A community-based emergency oxygen delivery model using mosques in Bangladesh: a conceptual public health systems analysis

Background Hypoxaemia is a major contributor to mortality from pneumonia, trauma, and obstetric emergencies in low- and middle-income countries (LMICs). Although hospital oxygen capacity has expanded in Bangladesh, many patients die before arrival due to prolonged pre-hospital delays, with ambulance response and transport times frequently exceeding 85–120 minutes and fewer than 15% of patients arriving by ambulance. This creates a critical “last-mile” gap in emergency oxygen access. Methods We developed a scenario-based conceptual public health systems model to assess the feasibility and potential impact of the Distributed Emergency Oxygen Network (DEON), a community-based emergency oxygen system using mosques as oxygen hubs. The model integrates Bangladesh census data on mosque density, published estimates of hypoxaemia prevalence and pre-hospital delays, UNICEF oxygen cost-effectiveness data, and WHO guidance on emergency oxygen delivery and lay responder systems. We estimated the number of patients who could receive early oxygen and potential lives saved under conservative, moderate, and high coverage scenarios. Results Bangladesh has approximately 300,000 mosques, providing near-universal geographic coverage. Scenario modelling suggests that even 1–10% participation could enable between 6,000 and 120,000 hypoxaemic patients per year to receive early oxygen during transport, potentially averting 600–24,000 deaths annually, assuming 10–20% mortality reduction from timely oxygen. Oxygen systems are highly cost-effective, with an estimated return of approximately US$21 in health gains for every US$1 invested. Conclusions A mosque-based community oxygen network represents a feasible, scalable approach to closing the pre-hospital oxygen gap in Bangladesh and similar LMIC settings. Integrating community oxygen hubs into emergency care strategies could substantially reduce avoidable deaths from hypoxaemia and should be piloted and rigorously evaluated.