Decentralizing Oxygen Availability and Use at Primary Care Level for Children Under-Five with Severe Pneumonia an Experience from 12 Health Centers in Ethiopia: A Pre-Post Non-Experimental Study Design

Abstract Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths in children under the age of five. Hypoxemia is a major cause of death in patients suffering from pneumonia. There is strong evidence that using pulse oximetry and having reliable oxygen sources in health care facilities can reduce deaths due to pneumonia by one-third. Despite its importance, hypoxemia is frequently overlooked in resource-constrained settings. Aside from the limited availability of pulse oximetry, evidence showed that healthcare workers did not use it as frequently to generate evidence-based decisions on the need for oxygen therapy. As a result, the goal of this study was to assess the availability of medical oxygen devices, operating manuals, guidelines, healthcare workers' knowledge, and skills in the practice of hypoxemia diagnosis and oxygen therapy in piloted health centers of Ethiopia. A pre-post non-experimental study design was employed. An interviewer-administered questionnaire was used to collect primary data and review medical record charts. A chi-square test with a statistical significance level of P<0.05 was used as a cut-off point for claiming statistical significance. Eighty-one percent of healthcare workers (HCWs) received oxygen therapy training, up from 6% at baseline. As a result of the interventions, the knowledge for example pulse oximetry uses and oxygen therapy provision, skill such as proper reading and interpretation of the reading of saturation and pulse, and practice of oxygen therapy has significantly improved among health care workers in the piloted HCs. In terms of availability of oxygen supply devices (cylinder, concentrator, and pulse oximetry) in the facilities, more than half of the facilities 7(58%) did not have any at baseline, but due to the interventions, all facilities were equipped with the oxygen devices. Given the prevalence of pneumonia and hypoxemia, a lack of access to oxygen delivery devices, as well as a lack of knowledge and skill among HCWs in the administration of oxygen therapy, may represent an important and reversible barrier to improved child survival. Therefore, scaling up clinician training, technical support, availability of oxygen devices, guidelines, manuals, strengthening maintenance schemes, and close monitoring of HCWs and health facilities is strongly advised.