Appropriate technology for managing hypoxaemia in children in remote hospitals in developing countries: description of a programme in Papua New Guinea

In Papua New Guinea (PNG) the major cause of death among children under 5 years old is pneumonia. Children with severe pneumonia need both antibiotics and oxygen but oxygen shortages are common due to the cost and complex logistics of transporting oxygen in cylinders. Detection of hypoxaemia using clinical signs can be difficult, especially in heavily pigmented children where cyanosis is difficult to detect. Pulse oximetry is the most reliable, non-invasive way of detecting hypoxaemia, however most hospitals in PNG do not have pulse oximetry. We proposed that the installation of a reliable, sufficient and cheap source of oxygen in hospitals coupled with the use of pulse oximetry would make a significant difference to child survival rates in PNG. Oxygen concentrators, which generate oxygen from ambient air, were installed in the children's wards of five rural hospitals during 2005. Pulse oximeters were also introduced to enable the better detection of hypoxaemia. This paper describes the equipment used, the basis on which this was selected, the installation, commissioning and testing processes and training for clinical and engineering staff. Such programs rely on good management at all levels. The impact of these interventions on the mortality of children is being evaluated in a prospective study. The results from this study will have implications for the treatment of childhood pneumonia and for hospitals in developing countries worldwide.