Oxygen saturations of medical inpatients in a Malawian hospital: cross-sectional study of oxygen supply and demand

Evans, Hywel-Gethin Tudur; Mahmood, Nadia; Fullerton, Duncan; Rylance, Jamie; Andrew, Gonani; Gordon, Stephen B.; Mortimer, Kevin; Allain, Theresa J.

doi:10.15172/pneu.2012.1/208

Cited by 16 publications

(17 citation statements)

References 3 publications

(3 reference statements)

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“…Given the observed strong association of hypoxemia with mortality, expansion of supplemental oxygen provision, which across much of sub-Saharan Africa is currently severely limited (39), represents an obvious strategy to be evaluated to improve CAP outcomes. Programmatic interventions in children in low-resource settings based on improved oxygen supply using oxygen concentrators have been associated with a 35% reduction in mortality (40).…”

Section: Discussionmentioning

confidence: 99%

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Aston

Jary

et al. 2019

Am J Respir Crit Care Med

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Rationale: In the context of rapid antiretroviral therapy rollout and an increasing burden of noncommunicable diseases, there are few contemporary data describing the etiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa. Objectives: To describe the current etiology of CAP in Malawi and identify risk factors for mortality. Methods: We conducted a prospective observational study of adults hospitalized with CAP to a teaching hospital in Blantyre, Malawi. Etiology was defined by blood culture, Streptococcus pneumoniae urinary antigen detection, sputum mycobacterial culture and Xpert MTB/RIF, and nasopharyngeal aspirate multiplex PCR. Measurements and Main Results: In 459 patients (285 [62.1%] males; median age, 34.7 [interquartile range, 29.4–41.9] yr), 30-day mortality was 14.6% (64/439) and associated with male sex (adjusted odds ratio, 2.60 [95% confidence interval, 1.17–5.78]), symptom duration greater than 7 days (2.78 [1.40–5.54]), tachycardia (2.99 [1.48–6.06]), hypoxemia (4.40 [2.03–9.51]), and inability to stand (3.59 [1.72–7.50]). HIV was common (355/453; 78.4%), frequently newly diagnosed (124/355; 34.9%), but not associated with mortality. S. pneumoniae (98/458; 21.4%) and Mycobacterium tuberculosis (75/326; 23.0%) were the most frequently identified pathogens. Viral infection occurred in 32.6% (148/454) with influenza (40/454; 8.8%) most common. Bacterial–viral coinfection occurred in 9.1% (28/307). Detection of M. tuberculosis was associated with mortality (adjusted odds ratio, 2.44 [1.19–5.01]). Conclusions: In the antiretroviral therapy era, CAP in Malawi remains predominantly HIV associated, with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxemia, should be evaluated in clinical trials to address CAP-associated mortality.

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Section: Discussionmentioning

confidence: 99%

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Aston

Jary

et al. 2019

Am J Respir Crit Care Med

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“…Hypoxaemia is a common complication of pneumonia and is independently associated with mortality . Supplemental oxygen provision in low‐income settings is inadequate: fewer than half of healthcare facilities in sub‐Saharan Africa have uninterrupted access to an oxygen source, and in those that do demand invariably outstrips supply . This is further compounded by the limited availability of pulse oximetry, such that the scant oxygen resources that are present may be inappropriately used in dyspnoeic but non‐hypoxaemic patients .…”

Section: Supportive Managementmentioning

confidence: 99%

Pneumonia in the developing world: Characteristic features and approach to management

Aston

2017

Respirology

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Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose. These differences in epidemiology and aetiological profile suggest that modified approaches to diagnosis, severity assessment and empirical antimicrobial therapy of CAP are necessary, but tailored individualized management approaches are constrained by limitations in the availability of radiological and laboratory diagnostic services, as well as medical expertise. The widespread introduction of the Xpert MTB/RIF platform represents a major advance for TB diagnosis, but innovations in rapid diagnostics for other opportunistic pathogens are urgently needed. Severity assessment tools (e.g. CURB65) that are used to guide early management decisions in CAP have not been widely validated in low-income settings and locally adapted tools are required. The optimal approach to initial antimicrobial therapy choices such as the need to provide early empirical cover for atypical bacteria and TB remain poorly defined. Improvements in supportive care such as correcting hypoxaemia and intravenous fluid management represent opportunities for substantial reductions in mortality.

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“…202 One obvious example is the supplemental oxygen availability, which even in tertiary-care settings is limited; provision of domiciliary oxygen treatment is nonexistent. 203,204 Treatment of respiratory failure is often limited to low flow oxygen concentrators, with little capacity for assisted ventilation. 205 Health care providers may be insufficiently trained to support the safe delivery of critical care, where a lack of infrastructure, clinical knowledge, and training seems to be more significantly limiting than the availability of drugs.…”

Section: Availability Of Drugs and Monitoringmentioning

confidence: 99%

Global Considerations in Human Immunodeficiency Virus-Associated Respiratory Disease

Rylance

Meghji

Miller

et al. 2016

Semin Respir Crit Care Med

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Respiratory tract infection, particularly tuberculosis, is a major cause of mortality among human immunodeficiency virus (HIV)-infected individuals. Antiretroviral therapy (ART) has resulted in a dramatic increase in survival, although coverage of HIV treatment remains low in many parts of the world. There is a concurrent growing burden of chronic noninfectious respiratory disease as a result of increased survival. Many risk factors associated with the development of respiratory disease, such as cigarette smoking and intravenous drug use, are overrepresented among people living with HIV. In addition, there is emerging evidence that HIV infection may directly cause or accelerate the course of chronic lung disease. This review summarizes the clinical spectrum and epidemiology of respiratory tract infections and noninfectious pulmonary pathologies, and factors that explain the global variation in HIV-associated respiratory disease. The potential for enhancing diagnoses of noninfective chronic conditions through the use of clinical algorithms is discussed. We also consider issues in assessment and management of HIV-related respiratory disease in view of the increasing global scale up of ART.

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Oxygen saturations of medical inpatients in a Malawian hospital: cross-sectional study of oxygen supply and demand

Cited by 16 publications

References 3 publications

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi

Pneumonia in the developing world: Characteristic features and approach to management

Global Considerations in Human Immunodeficiency Virus-Associated Respiratory Disease

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