Improving effective coverage of medical-oxygen services for neonates and children in health facilities in Uganda: a before-after intervention study.

IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Global Health Pub Date : 2024-09-01 DOI:10.1016/S2214-109X(24)00268-7
Hamish R Graham, Freddy Eric Kitutu, Yewande Kamuntu, Blasio Kunihira, Santa Engol, Jasmine Miller, Absolom Zisanhi, Dorcas Kemigisha, Lorraine Nabbanja Kabunga, Charles Olaro, Harriet Ajilong, Freddie Ssengooba, Felix Lam
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Abstract

Background: Medical oxygen services are essential for the care of acutely unwell patients. We aimed to assess the effects of a multilevel, multicomponent health-system intervention on hypoxaemia detection, oxygen therapy, and mortality among neonates and children attending level IV health centres and hospitals in Uganda.

Methods: For this before-after intervention study, we included children who attended paediatric or neonatal wards of 24 level IV health centres and seven general or regional referral hospitals in the Busoga and North Buganda regions of Uganda between June 1, 2020, and June 30, 2022. All neonates younger than 1 month and children aged 1 month to 14 years were eligible for inclusion. We excluded neonates who were not sick but stayed in the maternity ward for routine postnatal care. The intervention involved clinical training, mentorship, and supportive supervision; provision of pulse oximeters and cylinder-based oxygen sources; biomedical-capacity support; and support to develop and disseminate oxygen supply strategies, oxygen therapy guidelines, and lists of essential oxygen supplies. Trained research assistants extracted individual patient data from case notes using a standardised electronic data collection form. Data were collected on health-facility details, age, sex, clinical signs and symptoms, admission diagnoses, pulse oximetry readings, oxygen therapy details, and final patient outcome. The primary outcome was the proportion of admitted neonates and children with a pulse oximetry oxygen saturation reading documented in their patient case notes on day 1 of health-facility admission (ie, pulse oximetry coverage). We used mixed-effects logistic regression to evaluate the effect of the intervention.

Findings: We obtained data on 71 997 eligible neonates and children admitted to 31 participating health facilities; the primary analysis included 10 001 patients in the pre-intervention period (ie, June 1 to Oct 30, 2020) and 51 329 patients in the post-intervention period (ie, March 1, 2021, to June 30, 2022). Because 1356 patients had missing data for sex, 4365 (46·7%) of 9347 in the pre-intervention group and 22 831 (46·2%) of 49 410 in the post-intervention group were female; 4982 (53·3%) in the pre-intervention group and 26 579 (53·8%) in the post-intervention group were male. The proportion of neonates and children with pulse oximetry at admission increased from 2365 (23·7%) of 10 001 in the pre-intervention period to 45 029 (87·7%) of 51 328 in the post-intervention period. Adjusted analysis indicated greater likelihood of a patient receiving pulse oximetry during the post-intervention period compared with the pre-intervention period (adjusted odds ratio 40·10, 95% CI 37·38-42·93; p<0·0001).

Interpretation: Large-scale improvements in hospital oxygen services are achievable and have the potential to improve clinical outcomes. Governments should be encouraged to develop national oxygen plans and focus investment on interventions that have been shown to be effective, including the introduction of pulse oximetry into routine hospital care and clinical and biomedical mentoring and support.

Funding: Bill & Melinda Gates Foundation and ELMA Philanthropies.

Translations: For the Luganda and Lusoga translations of the abstract see Supplementary Materials section.

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提高乌干达医疗机构新生儿和儿童医用氧气服务的有效覆盖率:干预前后研究。
背景:医用供氧服务对急性病患者的护理至关重要。我们旨在评估一项多层次、多成分的医疗系统干预措施对乌干达四级医疗中心和医院的新生儿和儿童的低氧血症检测、氧气治疗和死亡率的影响:在这项干预前后对比研究中,我们纳入了 2020 年 6 月 1 日至 2022 年 6 月 30 日期间在乌干达布索加地区和北布干达地区的 24 家四级医疗中心和 7 家综合医院或地区转诊医院的儿科或新生儿病房就诊的儿童。所有小于 1 个月的新生儿和 1 个月至 14 岁的儿童均符合纳入条件。我们排除了没有生病但在产房接受常规产后护理的新生儿。干预措施包括临床培训、指导和支持性监督;提供脉搏血氧仪和气瓶式氧气源;生物医学能力支持;支持制定和传播氧气供应策略、氧气治疗指南和必要氧气供应清单。经过培训的研究助理使用标准化的电子数据收集表从病例记录中提取患者的个人数据。收集的数据包括医疗机构详情、年龄、性别、临床体征和症状、入院诊断、脉搏血氧饱和度读数、氧疗详情以及患者的最终结果。主要结果是新生儿和儿童入院第 1 天病例中记录有脉搏血氧饱和度读数的比例(即脉搏血氧饱和度覆盖率)。我们采用混合效应逻辑回归法来评估干预效果:我们获得了 31 家参与医疗机构收治的 71 997 名符合条件的新生儿和儿童的数据;主要分析包括干预前(即 2020 年 6 月 1 日至 10 月 30 日)的 10 001 名患者和干预后(即 2021 年 3 月 1 日至 2022 年 6 月 30 日)的 51 329 名患者。由于有 1356 名患者的性别数据缺失,因此干预前组的 9347 名患者中有 4365 名(46-7%)为女性,干预后组的 49 410 名患者中有 22 831 名(46-2%)为女性;干预前组的 4982 名患者中有 53-3%为男性,干预后组的 26 579 名患者中有 53-8%为男性。入院时使用脉搏血氧仪的新生儿和儿童比例从干预前的 10 001 人中的 2365 人(23-7%)增加到干预后的 51 328 人中的 45 029 人(87-7%)。调整后的分析表明,与干预前相比,干预后患者接受脉搏氧饱和度测量的可能性更大(调整后的几率比为 40-10,95% CI 为 37-38-42-93;P解释:大规模改善医院供氧服务是可以实现的,并有可能改善临床效果。应鼓励各国政府制定国家供氧计划,并将投资重点放在已证明有效的干预措施上,包括将脉搏血氧仪引入常规医院护理以及临床和生物医学指导与支持:比尔及梅林达-盖茨基金会和 ELMA 慈善机构:摘要的卢甘达语和卢索加语译文见补充材料部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Lancet Global Health
Lancet Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
44.10
自引率
1.20%
发文量
763
审稿时长
10 weeks
期刊介绍: The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts. The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.
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