Assessment of Public Hospitals’ Readiness to Manage Hypoxemia: A Cross-Sectional Study in Rwanda, 2022

Background Medical oxygen therapy is essential for treating hypoxemia, a driver of morbidity and mortality across a number of acute illnesses in children and adults. Healthcare providers must be equipped to detect hypoxemia and provide life-saving oxygen therapy. This study assessed the readiness of Rwandan public hospitals to provide oxygen therapy by evaluating availability of functional equipment, as well as healthcare workers’ self-reported experience with oxygen saturation monitoring and oxygen administration. Methods A cross-sectional study assessed public hospitals in Rwanda, between October to December 2022. The ratio of available oxygen equipment was calculated relative to need, based on patient bed counts within wards, categorized by acuity based on estimated oxygen requirements. Additionally, healthcare workers completed a self-administered survey on their experience with pulse oximetry and oxygen therapy. Results In Rwandan public hospitals, 75.6% (28/37, CI 95% 58.6–87.6%) were found to have sufficient medical oxygen therapy delivery points relative to their inpatient needs. Most, 89.2% (33/37), had piping infrastructure to safely deliver oxygen to the patient bedside. However, only 21.6% (8/37, CI 95% 10.8–38.5%) had sufficient functional pulse oximeter devices, used to detect hypoxemia. Ward specific analyses revealed differences in the distribution of equipment and infrastructures; of high-acute wards, 70.0% (7/10) Intensive Care Units had sufficient pulse oximeter devices, whilst only 40.0% (4/10) had sufficient oxygen delivery points. Whereas in medium-acute wards, 53.1% (17/32) neonatology wards met the recommended number of pulse oximeters, and 87.5% (28/32) had sufficient delivery points. Over half of healthcare workers reported only basic awareness of using pulse oximetry and providing oxygen therapy. Conclusions While Rwanda’s public hospitals demonstrate strong capacity in oxygen delivery, significant gaps in pulse oximetry and healthcare worker experience limit their full readiness to manage hypoxemia. This highlighted critical needs to strengthen capacity through increased equipment availability and healthcare worker experience, in order to deliver excellent hypoxemia management to all patients in need.