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Original article
Improved oxygen systems in district hospitals in Lao PDR: a prospective field trial of the impact on outcomes for childhood pneumonia and equipment sustainability
  1. Amy Zigrida Gray1,2,3,
  2. Melinda Morpeth1,2,
  3. Trevor Duke1,2,3,
  4. David Peel1,4,
  5. Christian Winter5,
  6. Manivanh Satvady6,
  7. Kongkham Sisouk7,
  8. Bouasengnignom Prasithideth7,
  9. Khamsay Detleuxay7
  1. 1 Department of Paediatrics, Centre for International Child Health, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 The Royal Children’s Hospital, Melbourne Australia, Parkville, Victoria, Australia
  3. 3 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  4. 4 Ashdown Consultants, Hartfield, UK
  5. 5 WHO Country Office, Vientiane, Lao PDR
  6. 6 Department of Health Care, Ministry of Health, Vientiane, Lao PDR
  7. 7 Mahosot Hospital, Ministry of Health, Vientiane, Lao PDR
  1. Correspondence to Dr Amy Zigrida Gray; amy.gray{at}rch.org.au

Abstract

Background Hypoxaemia is a common and potentially fatal complication of many childhood, newborn and maternal conditions but often not well recognised or managed in settings where resources are limited. Oxygen itself is often inaccessible due to cost or logistics. This paper describes implementation of oxygen systems in Lao district hospitals, clinical outcomes after 24 months and equipment outcomes after 40 months postimplementation.

Methods A prospective field trial was conducted in 20 district hospitals, including 10 intervention hospitals that received oxygen concentrators and 10 control hospitals. Equipment outcomes were evaluated at baseline, 12, 24 and 40 months. Clinical outcomes of children under 5 years of age with pneumonia were evaluated using a before-and-after controlled study design with information retrospectively collected from medical records.

Results Fourteen (37%), 7 (18%) and 12 (34%) of 38 concentrators required repair at 12, 24 and 40 months, respectively. The proportion of children discharged well increased in intervention (90% (641/712) to 95.2% (658/691)) and control hospitals (87.1% (621/713) to 92.1% (588/606)). In intervention hospitals, case fatality rates for childhood pneumonia fell from 2.7% (19/712) preintervention to 0.80% (6/691) postintervention with no change in control hospitals (1.7% (12/713) preintervention and 2.3% (14/606) postintervention).

Conclusion Medium-term sustainability of oxygen concentrators in hospitals accompanied by reduced case fatality for childhood pneumonia has been demonstrated in Lao PDR. Significant local engineering capacity to address multiple causes of equipment malfunction was critical. The ongoing requirements and fragile structures within the health system remain major risks to long-term sustainability.

  • general paediatrics
  • health services research
  • outcomes research
  • tropical paediatrics

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors AZG contributed to study design, developed the clinical training materials, assisted with the implementation of oxygen systems, supervised data collection and training of data collectors, analysed the data and was responsible for the first draft of the manuscript. MM contributed to supervision of data collection in the postimplementation era, entered, cleaned and analysed data and contributed to both the first draft and subsequent revisions of the manuscript. TD contributed to study design, planning of implementation and contributed to interpretation of results and revision of the manuscript. DP contributed to study design, provided technical expertise into the engineering aspects of the programme, supervised implementation of equipment and contributed to revision of the manuscript. CW contributed to study design, equipment procurement and implementation of oxygen systems as well as revision of the manuscript. MS contributed to study design, in particular hospital selection and liaison, implementation of oxygen systems, monitoring of equipment in the field and reviewed the manuscript. KS contributed to study design, clinical training in oxygen use, data collection from medical records and supervised other data collectors and reviewed the manuscript. BP contributed to study design, clinical training in oxygen use, data collection from medical records and supervised other data collectors and reviewed the manuscript. KD contributed to study design, clinical training in oxygen use and supervision of data collectors and reviewed the manuscript.

  • Funding This work was supported by the Japanese Embassy Lao PDR through the WHO Office, who procured the equipment for the project. Additional funding for evaluation came via AusAID funding to the Centre for International Child Health, The University of Melbourne. We thank the manufacturer Airsep for responding generously to our request for replacement machines and spare parts in the second year of the project. The funding sources had no role in the design of the study or the decision to publish this article.

  • Competing interests None declared.

  • Ethics approval Human Research Ethics Committee of The University of Melbourne and Lao National Ethics Committee for Health Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement On request we are happy to share the data pertaining to this study. Requests should be made by email to the corresponding author.

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