Format

Send to

Choose Destination
Trials. 2017 Oct 27;18(1):502. doi: 10.1186/s13063-017-2241-8.

Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial.

Author information

1
Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia. Hamish.Graham@rch.org.au.
2
Department of Paediatrics, University College Hospital, Ibadan, Nigeria. Hamish.Graham@rch.org.au.
3
Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
4
Department of Paediatrics, University of Ibadan, Ibadan, Nigeria.
5
Ashdown Consultants, Hartfield, England.
6
Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia.
7
Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia.
8
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
9
Bill and Melinda Gates Foundation, Seattle, WA, USA.

Abstract

BACKGROUND:

Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity.

METHODS/DESIGN:

This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018.

DISCUSSION:

Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally.

TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.

KEYWORDS:

Child; Developing countries; Infant; Oximetry; Pneumonia; Quality improvement; Solar energy; Stepped-wedge design; Theory-based evaluation

PMID:
29078810
PMCID:
PMC5659007
DOI:
10.1186/s13063-017-2241-8
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center