Solar-powered oxygen, quality improvement and child pneumonia deaths: a large-scale effectiveness study
Trevor Duke1,2, Francis Pulsan2, Doreen Panauwe3
1Intensive Care Unit, and Centre for International Child Health, Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia trevor.duke@rch.org.au.
Insights
Implementing solar-powered oxygen systems in rural Papua New Guinea significantly reduced child deaths from pneumonia. This intervention also decreased unnecessary referrals, saving lives and improving healthcare access in remote areas.
Area of Science:
- Global Health
- Pediatric Medicine
- Medical Technology
Background:
- Pneumonia is a leading cause of mortality in children in low-income countries.
- Lack of reliable oxygen access in rural hospitals contributes to preventable deaths and unsafe patient referrals.
- Effective oxygen therapy is crucial for managing pediatric pneumonia.
Purpose of the Study:
- To evaluate a program improving oxygen therapy in remote health facilities in Papua New Guinea.
- To assess the impact of solar-powered oxygen systems on pediatric pneumonia outcomes.
- To determine the effectiveness of a quality improvement approach in enhancing oxygen delivery.
Main Methods:
- A program utilizing oxygen concentrators, pulse oximeters, and solar power was implemented in 38 remote facilities.
- A quality improvement methodology, including training and problem-solving, was employed.
- Routine health data were analyzed for pediatric admissions, deaths, and referrals pre- and post-intervention using Poisson regression.
Main Results:
- Pneumonia admissions decreased significantly post-intervention.
- The incidence rate ratio for pneumonia deaths was 0.41 (p<0.005), indicating a substantial reduction.
- Child deaths overall decreased, with an incidence rate ratio of 0.60 (p<0.005), and over 1500 referrals were avoided.
Conclusions:
- Solar-powered oxygen systems, combined with quality improvement, are scalable in remote healthcare settings.
- The intervention was associated with reduced child mortality and fewer referrals.
- Context-specific quality improvement strategies are essential for optimizing effectiveness in rural facilities.
Background:
Pneumonia is the largest cause of child deaths in low-income countries. Lack of availability of oxygen in small rural hospitals results in avoidable deaths and unnecessary and unsafe referrals.
Method:
We evaluated a programme for improving reliable oxygen therapy using oxygen concentrators, pulse oximeters and sustainable solar power in 38 remote health facilities in nine provinces in Papua New Guinea. The programme included a quality improvement approach with training, identification of gaps, problem solving and corrective measures. Admissions and deaths from pneumonia and overall paediatric admissions, deaths and referrals were recorded using routine health information data for 2-4 years prior to the intervention and 2-4 years after. Using Poisson regression we calculated incidence rates (IRs) preintervention and postintervention, and incidence rate ratios (IRR).
Results:
There were 18 933 pneumonia admissions and 530 pneumonia deaths. Pneumonia admission numbers were significantly lower in the postintervention era than in the preintervention era. The IRs for pneumonia deaths preintervention and postintervention were 2.83 (1.98-4.06) and 1.17 (0.48-1.86) per 100 pneumonia admissions: the IRR for pneumonia deaths was 0.41 (0.24-0.71, p<0.005). There were 58 324 paediatric admissions and 2259 paediatric deaths. The IR for child deaths preintervention and postintervention were 3.22 (2.42-4.28) and 1.94 (1.23-2.65) per 100 paediatric admissions: IRR 0.60 (0.45-0.81, p<0.005). In the years postintervention period, an estimated 348 lives were saved, at a cost of US$6435 per life saved and over 1500 referrals were avoided.
Conclusions:
Solar-powered oxygen systems supported by continuous quality improvement can be achieved at large scale in rural and remote hospitals and health care facilities, and was associated with reduced child deaths and reduced referrals. Variability of effectiveness in different contexts calls for strengthening of quality improvement in rural health facilities.
Trial Registration Number:
ACTRN12616001469404.
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