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Smith V, Changoor A, Rummage S, Wolde HF, Zeleke EG, Belay GM, Barash D, Stunkel J, Reynolds C. An Oxygen Supply Is Not Enough: A Qualitative Analysis of a Pressure Swing Adsorption Oxygen Plant Program in Ethiopian Hospitals. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024:GHSP-D-23-00515. [PMID: 39019585 DOI: 10.9745/ghsp-d-23-00515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/04/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND In response to critical gaps in medical oxygen access, 2 pressure swing adsorption (PSA) oxygen production centers were established using an ecosystem-strengthening strategy in Amhara, Ethiopia, in 2019. A qualitative study was conducted to assess enablers and bottlenecks to oxygen access at the hospital level after installation. METHODS A variety of hospital staff (clinicians, biomedical professionals, hospital administrators, and procurement teams) across 13 hospitals procuring oxygen from the plants participated in comprehensive, semistructured focus group discussions. A thematic framework analysis approach was used to identify key themes. FINDINGS A total of 101 individuals participated in 26 focus groups in 2021, 2 years after plants were installed. Primary themes were accessibility of supply, affordability, and hospital readiness. Respondents indicated a substantial increase in their hospital's ability to access lower-cost oxygen, with many attributing this to the locality of plants and reduced transportation barriers. However, other challenges persisted, and the emergence of COVID-19 1 year after plant installation and a civil conflict exacerbated supply shortages. Investments in equipment, supplies, and training optimized clinical utilization of oxygen and were highlighted as a need for ongoing investment. CONCLUSION To achieve maximum impact, investments in large-scale oxygen systems must be accompanied by strategic plans to transport oxygen, reduce costs to hospitals, and provide support to clinical teams through equipment, supply procurement, and clinical training. These findings support comprehensive ecosystem approaches to strengthening oxygen access for sustainable impact.
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Affiliation(s)
| | - Alana Changoor
- Assist International, Ripon, CA, USA
- Grand Challenges Canada, Toronto, Canada
| | | | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Faculty of Health Sciences, Curtin University, Bentley, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Saidu Y, Valirie Ndip A, Diaby O, Hollong B, Katz Z, Battu A, Nchinjoh SC, Balkissou AD, Wiwa O. Functional availability of medical oxygen for the management of hypoxaemia in Cameroon: A nationwide facility-based cross-sectional survey. J Glob Health 2024; 14:04092. [PMID: 38726546 PMCID: PMC11082622 DOI: 10.7189/jogh.14.04092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Medical oxygen is essential for managing hypoxaemia, which has a multifactorial origin, including acute and chronic lung diseases such as pneumonia, asthma, and severe malaria. The coronavirus disease 2019 (COVID-19) revealed substantial gaps in the availability and accessibility of safe medical oxygen, especially in low- and middle-income countries (LMICs). This study aimed to assess the availability and sources, as well as the barriers to the availability of functional medical oxygen in hospitals in Cameroon. Methods This was a nationwide cross-sectional descriptive study conducted from 26 March to 1 June 2021. Using a convenient sampling technique, we sampled accredited public and private COVID-19 treatment centres in all ten regions in Cameroon. Representatives from the selected hospitals were provided with a pre-designed questionnaire assessing the availability, type, and state of medical oxygen in their facilities. All analyses were performed using R. Results In total, 114 hospitals were included in this study, with functional medical oxygen available in 65% (74/114) of the hospitals. About 85% (23/27) of the reference hospitals and only 59% (51/87) of the district hospitals had available functional medical oxygen. Compared to district hospitals, reference hospitals were more likely to have central oxygen units (reference vs. district: 10 vs. 0%), oxygen cylinders (74 vs. 42%), and oxygen concentrators (79 vs. 51%). The most common barriers to the availability of medical oxygen were inadequate oxygen supply to meet needs (district vs. reference hospitals: 55 vs. 30%), long delays in oxygen bottle refills (51 vs. 49%), and long distances from oxygen suppliers (57 vs. 49%). Conclusions The availability of medical oxygen in hospitals in Cameroon is suboptimal and more limited in districts compared to reference hospitals. The cost of medical oxygen, delays related to refills and supplies, and long distances from medical sources were the most common barriers to availability in Cameroon.
