Meeting Oxygen Needs in Africa: An Options Analysis from the Gambia/Repondre Aux Besoins En Oxygene En Afrique: Analyse Des Options Pour la Gambie/Atender Las Necesidades De Oxigeno En Africa: Analisis De Opciones En Gambia

Introduction Acute respiratory infection, principally pneumonia, remains the leading cause of death in young children worldwide. (1-3) Case management of pneumonia is a key component of the WHO Integrated Management of Childhood Illness strategy and is integral to the achievement of the fourth UN Millennium Development Goal: reducing under-5 mortality by two-thirds by 2015. (4) WHO guidelines for the management of pneumonia include antibiotic therapy, appropriate use of oxygen and general supportive care. Oxygen is needed to treat hypoxaemia, a life-threatening feature of very severe pneumonia resulting from impaired lung function. Medical oxygen, which is potentially life-saving, is in limited supply in the developing world, although the extent and nature of the problem are not well documented. (5) A situational analysis has shown that in the Gambia most health facilities have inadequate oxygen availability and that the factors that are important for ensuring oxygen supplies differ between facilities. (6) Oxygen concentrators have been proposed as an answer to the high cost and logistical problems associated with oxygen cylinders, the traditional method of supply. (7) However, there is a risk that the technology might be misapplied, compromising care. (8) The suitability of concentrators for the developing world is still in question, and a realistic appraisal of the role of concentrators in different contexts is needed, along with user-friendly guidance to assist decision-making. In this report, we analyse the options available, suggest a decision-making algorithm and present a software tool we have produced to analyse options and costs in a range of different contexts. Methods A health needs assessment framework was used to define issues that surround oxygen treatment in the Gambia and the options for improving it. (9-11) In this study we evaluated the two supply options, cylinders and concentrators, in terms of their cost, how well they work and their sustainability. Functionality assessment We first analysed the functionality of cylinders and concentrators. Data were collected in 2004-2007 and analysed in 2005-2008. We used semi-structured interviews with two instruments: the first was developed by one of the authors (SEH) specifically for a case study of failed oxygen concentrators in the Gambia, (6) and the other was adapted and validated by one of the authors (SEH) for a local study of oxygen use (8) from a WHO health facility assessment tool. Interviews were undertaken throughout the Gambia with health-care staff, administrators, policy-makers and others with relevant knowledge. Details of the instruments, interviewees and other aspects of methods used are described elsewhere. (6,8) In addition, we collated the international operational experience of our multi-disciplinary team of investigators, assessed the operational experience gained in the Gambia so far and reviewed others' published experience. The findings of the functional assessment were incorporated along with the cost analyses described below, into a decision algorithm. Cost modelling To provide comparative costs in different contexts, we broke down and costed each option by using the ingredients approach and applied a decision-analytic model to flame the alternative components, (12,13) taking into account capital and running costs, the scale of consumption and the context. We constructed a decision algorithm to identify the most cost-effective option for a range of circumstances. These results were incorporated into an options analysis tool developed on Microsoft Access software (Microsoft Corporation, Redmond, WA, United States of America), and the tool was applied to data from a previous situational analysis of Gambian health facilities.6 We used costs in 2007 and exchange rates of 22.66 dalasi per United States dollar (US$) and US$1.977 per United Kingdom pound on 24 December 2007. …