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CHERG - Child Epidemiology Reference Group

Oxygen Systems for Treatment of Pneumonia

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More Intervention Effect Estimate Summaries

Catto AG, Zgaga L, Theodoratou E, Huda T, Nair H, El Arifeen S, Rudan I, Duke T, and Campbell H. An evaluation of oxygen systems for treatment of childhood pneumonia.  BMC Public Health 2011 11 (Suppl 3):S28.


  • Several pathophysiological mechanisms cause death from pneumonia, but sepsis and hypoxemia are the two key mechanisms.  The prevalence of hypoxemic pneumonia amongst young children presenting at health services each year is roughly 1.5-2.7 million (1).  Although all of these children would benefit from treatment with supplemental oxygen (2), supplies are often unavailable and inappropriately utilized throughout the developing world (3-5).
  • Catto et al. summarized findings from a modified Child Health and Nutrition Research Initiative (CHNRI) process whereby a systematic literature review related to oxygen treatment systems was conducted, and the findings were presented to a group of 20 experts who then rated their degree of optimism (0-100%) on several criterion.

CHNRI Criterion

Answerability: production of an effective novel vaccine that can be fitted into the routine Expanded Programme of Immunization (EPI) schedule within 10 years.

  • Very high level of optimism (> 80%) – oxygen is a well established treatment for hypoxemic pneumonia

Low Development Cost, Product Cost and Implementation Cost

  • Very high level of optimism (100%) for development - The technology is already developed and ready for implementation without additional major development costs required.
  • Very high level of optimism (>80%) for product cost
  • High level of optimism (60%) for implementation cost

Efficacy and Effectiveness (the impact of the vaccines under ideal conditions)

  • There is a strong theoretical and experiential basis, founded on decades of beneficial experiences of oxygen therapy in clinical practices.  It is a universally accepted standard of care in the management of hypoxemia.
  • High level of optimism (78%) about the effectiveness of oxygen therapy interventions for the reduction of deaths from childhood pneumonia

Deliverability and Sustainability 

  • Moderate to high level of optimism (64%) for deliverability
  • Moderate level of optimism (54%) for sustainability – ensuring proper ongoing maintenance of the system to maintain maximal function is challenging

Disease Burden Reduction (median potential effectiveness)

  • 20% reduction (IQR: 10-35% in childhood pneumonia

Acceptability: among end-users and health workers 

  • High level of optimism (60-80%)

Equity: impact on decreasing child health inequity

  • Low to moderate level of optimism (44%)

Intervention Recommendation

  • Unlike other interventions such as antibiotics and vaccines, oxygen can be used to combat any form of hypoxemic pneumonia, regardless of its etiology.
  • It is feasible to implement and sustain an oxygen system, even in the most remote regions of the world; however, significant planning and infrastructure are required for successful implementation of oxygen systems.

References from Catto Paper Cited HereReferences from Catto Paper Cited Here

  1. Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T. The prevalence of hypoxaemia among ill children in developing countries: a systematic review. Lancet Infect Dis. 2009; 9(4):219–227.
  2. WHO. Pocket book of hospital care for children. 2005.
  3. Duke T, Keshishiyan E, Kuttumuratova A, Ostergren M, Ryumina I, Stasii E, Weber MW, Tamburlini G. Quality of hospital care for children in Kazakhstan, Republic of Moldova, and Russia: systematic observational assessment. Lancet. 2006; 367(9514):919–925.
  4. English M, Esamai F, Wasunna A, Were F, Ogutu B, Wamae A, Snow RW, Peshu N. Delivery of paediatric care at the first-referral level in Kenya. Lancet. 2004; 364(9445):1622–1629.
  5. Nolan T, Angos P, Cunha AJ, Muhe L, Qazi S, Simoes EA, Tamburlini G, Weber M, Pierce NF. Quality of hospital care for seriously ill children in less-developed countries. Lancet. 2001; 357(9250):106–110.

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