Implementation of an Oxygen Concentrator System in District Hospital Paediatric Wards throughout Malawi/Mise En Oeuvre De Concentrateurs D'oxygene Dans Des Services Pediatriques Hospitaliers De District a Travers le Malawi/ Implantacion De Un Sistema De Concentradores De Oxigeno En Salas De Pediatria De Hospitales De Distrito En Malawi

By Enarson, Penny; La Vicente, Sophie et al. | Bulletin of the World Health Organization, May 2008 | Go to article overview

Implementation of an Oxygen Concentrator System in District Hospital Paediatric Wards throughout Malawi/Mise En Oeuvre De Concentrateurs D'oxygene Dans Des Services Pediatriques Hospitaliers De District a Travers le Malawi/ Implantacion De Un Sistema De Concentradores De Oxigeno En Salas De Pediatria De Hospitales De Distrito En Malawi


Enarson, Penny, La Vicente, Sophie, Gie, Robert, Maganga, Ellubey, Chokani, Codewell, Bulletin of the World Health Organization


Background

Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, increasing the risk of dying fivefold. (1,2) Hospitals throughout the developing world have very limited access to oxygen (3) and, when oxygen is available, the equipment required to deliver it is often lacking. (4,5) WHO has published technical guidelines for oxygen therapy in the management of childhood pneumonia in low-income countries, covering the indications for use, sources and equipment for the administration of oxygen. (6)

The Child Lung Health Programme (CLHP) is a collaborative project between the Government of Malawi, the International Union Against Tuberculosis and Lung Disease and the Bill and Melinda Gares Foundation. The CLHP has been incorporated into Malawi's existing health services and implemented by personnel carrying out existing activities for control of acute respiratory infections within the integrated management of childhood illnesses. Policies and procedures, such as oxygen therapy, were coordinated with those in existing programmes.

Specific objectives of the CLHP were: (1) introduction of standard case management for the treatment of pneumonia at district hospital level; (2) improvement of health workers' practice through training and supervision; (3) direction of resources to children most at risk of dying; (4) uninterrupted supply and rational use of antibiotics and oxygen; and (5) generation and use of health services data to improve the quality of service.

In 2000, the International Union Against Tuberculosis and Lung Disease in collaboration with its partner, the Bill and Melinda Gates Foundation, technical experts, Ministry of Health and district health officers evaluated five district hospitals in Malawi to assess the burden of disease of common childhood illnesses. The team observed the functioning of the paediatric ward, pharmacy, radiology and laboratory, reviewed the paediatric outpatient and inpatient registers for the previous 15 months and reviewed the case management of lung disease among hospitalized children. The main causes of morbidity and mortality in hospitalized children aged less than 5 years were malaria, pneumonia, diarrhoea and anaemia.

Problem

During the situation analysis it was found that oxygen was not always available in four out of five district hospital paediatric wards visited. Health workers did not know when or how to administer oxygen to children. Oxygen cylinders were only provided to central hospitals and district hospital operating rooms, as they are expensive and difficult to deliver due to poor roads.

Most of the concentrators that were available on the paediatric wards were more than 10 years old and did not meet WHO/United Nations Children's Fund (UNICEF) specifications. (7) Where newer WHO/UNICEF-recommended models were available, they did not have flow-splitters, which allow oxygen to be delivered simultaneously to up to four children. Electromedical engineers are responsible for service and repair of oxygen concentrators in all government hospitals but scheduled maintenance visits did not occur, mainly due to a lack of filters and spare parts resulting from financial constraints within the Ministry of Health. Where oxygen was available, nasal prongs and catheters were lacking. Electricity blackouts of 3 hours or more were frequent. In most hospitals the generator and back-up oxygen cylinders were available to operating theatres only.

Approach

Following the situation analysis, the CLHP budget was revised to include oxygen concentrators, appropriate spares and supplies for oxygen delivery, and training of clinical staff and electromedical engineers, which had not been included originally. Therefore it was not possible to include extra funding required to repair and maintain those concentrators not purchased by the CLHE Costs such as central level monitoring visits and travel allowances were already included within the existing budget. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Implementation of an Oxygen Concentrator System in District Hospital Paediatric Wards throughout Malawi/Mise En Oeuvre De Concentrateurs D'oxygene Dans Des Services Pediatriques Hospitaliers De District a Travers le Malawi/ Implantacion De Un Sistema De Concentradores De Oxigeno En Salas De Pediatria De Hospitales De Distrito En Malawi
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.