title: Meeting oxygen needs in Africa: an options analysis from the Gambia.
abstract: OBJECTIVE
  To compare oxygen supply options for health facilities in the Gambia and develop a decision-making algorithm for choosing oxygen delivery systems in Africa and the rest of the developing world.
  
  
  METHODS
  Oxygen cylinders and concentrators were compared in terms of functionality and cost. Interviews with key informants using locally developed and adapted WHO instruments, operational assessments, cost-modelling and cost measurements were undertaken to determine whether oxygen cylinders or concentrators were the better choice. An algorithm and a software tool to guide the choice of oxygen delivery system were constructed.
  
  
  RESULTS
  In the Gambia, oxygen concentrators have significant advantages compared to cylinders where power is reliable; in other settings, cylinders are preferable as long as transporting them is feasible. Cylinder costs are greatly influenced by leakage, which is common, whereas concentrator costs are affected by the cost of power far more than by capital costs. Only two of 12 facilities in the Gambia were found suitable for concentrators; at the remaining 10 facilities, cylinders were the better option.
  
  
  CONCLUSIONS
  Neither concentrators nor cylinders are well suited to every situation, but a simple options assessment can determine which is better in each setting. Nationally this would result in improved supply and lower costs by comparison with conventional cylinders alone, although ensuring a reliable supply would remain a challenge. The decision algorithm and software tool designed for the Gambia could be applied in other developing countries.
authors.affiliation: Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, Gambia. showie@mrc.gm
authors.forename: Stephen R C
authors.initials: SR
authors.lastname: Howie
authors.forename: Sarah
authors.initials: S
authors.lastname: Hill
authors.forename: Augustine
authors.initials: A
authors.lastname: Ebonyi
authors.forename: Gautam
authors.initials: G
authors.lastname: Krishnan
authors.forename: Ousman
authors.initials: O
authors.lastname: Njie
authors.forename: Momodou
authors.initials: M
authors.lastname: Sanneh
authors.forename: Mariatou
authors.initials: M
authors.lastname: Jallow
authors.forename: Warren
authors.initials: W
authors.lastname: Stevens
authors.forename: Kevin
authors.initials: K
authors.lastname: Taylor
authors.forename: Martin W
authors.initials: MW
authors.lastname: Weber
authors.forename: Pamela Collier
authors.initials: PC
authors.lastname: Njai
authors.forename: Mary
authors.initials: M
authors.lastname: Tapgun
authors.forename: Tumani
authors.initials: T
authors.lastname: Corrah
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.forename: David
authors.initials: D
authors.lastname: Peel
authors.forename: Malick
authors.initials: M
authors.lastname: Njie
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hill
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
mesh_terms: D000349:Africa; D000465:Algorithms; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D005714:Gambia; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D010101:Oxygen Consumption; D010102:Oxygen Inhalation Therapy / Q000191:economics / Q000706:statistics & numerical data*; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years