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Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative Inc., Yaounde, Cameroon
- Institute for Global Health, University of Siena, Siena, Italy
| | - Agbor Valirie Ndip
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | | | | | - Zachary Katz
- Global Essential Medicines, Clinton Health Access Initiative Inc., Boston, Massachusetts, USA
| | - Audrey Battu
- Global Essential Medicines, Clinton Health Access Initiative Inc., Boston, Massachusetts, USA
| | | | | | - Owens Wiwa
- Clinton Health Access Initiative Inc., Yaounde, Cameroon
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Leeb G, Auchus I, Law T, Bickler P, Feiner J, Hashi S, Monk E, Igaga E, Bernstein M, Chou YC, Hughes C, Schornack D, Lester J, Moore K, Okunlola O, Fernandez J, Shmuylovich L, Lipnick M. The performance of 11 fingertip pulse oximeters during hypoxemia in healthy human participants with varied, quantified skin pigment. EBioMedicine 2024; 102:105051. [PMID: 38458110 PMCID: PMC10943300 DOI: 10.1016/j.ebiom.2024.105051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Fingertip pulse oximeters are widely available, inexpensive, and commonly used to make clinical decisions in many settings. Device performance is largely unregulated and poorly characterised, especially in people with dark skin pigmentation. METHODS Eleven popular fingertip pulse oximeters were evaluated using the US Food and Drug Administration (FDA) Guidance (2013) and International Organization for Standardization Standards (ISO, 2017) in 34 healthy humans with diverse skin pigmentation utilising a controlled desaturation study with arterial oxygen saturation (SaO 2) plateaus between 70% and 100%. Skin pigmentation was assessed subjectively using a perceived Fitzpatrick Scale (pFP) and objectively using the individual typology angle (ITA) via spectrophotometry at nine anatomical sites. FINDINGS Five of 11 devices had a root mean square error (ARMS) > 3%, falling outside the acceptable FDA performance range. Nine devices demonstrated worse performance in participants in the darkest skin pigmentation category compared with those in the lightest category. A commonly used subjective skin colour scale frequently miscategorised participants as being darkly pigmented when compared to objective quantification of skin pigment by ITA. INTERPRETATION Fingertip pulse oximeters have variable performance, frequently not meeting regulatory requirements for clinical use, and occasionally contradicting claims made by manufacturers. Most devices showed a trend toward worse performance in participants with darker skin pigment. Regulatory standards do not adequately account for the impact of skin pigmentation on device performance. We recommend that the pFP and other non-standardised subjective skin colour scales should no longer be used for defining diversity of skin pigmentation. Reliable methods for characterising skin pigmentation to improve diversity and equitable performance of pulse oximeters are needed. FUNDING This study was conducted as part of the Open Oximetry Project funded by the Gordon and Betty Moore Foundation, Patrick J McGovern Foundation, and Robert Wood Johnson Foundation. The UCSF Hypoxia Research Laboratory receives funding from multiple industry sponsors to test the sponsors' devices for the purposes of product development and regulatory performance testing. Data in this paper do not include sponsor's study devices. All data were collected from devices procured by the Hypoxia Research Laboratory for the purposes of independent research. No company provided any direct funding for this study, participated in study design or analysis, or was involved in analysing data or writing the manuscript. None of the authors own stock or equity interests in any pulse oximeter companies. Dr Ellis Monk's time utilised for data analysis, reviewing and editing was funded by grant number: DP2MH132941.
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Affiliation(s)
- Gregory Leeb
- Department of Anesthesia, University of California, San Francisco, USA
| | - Isabella Auchus
- Department of Anesthesia, University of California, San Francisco, USA.
| | - Tyler Law
- Department of Anesthesia, University of California, San Francisco, USA
| | - Philip Bickler
- Department of Anesthesia, University of California, San Francisco, USA
| | - John Feiner
- Department of Anesthesia, University of California, San Francisco, USA
| | - Shamsudini Hashi
- Department of Anesthesia, University of California, San Francisco, USA
| | - Ellis Monk
- Department of Sociology, Harvard University, USA
| | - Elizabeth Igaga
- Department of Anesthesia, College of Health Sciences, Makerere University, Uganda
| | | | - Yu Celine Chou
- Department of Anesthesia, University of California, San Francisco, USA
| | - Caroline Hughes
- Department of Anesthesia, University of California, San Francisco, USA
| | - Deleree Schornack
- Department of Anesthesia, University of California, San Francisco, USA
| | - Jenna Lester
- Department of Dermatology, University of California, San Francisco, USA
| | - Kelvin Moore
- University of California, San Francisco School of Medicine, USA
| | - Olubunmi Okunlola
- Department of Anesthesia, New York University Langone Hospital Brooklyn, USA
| | - Jana Fernandez
- Department of Anesthesia, University of California, San Francisco, USA
| | | | - Michael Lipnick
- Department of Anesthesia, University of California, San Francisco, USA; University of California, San Francisco Institute for Global Health Sciences, USA
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Mangipudi S. Solar-powered solutions to oxygen delivery challenges in Uganda: the next steps. Lancet 2024; 403:703-705. [PMID: 38367640 DOI: 10.1016/s0140-6736(23)02759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Sowmya Mangipudi
- Department of Surgery, Division of Vascular Surgery, University of California at San Francisco, San Francisco, CA 94113, USA.
