The spectrum of hypoxaemia in children admitted to hospital in The Gambia, West Africa

Abstract

Summaryobjective Hypoxia predicts mortality in children with acute lower respiratory infections (ALRIs). We investigated the prevalence and predictive value of hypoxia in ALRI and other acute infectious diseases.methods We studied the spectrum of hypoxaemia in 4047 children admitted to a tertiary hospital in The Gambia. Oxygen saturation was measured shortly after admission. Severe hypoxaemia was defined as an oxygen saturation below 90%.results 5.8% of all admissions had severe hypoxaemia. Prevalence of hypoxaemia varied between disease groups: it was 11.7% in ALRI cases, 16.5% in neonates; 2.9% in malaria cases overall but 6.5% in cerebral malaria patients; and 2.7% in children with meningitis. Hypoxaemia predicted a poor outcome; the odds ratio for death among paediatric admissions overall was 7.

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

“…In our study, flaring was significantly associated with mortality, and adjusted odds of mortality were increased three‐fold in hypoxaemic neonates. This is congruent with studies in The Gambia, Kenya and Papua New Guinea, which found odds or relative risk of death increased by 7.7, 4.3 and 3.1 times, respectively 2, 5, 36. In our study, death occurred despite availability of basic oxygen delivery devices, but with limited availability of CPAP and lack of mechanical ventilation and oxygen blenders.…”

“…This is higher than the prevalence of neonatal hypoxaemia reported in Kilifi, Kenya (23%)3 and The Gambia (16.5%)2 but lower than reported in India (38.5%)4 and Papua New Guinea (43%) 5. Taken together, these data suggest a high burden of neonatal hypoxaemia.…”

“…Preterm birth (<37 weeks gestation) is the leading cause of neonatal death, three‐quarters of which occur in sub‐Saharan Africa and South Asia,1 where availability of neonatal intensive care and necessary equipment are limited. Hypoxaemia may complicate neonatal illness and is reported to be common amongst sick neonates admitted to paediatric wards in low‐ and middle‐income countries (LMICs, ranging from 17% to 43%) 2, 3, 4, 5. In The Gambia, the mortality rate was 75% amongst neonates with hypoxemia, which they defined as oxygen saturation (SpO 2 ) <90% 2.…”

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

“…Costs per 1000 litres of oxygen were US$ 4.80 for the cylindersupplied period and US$ 0.84 for the concentrator-supplied period, compared to US$ 6.56 and US$ 0.86, respectively, for modelled costs in a 42-bed hospital with no cylinder leakage (leakage was fixed before study, see below) and an estimated twice-normal consumption as a result of the Medical Research Council Hospital's higher treatment cut-offs. 16 These costs were broadly similar, and the differences mainly reflected historical differences in item costs, exchange rates and concentrator use in the cylinder-supplied period (Table 4). During the cylinder-supplied period, concentrator backup was required for 2 days (a weekend) because of a delay in cylinder delivery, despite the proximity of the hospital to the supplier (less than 10 km on good roads).…”

“…We rated cylinder leakage at 10% for new well-maintained equipment connected directly to the patient, 50% for old poorly-maintained equipment connected directly to the patient, and 80% for old poorly-maintained equipment connected to a piped delivery system. Oxygen requirements were estimated based on local rates of severe hypoxaemia (oxygen saturation < 90%) among children admitted to hospital (6%) 16 and average local durations (3 days) and flow rates (1.5 L/ min) of oxygen treatment (unpublished data). We performed sensitivity analyses based on worse-than-expected equipment lifespans, variations in power availability and different levels of cylinder leakage.…”