Meeting oxygen needs in Africa: an options analysis from the Gambia

Howie, Stephen R. C.; Hill, Sarah; Ebonyi, Augustine O.; Krishnan, Gautam; Njie, Ousman; Sanneh, Momodou; Jallow, Mariatou; Stevens, Warren; Taylor, K.C.; Weber, Martin; Njai, Pamela Collier; Tapgun, Mary; Corrah, Tumani; Mulholland, Kim; Peel, David; Njie, Malick; Hill, Philip C.; Adegbola, Richard A.

doi:10.2471/blt.08.058370

Cited by 58 publications

(64 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These are the need for models that will operate reliably in challenging conditions and the need for a constant power supply to run them. 11 This article deals with the first of these, surveying the models of concentrator currently available and assessing their suitability for use in the developing world, tropical countries in particular. This work is part of a broader project aimed at improving the availability of oxygen treatment in The Gambia, a sub-Saharan African country, and learning lessons that may be applied more broadly in similar settings.…”

mentioning

confidence: 99%

Oxygen Concentrators for Use in Tropical Countries

Peel

Howie

2009

Journal of Clinical Engineering

Self Cite

View full text Add to dashboard Cite

Oxygen for the treatment of sick patients in tropical countries is in very short supply. Oxygen concentrators, which filter nitrogen from atmospheric air to produce 90% oxygen, have considerable potential to meet this need. However, being produced mainly for North American and European home use, many concentrators may not be well suited to use in challenging tropical conditions. This report gives a detailed evaluation of 11 models of oxygen concentrator on the basis of the information supplied by their manufacturers. The aim of the survey was to identify concentrators specified to operate in the heat and humidity of tropical countries and to identify which would be most suitable based also on their cost-effectiveness, energy efficiency, and maintenance requirements. Six of the 11 models surveyed were specified to operate at up to 408C and 95% relative humidity. The highest ranking models for performance, cost, and energy efficiency were from one manufacturer, AirSep, which was the only manufacturer to produce independent data showing successful use of their concentrators in a tropical country.Oxygen for medical use is in short supply in developing countries. 1-3 Oxygen is needed to treat patients whose blood oxygen levels are low (hypoxemia) 4 and is also needed for use during administration of anesthesia for surgery. Hypoxemia can be due to a variety of reasons, but usually, it is because gas exchange in the lungs has been impaired, commonly because of infection. Pneumonia, a serious infection of the lungs, particularly affects the youngest and the oldest members of the community. Pneumonia is the leading cause of death in young children globally, accounting for around 2 million of 10 million deaths annually for those younger than 5 years and presents a major obstacle to achieving the health-related UN Millennium Development Goals. 5,6 The conventional means of supplying oxygen is by compressed gas cylinders. The standard process of producing oxygen to fill cylinders requires high-energy consumption, making the end product expensive. 7 Furthermore, the logistical barriers to successfully distributing oxygen cylinders to health facilities in developing countries are considerable thereby compounding the supply problem at the patient level.Increasingly oxygen concentrators are being used as an alternative source of medical oxygen in developing countries. 8 These devices, which take atmospheric air and filter out the nitrogen to produce around 90% pure oxygen, 9 have been used in developed countries for decades particularly for home treatment of those with chronic lung conditions. 10 The concentrator market has developed over the last 30 years, and there are currently many manufacturers worldwide. Several millions of concentrators have been manufactured, and the performance of new models improves steadily. Costs have come down as a result of economies of scale.Although concentrators have potential to alleviate the oxygen shortage in the developing world, there are important obstacles to their success. These are the ...

show abstract

mentioning

confidence: 99%

Oxygen Concentrators for Use in Tropical Countries

Peel

Howie

2009

Journal of Clinical Engineering

Self Cite

View full text Add to dashboard Cite

show abstract

“…Studies consistently reported the importance of procuring oxygen concentrators that were proven to work in hot and humid conditions. This was based on observations of maintenance problems and premature equipment failure when projects provided untested concentrators or used a variety of concentrator types (Gray et al) 28 , 36 , 46 , 51 , 53 …”

Section: Resultsmentioning

confidence: 99%

Providing oxygen to children in hospitals: a realist review

Graham

Tosif

Gray

et al. 2017

Bull. World Health Organ.

