Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi.
OBJECTIVE
Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, yet oxygen was not available in most paediatric wards in Malawi.


METHODS
The Child Lung Health Programme in Malawi made oxygen available by supplying oxygen concentrators and essential supplies to 22 district and 3 regional hospitals' paediatric wards. Five key steps were taken to introduce concentrators: (1) develop a curriculum and training materials; (2) train staff on use and maintenance; (3) retrain electromedical departments on maintenance and repair; (4) conduct training once concentrators arrived in the country; and (5) distribute concentrators once staff had been trained.


METHODS
The paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in Malawi.


RESULTS
Main changes were: (1) provision of a source of oxygen in every paediatric ward in all district hospitals; (2) training of electrical engineering and health personnel in the use, maintenance and repair of oxygen concentrators; and (3) setting-up of high-dependency rooms or areas for severely ill children where oxygen is administered.


CONCLUSIONS
It is feasible to implement an oxygen system using concentrators throughout a low-income country. Oxygen delivery requires trained staff with necessary equipment and supplies. Regular maintenance and supervision are essential to ensure optimal utilization.
International Union Against Tuberculosis and Lung Disease, Paris, France. penarson@iuatld.org
Penny
P
Enarson
Sophie
S
La Vincente
Robert
R
Gie
Ellubey
E
Maganga
Codewell
C
Chokani
D002648:Child; D006297:Health Services Accessibility / Q000458:organization & administration; D006767:Hospitals, District; D006776:Hospitals, Pediatric; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007318:Inservice Training; D008295:Malawi; D010102:Oxygen Inhalation Therapy / Q000191:economics* / Q000295:instrumentation; D010372:Pediatrics; D011014:Pneumonia / Q000150:complications / Q000628:therapy*; D013192:Staff Development / Q000458:organization & administration; D013222:State Medicine