Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.

<h4>Objectives</h4>To evaluate the effect of improved hospital oxygen systems on quality of care (QOC) for children with severe pneumonia, severe malaria, and diarrhoea with severe dehydration.<h4>Design</h4>Stepped-wedge cluster randomised trial (unblinded), randomised at ho...

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Autores principales:	Hamish R Graham, Jaclyn Maher, Ayobami A Bakare, Cattram D Nguyen, Adejumoke I Ayede, Oladapo B Oyewole, Amy Gray, Rasa Izadnegahdar, Trevor Duke, Adegoke G Falade
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1e176cb2e1314c7ea5f13df4430b7116
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spelling	oai:doaj.org-article:1e176cb2e1314c7ea5f13df4430b71162021-12-02T20:09:36ZOxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.1932-620310.1371/journal.pone.0254229https://doaj.org/article/1e176cb2e1314c7ea5f13df4430b71162021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254229https://doaj.org/toc/1932-6203<h4>Objectives</h4>To evaluate the effect of improved hospital oxygen systems on quality of care (QOC) for children with severe pneumonia, severe malaria, and diarrhoea with severe dehydration.<h4>Design</h4>Stepped-wedge cluster randomised trial (unblinded), randomised at hospital-level.<h4>Setting</h4>12 hospitals in south-west Nigeria.<h4>Participants</h4>7,141 children (aged 28 days to 14 years) admitted with severe pneumonia, severe malaria or diarrhoea with severe dehydration between January 2014 and October 2017.<h4>Interventions</h4>Phase 1 (pulse oximetry) introduced pulse oximetry for all admitted children. Phase 2 (full oxygen system) (i) standardised oxygen equipment package, (ii) clinical education and support, (iii) technical training and support, and (iv) infrastructure and systems support.<h4>Outcome measures</h4>We used quantitative QOC scores evaluating assessment, diagnosis, treatment, and monitoring practices against World Health Organization and Nigerian standards. We evaluated mean differences in QOC scores between study periods (baseline, oximetry, full oxygen system), using mixed-effects linear regression.<h4>Results</h4>7,141 eligible participants; 6,893 (96.5%) had adequate data for analysis. Mean paediatric QOC score (maximum 6) increased from 1.64 to 3.00 (adjusted mean difference 1.39; 95% CI 1.08-1.69, p<0.001) for severe pneumonia and 2.81 to 4.04 (aMD 1.53; 95% CI 1.23-1.83, p<0.001) for severe malaria, comparing the full intervention to baseline, but did not change for diarrhoea with severe dehydration (aMD -0.12; 95% CI -0.46-0.23, p = 0.501). After excluding practices directly related to pulse oximetry and oxygen, we found aMD 0.23 for severe pneumonia (95% CI -0.02-0.48, p = 0.072) and 0.65 for severe malaria (95% CI 0.41-0.89, p<0.001) comparing full intervention to baseline. Sub-analysis showed some improvements (and no deterioration) in care processes not directly related to oxygen or pulse oximetry.<h4>Conclusion</h4>Improvements in hospital oxygen systems were associated with higher QOC scores, attributable to better use of pulse oximetry and oxygen as well as broader improvements in clinical care, with no negative distortions in care practices.<h4>Trial registration</h4>ACTRN12617000341325.Hamish R GrahamJaclyn MaherAyobami A BakareCattram D NguyenAdejumoke I AyedeOladapo B OyewoleAmy GrayRasa IzadnegahdarTrevor DukeAdegoke G FaladePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254229 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Hamish R Graham Jaclyn Maher Ayobami A Bakare Cattram D Nguyen Adejumoke I Ayede Oladapo B Oyewole Amy Gray Rasa Izadnegahdar Trevor Duke Adegoke G Falade Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.
description	<h4>Objectives</h4>To evaluate the effect of improved hospital oxygen systems on quality of care (QOC) for children with severe pneumonia, severe malaria, and diarrhoea with severe dehydration.<h4>Design</h4>Stepped-wedge cluster randomised trial (unblinded), randomised at hospital-level.<h4>Setting</h4>12 hospitals in south-west Nigeria.<h4>Participants</h4>7,141 children (aged 28 days to 14 years) admitted with severe pneumonia, severe malaria or diarrhoea with severe dehydration between January 2014 and October 2017.<h4>Interventions</h4>Phase 1 (pulse oximetry) introduced pulse oximetry for all admitted children. Phase 2 (full oxygen system) (i) standardised oxygen equipment package, (ii) clinical education and support, (iii) technical training and support, and (iv) infrastructure and systems support.<h4>Outcome measures</h4>We used quantitative QOC scores evaluating assessment, diagnosis, treatment, and monitoring practices against World Health Organization and Nigerian standards. We evaluated mean differences in QOC scores between study periods (baseline, oximetry, full oxygen system), using mixed-effects linear regression.<h4>Results</h4>7,141 eligible participants; 6,893 (96.5%) had adequate data for analysis. Mean paediatric QOC score (maximum 6) increased from 1.64 to 3.00 (adjusted mean difference 1.39; 95% CI 1.08-1.69, p<0.001) for severe pneumonia and 2.81 to 4.04 (aMD 1.53; 95% CI 1.23-1.83, p<0.001) for severe malaria, comparing the full intervention to baseline, but did not change for diarrhoea with severe dehydration (aMD -0.12; 95% CI -0.46-0.23, p = 0.501). After excluding practices directly related to pulse oximetry and oxygen, we found aMD 0.23 for severe pneumonia (95% CI -0.02-0.48, p = 0.072) and 0.65 for severe malaria (95% CI 0.41-0.89, p<0.001) comparing full intervention to baseline. Sub-analysis showed some improvements (and no deterioration) in care processes not directly related to oxygen or pulse oximetry.<h4>Conclusion</h4>Improvements in hospital oxygen systems were associated with higher QOC scores, attributable to better use of pulse oximetry and oxygen as well as broader improvements in clinical care, with no negative distortions in care practices.<h4>Trial registration</h4>ACTRN12617000341325.
format	article
author	Hamish R Graham Jaclyn Maher Ayobami A Bakare Cattram D Nguyen Adejumoke I Ayede Oladapo B Oyewole Amy Gray Rasa Izadnegahdar Trevor Duke Adegoke G Falade
author_facet	Hamish R Graham Jaclyn Maher Ayobami A Bakare Cattram D Nguyen Adejumoke I Ayede Oladapo B Oyewole Amy Gray Rasa Izadnegahdar Trevor Duke Adegoke G Falade
author_sort	Hamish R Graham
title	Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.
title_short	Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.
title_full	Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.
title_fullStr	Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.
title_full_unstemmed	Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.
title_sort	oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: analysis of a stepped-wedge trial in nigeria.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/1e176cb2e1314c7ea5f13df4430b7116
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Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria.

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