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Medical oxygen key to reversing pneumonia deaths

Pneumonia
Pneumonia remains a hidden killer. FILE PHOTO | NMG 

Pneumonia kills more children than any other disease. It causes immeasurable suffering, leaving its victims gasping for air, and their parents and siblings coping with anxiety, fear and loss.

Treatment of the illness imposes costs on desperately poor families, and huge demands on health systems. Yet pneumonia remains a hidden killer. According to the United Nations Children's Fund (Unicef), the 2018/2019 data released last month found that six per 1,000 live births under-five mortality rate were due to pneumonia in 2018, accounting for 15 percent of child deaths. It was the second biggest killer of children under five in 2017.

In Kenya, 11,203 children under the age of five died of pneumonia, a slight reduction from the 14,972 who died in 2010. This is despite the fact that most cases of pneumonia can be prevented through vaccines or treated with antibiotics.

According to a Johns Hopkins University study, scaling up pneumonia treatment and prevention services worldwide can save the lives of 3.2 million children under the age of five. It would also create ‘a ripple effect’ that would prevent 5.7 million extra child deaths from other major childhood diseases at the same time, underscoring the need for integrated health services.

The combination of medical oxygen and timely diagnosis can dramatically cut death rates. Yet oxygen is seldom beyond urban hospitals and private providers. Pulse oximeters, effective and inexpensive diagnostic devices for measuring blood oxygen levels, are similarly unavailable to those who need them most.

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Having low oxygen levels in the blood increases a patient’s chances of dying by more than five times. Facility evaluations of Kenyan hospitals have shown that oxygen supply is often not available on paediatric wards, pulse oximetres are uncommonly used outside operating theaters, and healthcare workers lack training on how to use oxygen and pulse oximetres.

At the hospital level, there are three key barriers to improving oxygen access and First, oxygen‐related equipment, if available, is often low quality, faulty, and poorly maintained.

Second, clinical guidance, training, and support to use oxygen is limited and poorly implemented. Oxygen therapy is unlike most other medications as it’s administered using equipment and titrated by nurses based on serial clinical assessments . Clinical use of oxygen is not complicated, but healthcare workers do require some basic knowledge and skills.

Third, oxygen‐related care is expensive to hospitals and patients. Maintaining supply of medical oxygen is expensive, and is made costlier by faulty equipment and poor clinical practices. A positive initiative, Kenya is Hewa Tele, is a social enterprise that distributes oxygen cylinders to health facilities.

The scheme was piloted in Western Kenya where it now serves 73 facilities across the region. Hewa Tele has leveraged new technologies and finance to produce high-quality, low-cost cylinders, using local production, and provided training for health workers. Oxygen tanks are now just shipped a few kilometres to rural facilities with charges that are 30 percent less than the current monopolist suppliers.

The writer is executive director, Centre for Public Health and Development.

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