Апстракт
Background: Oxygen is important for the treatment of hypoxaemia associated with pneumonia, malaria, and other medical, obstetric, and surgical conditions. Access to oxygen therapy is limited in many of the high mortality settings where it would be of most benefit.
Methods: A needs assessment of 12 non-tertiary hospitals in south-west Nigeria, assessing structural, technical and clinical barriers to the provision of safe and effective oxygen therapy.
Results: Oxygen supply was reported to be a major challenge by hospital directors. All hospitals had some access to oxygen cylinders, which were expensive and frequently ran out. Nine (75%) hospitals used oxygen concentrators, which were limited by inadequate power supply and lack of maintenance capacity. Appropriate oxygen delivery and monitoring devices (nasal prongs, catheters, pulse oximeters) were poorly available, and no hospitals had clinical guidelines pertaining to the use of oxygen for children. Oxygen was expensive to patients (median US$20/day) and to hospitals. Estimated oxygen demand is reported using both a constant mean-based estimate and adjustment for seasonal and other variability.
Conclusions: Making oxygen available to sick children and neonates in Nigerian hospitals will require: improving detection of hypoxaemia through routine use of pulse oximetry; improving access to oxygen through equipment, training, and maintenance structures; and commitment to building hospital and state structures that can sustain and expand oxygen initiatives.
Keywords: Oxygen, needs, assessment, children, non- tertiary hospital
Résumé
Contexte: L’oxygène est important pour le traitement de l’hypoxémie associée à la pneumonie, paludisme et autresconditions médicaux, obstétriques et chirurgicales. L’accès à la thérapie d’oxygène est limité dans la plupart des lieux avec tauxde mortalitéélevés où il serait le plus bénéfique.
Méthodes: Une évaluation des besoins de 12 hôpitaux non tertiaires dans le sud-ouest du Nigeria, évaluant les obstacles structurels, techniques et cliniques à la mise à disposition d’un traitement sûr et efficace de la thérapie d’oxygène.
Résultats: L’approvisionnement en oxygène a été signalé comme étant un défi majeur par les directeurs d’hôpitaux. Tous leshôpitaux avaient un accès à des bouteilles d’oxygène, qui étaient coûteux et fréquemment manquaient en oxygène. Neuf (75%) des hôpitaux utilisaient des concentrateurs d’oxygène, qui ont été limités par l’alimentation inadéquate d’électricité et le manque de capacité d’entretien. Les dispositifs appropriés de livraison et de surveillance d’oxygène (sondes nasales, cathéters, oxymètres de pouls) étaient difficilement accessibles, et pas d’hôpitaux avaient des directives cliniques relatives à l’utilisation d’oxygène pour les enfants. L’oxygène était cher aux patients (médian 20 US $/jour) et aux hôpitaux. L’estimée demanded’oxygène est signalé à la foisà l’aided’une moyenne de base constanted’estimation et ajustement saisonnière et autres variabilités.
Conclusions: Mettrel’oxygène disponible pour les enfants et nouveau-nésmalades dans les hôpitaux nigérians nécessitera à: améliorer la détection de l’hypoxémie par l’utilisation systématique de l’oxymétrie de pouls; améliorer l’accès à l’oxygène à travers l’équipement, la formation et les structures de maintenance; et l’engagement à la construction des structuresd’hôpital etd’état qui peuvent soutenir et étendre les initiatives d’oxygène.
Mots-clés: Oxygène, besoins, évaluation, enfants, hôpital non tertiaire
Correspondence: Dr. A.I. Aiyede, Department of Paediatrics, College of Medicine,University of Ibadan, Nigeria. E-mail: idayede@yahoo.co.uk
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