Introduction of improved oxygen systems in developing nations reduce child pneumonia mortality and are cost effective compared with other public-health interventions. These are the conclusions of authors of an Article published early Online and in an upcoming edition of the Lancet.
In rural hospitals in developing nations, oxygen supplies are poor and detection of hypoxaemia (low blood oxygen) is difficult. Dr Trevor Duke, Centre for International Child Health at the University of Melbourne, and colleagues from the Department of Health in Papua New Guinea, did a study of more than 11000 children with pneumonia in five rural hospitals in Papua New Guinea. The children were divided into two groups, the pre-intervention group (treated 2001-04, before the improved oxygen systems were installed), and the post-intervention group, treated 2005-07, who had access to oxygen concentrators and pulse oximeters. In the post-intervention group, all children had their blood oxygen saturation measured with a pulse oximeter; those with a value less than 90% had oxygen supplied via nasal prongs and an oxygen concentrator. All costs associated with the systems were recorded. A program of training for clinicians and engineers, equipment maintenance, and guidelines for the use of oxygen was put in place.
The researchers found the case-fatality rate for child pneumonia fell from 4.97% pre-intervention to 3.22% post-intervention, thus making the risk of death for a child 35% lower post-intervention, although mortality rates varied among the five hospitals. The costs of the improved oxygen systems were US$51 per patient treated, US$1673 per life saved, and US$50 per disability-adjusted life-year (DALY) averted. The authors conclude: "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."
In an accompanying Comment, Dr André Cantin, University of Sherbrooke, Quebec, Canada, says: "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."
Dr Trevor Duke, Centre for International Child Health, Royal Children's Hospital, Melbourne, VIC, Australia T) +61 3 9345 5968 E) Trevor.duke@rch.org.au
Dr André Cantin, University of Sherbrooke, Quebec, Canada, contact by e-mail only E) andre.cantin@usherbrooke.ca
full paper:
http://press.thelancet.com/Oxygenfinal.pdf
Journal
The Lancet