Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review.

Abstract

Background

Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in sub-Saharan Africa is not well-described. We aim to identify and describe existing data around oxygen availability and provision for adults in sub-Saharan Africa, determine knowledge or research gaps, and make recommendations for future research and capacity building.

Methods

We systematically searched four databases for articles on April 22, 2020, for variations of keywords related to oxygen with a focus on countries in sub-Saharan Africa. Inclusion criteria were studies that included adults and addressed hypoxemia assessment or outcome, oxygen delivery mechanisms, oxygen availability, oxygen provision infrastructure, and oxygen therapy and outcomes.

Results

35 studies representing 22 countries met inclusion criteria. Availability of oxygen delivery systems ranged from 42%-94% between facilities, with wide variability in the consistency of availability. There was also wide reported prevalence of hypoxemia, with most studies focusing on specific populations. In facilities where oxygen is available, health care workers are ill-equipped to identify adult patients with hypoxemia, provide oxygen to those who need it, and titrate or discontinue oxygen appropriately. Oxygen concentrators were shown to be the most cost-effective delivery system in areas where power is readily available.

Conclusions

There is a substantial need for building capacity for oxygen delivery throughout sub-Saharan Africa. Addressing this critical issue will require innovation and a multi-faceted approach of developing infrastructure, better equipping facilities, and health care worker training.

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Citation

Published Version (Please cite this version)

10.7189/jogh.11.04018

Publication Info

Navuluri, Neelima, Maria L Srour, Peter S Kussin, David M Murdoch, Neil R MacIntyre, Loretta G Que, Nathan M Thielman, Eric D McCollum, et al. (2021). Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review. Journal of global health, 11. p. 04018. 10.7189/jogh.11.04018 Retrieved from https://hdl.handle.net/10161/23263.

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Scholars@Duke

Navuluri

Neelima Navuluri

Assistant Professor of Medicine
Kussin

Peter Samuel Kussin

Professor of Medicine

The majority of my effort is devoted to clinical care of patients with advanced lung disease and teaching.

I spend four months a year in Eldoret Kenya working at Moi Teaching and Referral Hospital as part of The Duke Hubert Yeargan Institute for Global Health and AMPATH- a consortium of North American Medical Schools collaborating with Moi University School of Medicine and Moi Teaching and Referral Hospital. I work primarily in the intensive care unit and medicine wards. I am involved in broad range of research efforts in critical care and pulmonary medicine  in resource limited countries.

Murdoch

David Martin Murdoch

Associate Professor of Medicine

As a physician and researcher, my career has been driven by a passion for linking the basic and clinical sciences with the primary goal of understanding the disease pathogenesis. Through my training in epidemiology, basic science immunology, and clinical medicine, I have acquired a breadth of experience, knowledge, collaborators, and an adaptability which has culminated in a research focus on the reconstitution of immune responses and systemic inflammation in immunocompromised patients and vulnerable populations. My research focuses on T cell immunology utilizing a variety of platforms including polychromatic flow cytometry, cytokine multiplexing, and novel single cell assays. My initial research centered on the immune reconstitution syndrome (IRIS), with a focus on the mycobacterial precipitants of the disease, its epidemiology, and research efforts into elucidating the pathogenesis of the syndrome. Recently, I have translated my interest in co-infection immunology in the immunocompromised transplant population. With a career long interest in contrasting compartmental and peripheral immune responses, I have partnered with engineers in the Duke Pratt School of Engineering in order to develop novel single cell immune assays in order to comprehensively profile the immune response on limited specimens.

Thielman

Nathan Maclyn Thielman

Professor of Medicine

Broadly, my research focuses on a range of clinical and social issues that affect persons living with or at risk for HIV infection in resource-poor settings. In Tanzania, our group is applying novel methods to optimize HIV testing uptake among high-risk groups. We recently demonstrated that the Discrete Choice Experiment (DCE), a form of stated preference survey research, is a robust tool for identifying (a) which characteristics of HIV testing options are most preferred by different populations and (b) which tradeoffs individuals make in evaluating testing options. Building on more than a decade of productive HIV testing research in the Kilimanjaro Region, the next phase of our NIMH funded project will test the hypothesis that DCE-derived HIV testing options significantly increases rates of testing among groups at high risk for HIV infection. This work holds promise not only for optimizing HIV testing uptake in the Kilimanjaro Region, but also for applying novel tools in the service of translational epidemiology and implementation research.


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