PLoS Medicine (Nov 2019)

Oxygen systems to improve clinical care and outcomes for children and neonates: A stepped-wedge cluster-randomised trial in Nigeria.

  • Hamish R Graham,
  • Ayobami A Bakare,
  • Adejumoke I Ayede,
  • Amy Z Gray,
  • Barbara McPake,
  • David Peel,
  • Olatayo Olatinwo,
  • Oladapo B Oyewole,
  • Eleanor F G Neal,
  • Cattram D Nguyen,
  • Shamim A Qazi,
  • Rasa Izadnegahdar,
  • John B Carlin,
  • Adegoke G Falade,
  • Trevor Duke

DOI
https://doi.org/10.1371/journal.pmed.1002951
Journal volume & issue
Vol. 16, no. 11
p. e1002951

Abstract

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BackgroundImproving oxygen systems may improve clinical outcomes for hospitalised children with acute lower respiratory infection (ALRI). This paper reports the effects of an improved oxygen system on mortality and clinical practices in 12 general, paediatric, and maternity hospitals in southwest Nigeria.Methods and findingsWe conducted an unblinded stepped-wedge cluster-randomised trial comparing three study periods: baseline (usual care), pulse oximetry introduction, and stepped introduction of a multifaceted oxygen system. We collected data from clinical records of all admitted neonates (ConclusionsWe observed no mortality benefit for children and a possible higher risk of neonatal death following the introduction of a multifaceted oxygen system compared to introducing pulse oximetry alone. Where some oxygen is available, pulse oximetry may improve oxygen usage and clinical outcomes for children with ALRI.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12617000341325.