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5
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Navuluri N, Lagat DK, Birgen E, Kitur S, Kussin PS, Murdoch DM, Thielman NM, Parish A, Green CL, MacIntyre N, Egger JR, Wools-Kaloustian K, Que LG. Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study. BMJ Open 2023; 13:e072111. [PMID: 37723111 PMCID: PMC10510888 DOI: 10.1136/bmjopen-2023-072111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya, with a focus on chronic hypoxaemia. DESIGN Single-centre, prospective cohort study. SETTING National tertiary referral hospital in Eldoret, Kenya between September 2019 and April 2022. PARTICIPANTS Adults (age ≥18 years) admitted to general medicine wards. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was proportion of patients who were hypoxaemic (oxygen saturation, SpO2 ≤88%) on admission. Secondary outcomes were proportion of patients with hypoxaemia on admission who had hypoxaemia resolution, hospital discharge, transfer, or death among those with unresolved hypoxaemia or chronic hypoxaemia. Patients remaining hypoxaemic for ≤3 days after admission were enrolled into an additional cohort to determine chronic hypoxaemia. Chronic hypoxaemia was defined as an SpO2 ≤ 88% at either 1-month post-discharge follow-up or, for patients who died prior to follow-up, a documented SpO2 ≤88% during a previous hospital discharge or outpatient visit within the last 6 months. RESULTS We screened 4104 patients (48.5% female, mean age 49.4±19.4 years), of whom 23.8% were hypoxaemic on admission. Hypoxaemic patients were significantly older and more predominantly female than normoxaemic patients. Among those hypoxaemic on admission, 33.9% had resolution of their hypoxaemia as inpatients, 55.6% had unresolved hypoxaemia (31.0% died before hospital discharge, 13.3% were alive on discharge and 11.4% were transferred) and 10.4% were lost to follow-up. The prevalence of chronic hypoxaemia was 2.1% in the total screened population, representing 8.8% of patients who were hypoxaemic on admission. Chronic hypoxaemia was determined at 1-month post-discharge among 59/86 patients and based on prior documentation among 27/86 patients. CONCLUSION Hypoxaemia is highly prevalent among adults admitted to a general medicine ward at a national referral hospital in Kenya. Nearly 1 in 11 patients who are hypoxaemic on admission are chronically hypoxaemic.
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Affiliation(s)
- Neelima Navuluri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - David K Lagat
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Elcy Birgen
- Duke Global Health Institute, Durham, North Carolina, USA
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sylvia Kitur
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peter S Kussin
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David M Murdoch
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan M Thielman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neil MacIntyre
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph R Egger
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Loretta G Que
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Lustenberger UB, Krestnikova A, Gröninger OG, Grass RN, Stark WJ. Knowledge Transfer in Support of the Development of Oxygen Concentrators in Emergency Settings During the COVID-19 Pandemic. JOURNAL OF CHEMICAL EDUCATION 2023; 100:1858-1865. [PMID: 37552711 PMCID: PMC10176972 DOI: 10.1021/acs.jchemed.2c00925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/13/2023] [Indexed: 08/10/2023]
Abstract
The COVID-19 pandemic simultaneously disrupted supply chains and generated an urgent demand in medical infrastructure. Among personal protective equipment and ventilators, there was also an urgent demand for chemical oxygen. As devices to purify oxygen could not be manufactured and shipped rapidly enough, a simple and accessible oxygen concentrator based on pressure swing adsorption was developed at ETH Zurich in spring 2020. Instead of building devices locally and shipping them, it was decided to educate others in need of oxygen. The implementation encompassed education on process chemistry, material choice, and assembly and optimization of the concentrator and was realized using synchronous teaching tools, such as video call, and asynchronous ones, such as a website and video streaming. The project gained traction and interaction with engineering teams from universities and non-Governmental Organizations (Red Cross and the UN Development Program) in developing countries and emerging market economies, including Ecuador, Mexico, Somalia, and Peru. At the end of the project, the teams were surveyed regarding their experience in the educative knowledge transfer. It was reported that the learning experience prepared these groups well to build the device and to teach others as well. Major challenges were accessing some parts of the device and optimizing its performance. While synchronous communication is expected to be a very effective teaching method, the survey results showed that explanations via a website and video streaming have contributed the most to the implementation of the oxygen concentrator and thereby provide autonomous and sustainable education tools.
