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. 2021 Aug;6(8):e006069.
doi: 10.1136/bmjgh-2021-006069.

Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

Hamish R Graham  1   2 , Omotayo E Olojede  2 , Ayobami A Bakare  3   4 , Agnese Iuliano  5 , Oyaniyi Olatunde  2 , Adamu Isah  6 , Adams Osebi  6 , Tahlil Ahmed  7 , Obioma C Uchendu  3   8 , Rochelle Burgess  5 , Eric McCollum  9 , Tim Colbourn  5 , Carina King  5   10 , Adegoke G Falade  2   11 ; INSPIRING Project Consortium
Collaborators, Affiliations

Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

Hamish R Graham et al. BMJ Glob Health. 2021 Aug.

Abstract

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure 'oxygen access'. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.

Keywords: COVID-19; cross-sectional survey; health services research; pneumonia; treatment.

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Conflict of interest statement

Competing interests: HRG, EM and CK are advisors to the Lifebox Foundation on pulse oximetry. AAB, AGF and HRG are board members for Oxygen for Life Initiative (OLI), a private non-profit that has provided services to the INSPIRING project. SA, TA, CC and PV are employed by Save the Children UK who are part of the partnership funding the research. TFO and MM are employees of and stockholders in GSK, a multinational for-profit pharmaceutical company that produces pharmaceutical products for childhood pneumonia, including a SARS-CoV-2 vaccine, and no direct financial interests in oxygen or pulse oximeter products.

Figures

Figure 1
Figure 1
Hospital oxygen systems require key components, including people, maintenance systems, infrastructure and a range of medical devices and supplies (adapted from WHO, UNICEF5). CPAP, continuous positive airway Pressure.
Figure 2
Figure 2
Flow diagram showing selection of 58 health facilities in Lagos, Nigeria. Initial identification of facilities conducted in November 2019. We randomly assigned numbers to private facilities then screened and selected until reaching the prespecified target number for enrolment. LGA, local government area.
Figure 3
Figure 3
Three domains of data on the quality of ‘oxygen access’.
See this image and copyright information in PMC

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