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Cost-effectiveness ...
Cost-effectiveness and sustainability of improved hospital oxygen systems in Nigeria
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Graham, HR (author)
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- Bakare, AA (author)
- Karolinska Institutet
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Ayede, AI (author)
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Eleyinmi, J (author)
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Olatunde, O (author)
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Bakare, OR (author)
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Edunwale, B (author)
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Neal, EFG (author)
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Qazi, S (author)
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McPake, B (author)
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Peel, D (author)
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Gray, AZ (author)
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Duke, T (author)
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Falade, AG (author)
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(creator_code:org_t)
- 2022-08-10
- 2022
- English.
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In: BMJ global health. - : BMJ. - 2059-7908. ; 7:8
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https://doi.org/10.1...
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Abstract
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- Improving hospital oxygen systems can improve quality of care and reduce mortality for children, but we lack data on cost-effectiveness or sustainability. This study evaluated medium-term sustainability and cost-effectiveness of the Nigeria Oxygen Implementation programme.MethodsProspective follow-up of a stepped-wedge trial involving 12 secondary-level hospitals. Cross-sectional facility assessment, clinical audit (January–March 2021), summary admission data (January 2018–December 2020), programme cost data. Intervention: pulse oximetry introduction followed by solar-powered oxygen system installation with clinical and technical training and support. Primary outcomes: (i) proportion of children screened with pulse oximetry; (ii) proportion of hypoxaemic (SpO2 <90%) children who received oxygen. Comparison across three time periods: preintervention (2014–2015), intervention (2016–2017) and follow-up (2018–2020) using mixed-effects logistic regression. Calculated cost-effectiveness of the intervention on child pneumonia mortality using programme costs, recorded deaths and estimated counterfactual deaths using effectiveness estimates from our effectiveness study. Reported cost-effectiveness over the original 2-year intervention period (2016–2017) and extrapolated over 5 years (2016–2020).ResultsPulse oximetry coverage for neonates and children remained high during follow-up (83% and 81%) compared with full oxygen system period (94% and 92%) and preintervention (3.9% and 2.9%). Oxygen coverage for hypoxaemic neonates/children was similarly high (94%/88%) compared with full oxygen system period (90%/82%). Functional oxygen sources were present in 11/12 (92%) paediatric areas and all (8/8) neonatal areas; three-quarters (15/20) of wards had a functional oximeter. Of 32 concentrators deployed, 23/32 (72%) passed technical testing and usage was high (median 10 797 hours). Estimated 5-year cost-effectiveness US$86 per patient treated, $2694–4382 per life saved and $82–125 per disability-adjusted life year-averted. We identified practical issues for hospitals and Ministries of Health wishing to adapt and scale up pulse oximetry and oxygen.ConclusionHospital-level improvements to oxygen and pulse oximetry systems in Nigerian hospitals have been sustained over the medium-term and are a highly cost-effective child pneumonia intervention.
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- By the author/editor
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Graham, HR
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Bakare, AA
-
Ayede, AI
-
Eleyinmi, J
-
Olatunde, O
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Bakare, OR
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show more...
-
Edunwale, B
-
Neal, EFG
-
Qazi, S
-
McPake, B
-
Peel, D
-
Gray, AZ
-
Duke, T
-
Falade, AG
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show less...
- Articles in the publication
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BMJ global healt ...
- By the university
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Karolinska Institutet