A feasibility study evaluating a reservoir storage system for continuous oxygen delivery for children with hypoxemia in Kenya.

BACKGROUND: Supplemental oxygen is an essential treatment for childhood pneumonia but is often unavailable in low-resource settings or unreliable due to frequent and long-lasting power outages. We present a novel medium pressure reservoir (MPR) which delivers continuous oxygen to pediatric patients through power outages. METHODS: An observational case series pilot study assessing the capacity, efficacy and user appraisal of a novel MPR device for use in low-resource pediatric wards. We designed and tested a MPR in a controlled preclinical setting, established feasibility of the device in two rural Kenyan hospitals, and sought user feedback and satisfaction using a standardized questionnaire. RESULTS: Preclinical data showed that the MPR was capable of bridging power outages and delivering a continuous flow of oxygen to a simulated patient. The MPR was then deployed for clinical testing in nine pediatric patients at Ahero and Suba Hospitals. Power was unavailable for 2% of the total time observed due to 11 power outages (median 4.6 min, IQR 3.6-13.0 min) that occurred during treatment with the MPR. Oxygen flowrates remained constant across all 11 power outages. Feedback on the MPR was uniformly positive; all respondents indicated that the MPR was easy to use and provided clinically significant help to their patients. CONCLUSION: We present a MPR oxygen delivery device that has the potential to mitigate power insecurity and improve the standard of care for hypoxemic pediatric patients in resource-limited settings.

Oxygen insecurity and mortality in resource-constrained healthcare facilities in rural Kenya.

INTRODUCTION: Pneumonia is the leading cause of death globally in children. Supplemental oxygen reduces mortality but is not available in many low-resource settings. Inadequate power supply to drive oxygen concentrators is a major contributor to this failure. The objectives of our study were to (a) assess the availability of therapeutic oxygen; (b) evaluate the reliability of the electrical supply; and (c) investigate the effects of suboptimal oxygen delivery on patient outcomes in selected healthcare facilities in rural Kenya. MATERIALS AND METHODS: A cross-sectional descriptive study on oxygen availability and descriptive case series of Kenyan children and youth hospitalized with hypoxemia. RESULTS: Two of 11 facilities had no oxygen equipment and nine facilities had at least one concentrator or cylinder. Facilities had a median of seven power interruptions per week (range: 2-147). The median duration of the power outage was 17 minutes and the longest was more than 6 days. The median proportion of time without power was out 7% (range: 1%-58%). Fifty-seven patients hospitalized with hypoxemia (median oxygen saturation 85% [interquartile range {IQR}: 82-87]) were included in our case series. Patients received supplemental oxygen for a median duration of 4.6 hours (IQR: 3.0-7.8). Eighteen patients (32%) faced an oxygen interruption of the median duration of 11 minutes (IQR: 9-20). A back-up cylinder was used in 5/18 (28%) cases. The case fatality rate was 11/57 (19%). CONCLUSION: Mortality due to hypoxemia remains unacceptably high in low-resource healthcare facilities and may be associated with oxygen insecurity, related to lack of equipment and/or reliable power.