Prevalence of undiagnosed hypoxemia in adults and children in an under-resourced district hospital in Zambia

Abstract

BackgroundIn adequately resourced clinical environments, diagnosis of hypoxemia via pulse oximetry is routine. Unfortunately, pulse oximetry is rarely utilized in under-resourced hospitals in developing countries.AimThe prevalence of undiagnosed hypoxemia among adults and children with illnesses other than pneumonia in these environments remains poorly described.MethodsThis cross-sectional analysis of the prevalence of hypoxemia was conducted in Kapiri Mposhi, Zambia, at the 60-bed District Hospital, which serves a population of 320,000. The resting room air oxygen saturations of two consecutive samples of all adult and pediatric inpatients were measured in December 2008 and March 2009 using handheld pulse oximetry. Hypoxemia was defined as resting room air SpO2 less than 90%.ResultsA total of 192 patients were enrolled: 68 young children (<5 years old), 15 older children (5–17 years old), and 109 adults (≥18 years old). Five young children (7%), 0 older children (0%), and 10 adults (9%) were hypoxemic. No hypoxemic patients were receiving oxygen therapy at the time of diagnosis. Pneumonia, tuberculosis, and malnutrition were the most common conditions among those with hypoxemia. Oximetry data changed clinical management in all observed cases of hypoxemia and several cases of normoxemia, leading to application of supplemental oxygen, initiation of further diagnostic testing, prolongation of inpatient stay, or expedited discharge home.ConclusionsUndiagnosed hypoxemia is present among inpatients at this district hospital in rural Zambia with high prevalence in both adults and young children. These results support routine screening for hypoxemia in similar facilities in both age groups. Further investigation is warranted into the clinical impact and cost-effectiveness of pulse oximetry, provision of oxygen concentrators, and training on their use in developing countries.

Prevalence of Hypoxaemia in Paediatric Patients Attending Children Out Patient Clinic

“…In this study, hypoxaemia was found among many patients with a variety of diagnosis, though acute respiratory infection accounted for a majority (27.5%) of the cases, closely followed by malaria (10.0%) and diarrhoea (10.0%). This was in line with the report of Foran [20] that the most common diagnosis among the patients with hypoxaemia was respiratory infections. Acute respiratory tract infection, especially pneumonia is a very serious disease in children because it is one of the major killers of children under five years of age.…”

“…This study investigated the prevalence of hypoxaemia among children with different diagnosis in the children outpatient clinic in the Department of Paediatrics, University of Port Harcourt Teaching Hospital. The overall prevalence of hypoxia in this study was 11.4%, which is slightly higher than the 8% reported by Foran [20] among patients on admission in a district hospital in Zambia, though their sample population consisted of children and adults, while ours consisted of only children. It was also higher than the 5.3% prevalence of hypoxaemia reported by McCollum among hospitalized Malawian children under 15 years of age.…”

Occurrence of hypoxia in the wards of a teaching hospital

“…In this study, 10.36% of the total patients admitted in the hospital had hypoxia. In previous studies[458] carried out in various hospitals, 7.8% to 40% of the study subjects had hypoxia. In medical wards, the most common diagnosis among the patients of hypoxia was stroke in our study.…”

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

“…There are three commonly used methods to supply ICUs in resource-limited settings with oxygen: oxygen cylinders, oxygen concentrators, and centralized, piped oxygen systems [73]. Oxygen cylinders provide pressurized oxygen at variably high flow rates but-depending on their size-only do so for a limited period.…”

“…Multiple studies from resource-limited settings demonstrated greater cost reductions with oxygen concentrator systems compared to cylinders and generators. In Papua New Guinea, the overall 2-year cost estimate for cylinders, capable of producing 35,000 L/day, was approximately USD $205,000 when compared to three oxygen concentrators (USD $82,400) and an oxygen generator system (USD $390,000), both capable of producing 60,000 L/day, [73]. In The Gambia, annual costs for cylinders at one hospital were USD $152,747 vs. USD $18,742 for concentrators with 24 h availability of grid power [76].…”