Oxygen systems strengthening as an intervention to prevent childhood deaths due to pneumonia in low-resource settings: systematic review, meta-analysis and cost-effectiveness

Felix Lam; Angela Stegmuller; Victoria B Chou; Hamish R Graham

doi:10.1136/bmjgh-2021-007468

Oxygen systems strengthening as an intervention to prevent childhood deaths due to pneumonia in low-resource settings: systematic review, meta-analysis and cost-effectiveness

BMJ Glob Health. 2021 Dec;6(12):e007468. doi: 10.1136/bmjgh-2021-007468.

Authors

Felix Lam¹, Angela Stegmuller², Victoria B Chou², Hamish R Graham^{3

4}

Affiliations

¹ Clinton Health Access Initiative, Boston, Massachusetts, USA flam@clintonhealthaccess.org.
² International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
³ Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Victoria, Australia.
⁴ Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.

Abstract

Objectives: Increasing access to oxygen services may improve outcomes among children with pneumonia living in low-resource settings. We conducted a systematic review to estimate the impact and cost-effectiveness of strengthening oxygen services in low-income and middle-income countries with the objective of including oxygen as an intervention in the Lives Saved Tool.

Design: We searched EMBASE and PubMed on 31 March 2021 using keywords and MeSH terms related to 'oxygen', 'pneumonia' and 'child' without restrictions on language or date. The risk of bias was assessed for all included studies using the quality assessment tool for quantitative studies, and we assessed the overall certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluations. Meta-analysis methods using random effects with inverse-variance weights was used to calculate a pooled OR and 95% CIs. Programme cost data were extracted from full study reports and correspondence with study authors, and we estimated cost-effectiveness in US dollar per disability-adjusted life-year (DALY) averted.

Results: Our search identified 665 studies. Four studies were included in the review involving 75 hospitals and 34 485 study participants. We calculated a pooled OR of 0.52 (95% CI 0.39 to 0.70) in favour of oxygen systems reducing childhood pneumonia mortality. The median cost-effectiveness of oxygen systems strengthening was $US62 per DALY averted (range: US$44-US$225). We graded the risk of bias as moderate and the overall certainty of the evidence as low due to the non-randomised design of the studies.

Conclusion: Our findings suggest that strengthening oxygen systems is likely to reduce hospital-based pneumonia mortality and may be cost-effective in low-resource settings. Additional implementation trials using more rigorous designs are needed to strengthen the certainty in the effect estimate.

Keywords: child health; health economics; pneumonia; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Child
Cost-Benefit Analysis
Humans
Oxygen*
Pneumonia* / prevention & control

Substances

Oxygen