title: An evaluation of oxygen systems for treatment of childhood pneumonia.
abstract: BACKGROUND
  Oxygen therapy is recommended for all of the 1.5 - 2.7 million young children who consult health services with hypoxemic pneumonia each year, and the many more with other serious conditions. However, oxygen supplies are intermittent throughout the developing world. Although oxygen is well established as a treatment for hypoxemic pneumonia, quantitative evidence for its effect is lacking. This review aims to assess the utility of oxygen systems as a method for reducing childhood mortality from pneumonia.
  
  
  METHODS
  Aiming to improve priority setting methods, The Child Health and Nutrition Research Initiative (CHNRI) has developed a common framework to score competing interventions into child health. That framework involves the assessment of 12 different criteria upon which interventions can be compared. This report follows the proposed framework, using a semi-systematic literature review and the results of a structured exercise gathering opinion from experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies), to assess and score each criterion as their "collective optimism" towards each, on a scale from 0 to 100%.
  
  
  RESULTS
  A rough estimate from an analysis of the literature suggests that global strengthening of oxygen systems could save lives of up to 122,000 children from pneumonia annually. Following 12 CHNRI criteria, the experts expressed very high levels of optimism (over 80%) for answerability, low development cost and low product cost; high levels of optimism (60-80%) for low implementation cost, likelihood of efficacy, deliverability, acceptance to end users and health workers; and moderate levels of optimism (40-60%) for impact on equity, affordability and sustainability. The median estimate of potential effectiveness of oxygen systems to reduce the overall childhood pneumonia mortality was ~20% (interquartile range: 10-35%, min. 0%, max. 50%). However, problems with oxygen systems in terms of affordability, sustainability and impact on equity are noted in both expert opinion scores and on review.
  
  
  CONCLUSIONS
  Oxygen systems are likely to be an effective intervention in combating childhood mortality from pneumonia. However, a number of gaps in the evidence base exist that should be addressed to complete the investment case and research addressing these issues merit greater funding attention.
authors.affiliation: Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.
authors.forename: Alastair G
authors.initials: AG
authors.lastname: Catto
authors.forename: Lina
authors.initials: L
authors.lastname: Zgaga
authors.forename: Evropi
authors.initials: E
authors.lastname: Theodoratou
authors.forename: Tanvir
authors.initials: T
authors.lastname: Huda
authors.forename: Harish
authors.initials: H
authors.lastname: Nair
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Igor
authors.initials: I
authors.lastname: Rudan
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
mesh_terms: D002648:Child; D019317:Evidence-Based Medicine; D006801:Humans; D000860:Hypoxia / Q000401:mortality / Q000628:therapy*; D010102:Oxygen Inhalation Therapy / Q000191:economics / Q000295:instrumentation*; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome