Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria. Issue 8 (3rd August 2021)

• Record Type: Journal Article
• Authors: Graham, Hamish R; Olojede, Omotayo E; Bakare, Ayobami A; Iuliano, Agnese; Olatunde, Oyaniyi; Isah, Adamu; Osebi, Adams; Ahmed, Tahlil; Uchendu, Obioma C; Burgess, Rochelle; McCollum, Eric; Colbourn, Tim; King, Carina; Falade, Adegoke G
• Other Names: author non-byline.; King Carina author non-byline.; Colbourn Tim author non-byline.; Burgess Rochelle Ann author non-byline.; Iuliano Agnese author non-byline.; Graham Hamish R author non-byline.; McCollum Eric D author non-byline.; Ahmed Tahlil author non-byline.; Ahmar Samy author non-byline.; Cassar Christine author non-byline.; Valentine Paula author non-byline.; Isah Adamu author non-byline.; Osebi Adams author non-byline.; Haruna Ibrahim author non-byline.; Magama Abdullahi author non-byline.; Seriki Ibrahim author non-byline.; Olowookere Temitayo Folorunso author non-byline.; MacCalla Matt author non-byline.; Falade Adegoke G author non-byline.; Bakare Ayobami Adebayo author non-byline.; Uchendu Obioma author non-byline.; Salako Julius author non-byline.; Shittu Funmilayo author non-byline.; Bakare Damola author non-byline.; Olojede Omotayo E author non-byline.
• Is Part Of: BMJ global health. Volume 6:Issue 8(2021)
• Publication Date: 2021-08-03
• Subjects: health services research -- treatment -- cross-sectional survey -- COVID-19 -- pneumonia; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2021-006069
• Languages: English
• ISSNs: 2059-7908

Abstract

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.