Solar-powered oxygen, quality improvement and child pneumonia deaths: a large-scale effectiveness study.

Autor:	Duke T; Intensive Care Unit, and Centre for International Child Health, Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia trevor.duke@rch.org.au.; Discipline of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea., Pulsan F; Discipline of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea., Panauwe D; Department of Paediatrics, Wabag General Hospital, Wabag, Enga Province, Papua New Guinea., Hwaihwanje I; Department of Paediatrics, Goroka General Hospital, Goroka, Eastern Highlands Province, Papua New Guinea., Sa'avu M; Department of Paediatrics, Mendi General Hospital, Mendi, Southern Highlands, Papua New Guinea., Kaupa M; Department of Paediatrics, Mt Hagen General Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea., Karubi J; Department of Paediatrics, Mt Hagen General Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea., Neal E; Infection and Immunity, Murdoch Childrens Research Institute, Parkville, Victoria, Australia., Graham H; Infection and Immunity, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia., Izadnegahdar R; Bill and Melinda Gates Foundation, Seattle, Washington, USA., Donath S; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Archives of disease in childhood [Arch Dis Child] 2021 Mar; Vol. 106 (3), pp. 224-230. Date of Electronic Publication: 2020 Oct 16.
DOI:	10.1136/archdischild-2020-320107
Abstrakt:	Background: Pneumonia is the largest cause of child deaths in low-income countries. Lack of availability of oxygen in small rural hospitals results in avoidable deaths and unnecessary and unsafe referrals. Method: We evaluated a programme for improving reliable oxygen therapy using oxygen concentrators, pulse oximeters and sustainable solar power in 38 remote health facilities in nine provinces in Papua New Guinea. The programme included a quality improvement approach with training, identification of gaps, problem solving and corrective measures. Admissions and deaths from pneumonia and overall paediatric admissions, deaths and referrals were recorded using routine health information data for 2-4 years prior to the intervention and 2-4 years after. Using Poisson regression we calculated incidence rates (IRs) preintervention and postintervention, and incidence rate ratios (IRR). Results: There were 18 933 pneumonia admissions and 530 pneumonia deaths. Pneumonia admission numbers were significantly lower in the postintervention era than in the preintervention era. The IRs for pneumonia deaths preintervention and postintervention were 2.83 (1.98-4.06) and 1.17 (0.48-1.86) per 100 pneumonia admissions: the IRR for pneumonia deaths was 0.41 (0.24-0.71, p<0.005). There were 58 324 paediatric admissions and 2259 paediatric deaths. The IR for child deaths preintervention and postintervention were 3.22 (2.42-4.28) and 1.94 (1.23-2.65) per 100 paediatric admissions: IRR 0.60 (0.45-0.81, p<0.005). In the years postintervention period, an estimated 348 lives were saved, at a cost of US$6435 per life saved and over 1500 referrals were avoided. Conclusions: Solar-powered oxygen systems supported by continuous quality improvement can be achieved at large scale in rural and remote hospitals and health care facilities, and was associated with reduced child deaths and reduced referrals. Variability of effectiveness in different contexts calls for strengthening of quality improvement in rural health facilities. Trial Registration Number: ACTRN12616001469404. Competing Interests: Competing interests: Apart from being funded through the Bill & Melinda Gates Foundation for the conduct of this work, none of the authors have any competing interests in regard to this manuscript. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu