Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

  1. Hamish R Graham
  2. Omotayo E Olojede
  3. Ayobami A Bakare
  4. Agnese Iuliano
  5. Oyaniyi Olatunde
  6. Adamu Isah
  7. Adams Osebi
  8. Tahlil Ahmed
  9. Rochelle Ann Burgess
  10. Eric D McCollum
  11. Tim Colbourn
  12. Carina King
  13. Obioma C Uchendu
  14. Adegoke G Falade

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Abstract

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO 2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.

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  1. Version published to 10.1136/bmjgh-2021-006069
  2. ScreenIT

    SciScore for 10.1101/2021.04.21.21255772: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, we recognise the difficulties in obtaining sensitive financial information and the limitations of relying on administrator or technician recall in the absence of reliable financial records. Finally, our case study highlights opportunities for priority improvements in existing oxygen systems. First, pulse oximeters are low-cost devices that were grossly lacking and could substantially improve rational use of existing oxygen supplies. Second, while many devices were not fit for use, support for technicians could likely rehabilitate some of these and prevent future growth of equipment graveyards (e.g. Open O2 in Malawi, www.openo2.org). Third, many devices did not have CE or similar quality control markings, highlighting the ongoing challenge of inappropriate equipment donation and procurement of consumer devices for medical purposes. Fourth, the differences between government and private facilities highlights that oxygen access is fundamentally an issue of equity, and efforts must include smaller, poorer, and more rural facilities that care for the most at-risk populations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.04.21.21255772v1 on medRxiv