Self Cite

View full text Add to dashboard Cite

ObjectiveTo identify and describe interventions to improve oxygen therapy in hospitals in low-resource settings, and to determine the factors that contribute to success and failure in different contexts.MethodsUsing realist review methods, we scanned the literature and contacted experts in the field to identify possible mechanistic theories of how interventions to improve oxygen therapy systems might work. Then we systematically searched online databases for evaluations of improved oxygen systems in hospitals in low- or middle-income countries. We extracted data on the effectiveness, processes and underlying theory of selected projects, and used these data to test the candidate theories and identify the features of successful projects.FindingsWe included 20 improved oxygen therapy projects (45 papers) from 15 countries. These used various approaches to improving oxygen therapy, and reported clinical, quality of care and technical outcomes. Four effectiveness studies demonstrated positive clinical outcomes for childhood pneumonia, with large variation between programmes and hospitals. We identified factors that help or hinder success, and proposed a practical framework depicting the key requirements for hospitals to effectively provide oxygen therapy to children. To improve clinical outcomes, oxygen improvement programmes must achieve good access to oxygen and good use of oxygen, which should be facilitated by a broad quality improvement capacity, by a strong managerial and policy support and multidisciplinary teamwork.ConclusionOur findings can inform practitioners and policy-makers about how to improve oxygen therapy in low-resource settings, and may be relevant for other interventions involving the introduction of health technologies.

show abstract

“…We assumed that no extra operations would be carried out as a result of introducing oximetry and that no extra clinical staff time would be required. We included supplementary oxygen 9 resulting from an increase in the incidence of detected hypoxia 10 when oximetry is used.…”

Section: Methodsmentioning

confidence: 99%

Peri-operative pulse oximetry in low-income countries: a cost–effectiveness analysis

Burn

Chilton

Gawande

et al. 2014

Bull. World Health Organ.

View full text Add to dashboard Cite

ObjectiveTo evaluate the cost–effectiveness of pulse oximetry – compared with no peri-operative monitoring – during surgery in low-income countries.MethodsWe considered the use of tabletop and portable, hand-held pulse oximeters among patients of any age undergoing major surgery in low-income countries. From earlier studies we obtained baseline mortality and the effectiveness of pulse oximeters to reduce mortality. We considered the direct costs of purchasing and maintaining pulse oximeters as well as the cost of supplementary oxygen used to treat hypoxic episodes identified by oximetry. Health benefits were measured in disability-adjusted life-years (DALYs) averted and benefits and costs were both discounted at 3% per year. We used recommended cost–effectiveness thresholds – both absolute and relative to gross domestic product (GDP) per capita – to assess if pulse oximetry is a cost–effective health intervention. To test the robustness of our results we performed sensitivity analyses.FindingsIn 2013 prices, tabletop and hand-held oximeters were found to have annual costs of 310 and 95 United States dollars (US$), respectively. Assuming the two types of oximeter have identical effectiveness, a single oximeter used for 22 procedures per week averted 0.83 DALYs per annum. The tabletop and hand-held oximeters cost US$ 374 and US$ 115 per DALY averted, respectively. For any country with a GDP per capita above US$ 677 the hand-held oximeter was found to be cost–effective if it prevented just 1.7% of anaesthetic-related deaths or 0.3% of peri-operative mortality. ConclusionPulse oximetry is a cost–effective intervention for low-income settings.

show abstract

Meeting oxygen needs in Africa: an options analysis from the Gambia

Cited by 58 publications

References 18 publications

Oxygen Concentrators for Use in Tropical Countries

Oxygen Concentrators for Use in Tropical Countries

Providing oxygen to children in hospitals: a realist review

Peri-operative pulse oximetry in low-income countries: a cost–effectiveness analysis

Contact Info

Product

Resources

About