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Alilio M, Hariharan N, Lugten E, Garrison K, Bright R, Owembabazi W, Inyang U, Hassan SED, Saldana K. Strategies to Promote Health System Strengthening and Global Health Security at the Subnational Level in a World Changed by COVID-19. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00478. [PMID: 35487550 PMCID: PMC9053150 DOI: 10.9745/ghsp-d-21-00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
Structural weaknesses in national health systems have led to huge variations in responses to COVID-19. This calls for a unified approach to health security and essential health services as public health threats and the expectation for health care systems to provide improved access and services at affordable cost increases.
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Affiliation(s)
- Martin Alilio
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
| | - Neetu Hariharan
- U.S. Agency for International Development, Camris International, Bethesda, MD, USA
| | - Elizabeth Lugten
- U.S. Agency for International Development, Credence LLC, Vienna, VA, USA
| | - Kama Garrison
- U.S. Agency for International Development, Social Solutions International, North Bethesda, MD, USA
| | - Rhea Bright
- Social Solutions International, North Bethesda, MD, USA
| | | | - Uwem Inyang
- U.S. Agency for International Development Nigeria, Abuja. Nigeria
| | - Saad El-Din Hassan
- U.S. Agency for International Development Cambodia, Phnom Penh, Cambodia
| | - Kelly Saldana
- Bureau for Global Health, U.S. Agency for International Development, Washington, DC, USA
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Ogboghodo EO, Osaigbovo II, Obaseki DE, Iduitua MTN, Asamah D, Oduware E, Okwara BU. Implementation of a COVID-19 screening tool in a southern Nigerian tertiary health facility. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000578. [PMID: 36962763 PMCID: PMC10021546 DOI: 10.1371/journal.pgph.0000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Screening for coronavirus disease 2019 (COVID-19) in emergency rooms of health facilities during outbreaks prevents nosocomial transmission. However, effective tools adapted for use in African countries are lacking. This study appraised an indigenous screening and triage tool for COVID-19 deployed at the medical emergency room of a Nigerian tertiary facility and determined the predictors of a positive molecular diagnostic test for COVID-19. A cross-sectional study of all patients seen between May and July 2020 at the Accident and Emergency of the University of Benin Teaching Hospital was conducted. Patients with any one of the inputs- presence of COVID-19 symptoms, history of international travel, age 60 years and above, presence of comorbidities and oxygen saturation < 94%- were stratified as high-risk and subjected to molecular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Data was obtained from the screening record book patterned after a modified screening tool for COVID-19, deidentified and entered into IBM-SPSS version 25.0. Binary logistic regression was conducted to determine significant predictors of a positive SARS-CoV-2 test. The level of significance was set at p < 0.05. In total, 1,624 patients were screened. Mean age (standard deviation) was 53.9±18.0 years and 651 (40.1%) were 60 years and above. One or more symptoms of COVID-19 were present in 586 (36.1%) patients. Overall, 1,116 (68.7%) patients were designated high risk and tested for SARS-CoV-2, of which 359 (32.2%) were positive. Additional inputs, besides symptoms, increased COVID-19 detection by 108%. Predictors of a positive test were elderly age [AOR = 1.545 (1.127-2.116)], co-morbidity [AOR = 1.811 (1.296-2.530)] and oxygen saturation [AOR = 3.427 (2.595-4.528)]. This protocol using additional inputs such as oxygen saturation improved upon symptoms-based screening for COVID-19. Models incorporating identified predictors will be invaluable in resource limited settings.
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Affiliation(s)
- Esohe O Ogboghodo
- Department of Public Health and Community Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Iriagbonse I Osaigbovo
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Darlington E Obaseki
- Chief Medical Director's Office, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Micah T N Iduitua
- Accident and Emergency Department, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Doris Asamah
- Department of Nursing Services, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Emmanuel Oduware
- Department of Family Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Benson U Okwara
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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