource-constrained healthcare facilities in rural Kenya
Dickson Otiangala1, Nicholas O Agai1, Bernard Olayo1
1Center for Public Health and Development, Nairobi, Kenya.
Insights
Unreliable electricity and lack of oxygen equipment in rural Kenyan facilities contribute to high child mortality from pneumonia. Improving oxygen access is critical for saving lives in low-resource settings.
Area of Science:
- Pediatrics
- Global Health
- Medical Technology
Background:
- Pneumonia is a leading global cause of child mortality.
- Supplemental oxygen therapy is effective but often unavailable in low-resource settings.
- Inconsistent electrical power supply hinders the operation of oxygen concentrators.
Purpose of the Study:
- To assess therapeutic oxygen availability in rural Kenyan healthcare facilities.
- To evaluate the reliability of electrical power supply for medical equipment.
- To investigate the impact of suboptimal oxygen delivery on patient outcomes.
Main Methods:
- A cross-sectional descriptive study design.
- Assessed oxygen equipment availability and electrical supply reliability.
- Conducted a descriptive case series of children with hypoxemia.
Main Results:
- Only 2 of 11 facilities had no oxygen equipment; 9 had concentrators or cylinders.
- Facilities experienced a median of 7 power interruptions weekly, with outages up to 7% of the time.
- 19% of hypoxemic children in the case series died, with 32% experiencing oxygen interruptions.
Conclusions:
- High mortality from hypoxemia persists in low-resource settings.
- Oxygen insecurity, due to equipment scarcity and unreliable power, is a likely contributor.
- Addressing these challenges is crucial for improving pediatric survival rates.
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.
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