Solar-Powered Oxygen Delivery in Low-Resource Settings: A Randomized Clinical Noninferiority Trial | Global Health | JAMA Pediatrics | JAMA Network
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Research Letter
July 2018

Solar-Powered Oxygen Delivery in Low-Resource Settings: A Randomized Clinical Noninferiority Trial

Author Affiliations
  • 1Department of Pediatrics, School of Public Health, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
  • 2Department of Medical Microbiology & Immunology, School of Public Health, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
  • 3Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis
  • 4Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda
  • 5Department of Diagnostic Imaging, University of Alberta, WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
  • 6Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Medical and Related Sciences Centre, Toronto, Ontario, Canada
  • 7Department of Medicine, University of Toronto, Tropical Disease Unit, University Health Network-Toronto General Hospital, Medical and Related Sciences Centre, Toronto, Ontario, Canada
  • 8Faculty of Medicine, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
  • 9Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kawempe, Kampala, Uganda
JAMA Pediatr. 2018;172(7):694-696. doi:10.1001/jamapediatrics.2018.0228

Oxygen is an essential medicine for life-threatening hypoxemic illnesses, including pneumonia, which is currently the leading cause of childhood mortality worldwide.1,2 However, oxygen is not available in many pediatric wards in low-income countries. In a survey of 12 African countries, only 44% of 231 health centers, district hospitals, and provincial or general hospitals had access to oxygen on a continuous basis.3 Pragmatic solutions are needed to improve access to oxygen in low-resource settings.

In resource-constrained settings, compressed oxygen cylinders and oxygen concentrators are commonly used. Oxygen cylinders are ready to use and do not require any electricity; however, their availability may be compromised by weak stock management, the need for transportation from supplier to hospital, and leakage from ill-fitting regulators. Oxygen concentrators generate oxygen on site from ambient air through selective adsorption of nitrogen using aluminum silicate sieve beds. Concentrators overcome the logistical supply barriers of cylinder oxygen, require minimal service and maintenance, and are more user-friendly than cylinders. However, oxygen concentrators require a continuous and reliable source of electricity. A systematic review found that only 34% of hospitals in sub-Saharan Africa have reliable access to electricity.4 Interruptions in oxygen therapy owing to power outages are therefore frequent and potentially fatal in the settings in which most deaths from pneumonia occur.4

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