Evidence map›Paper›PMID 33067311›Full record

Trial reportArchives of disease in childhood2021

Solar-powered oxygen, quality improvement and child pneumonia deaths: a large-scale effectiveness study.

Trevor Duke, Francis Pulsan, Doreen Panauwe, Ilomo Hwaihwanje, Martin Sa'avu, Magdalynn Kaupa, Jonah Karubi, Eleanor Neal, Hamish Graham, Rasa Izadnegahdar and 1 more

Open access · hybridAbstract readClinical TrialComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Archives of disease in childhood, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 4 pooled it
3.9field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 30 citations in OpenAlex.

  1. Pooled it
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  5. Trial
  6. Assessing the impacts of sufficient and reliable electricity in low-resource healthcare facilities.Proceedings of the National Academy of Sciences of the United States of America · 2026
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  15. Systematic review of economic evaluations for paediatric pulmonary diseases.Cost effectiveness and resource allocation : C/E · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 8 institutions in 3 countries.

Trevor DukeIntensive Care Unit, and Centre for International Child Health, Department of Paediatrics, University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia trevor.duke@rch.org.au.ORCID 0000-0003-4637-1416
Francis PulsanDiscipline of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
Doreen PanauweDepartment of Paediatrics, Wabag General Hospital, Wabag, Enga Province, Papua New Guinea.
Ilomo HwaihwanjeDepartment of Paediatrics, Goroka General Hospital, Goroka, Eastern Highlands Province, Papua New Guinea.
Martin Sa'avuDepartment of Paediatrics, Mendi General Hospital, Mendi, Southern Highlands, Papua New Guinea.
Magdalynn KaupaDepartment of Paediatrics, Mt Hagen General Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea.
Jonah KarubiDepartment of Paediatrics, Mt Hagen General Hospital, Mt Hagen, Western Highlands Province, Papua New Guinea.
Eleanor NealInfection and Immunity, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Hamish GrahamInfection and Immunity, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.ORCID 0000-0003-2461-0463
Rasa IzadnegahdarBill and Melinda Gates Foundation, Seattle, Washington, USA.
Susan DonathClinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Mount Hagen Provincial Hospital · PGMurdoch Children's Research Institute · AUGates Foundation · USGoroka Base Hospital · PGPort Moresby General Hospital · PGRoyal Children's Hospital · AUThe University of Melbourne · AUUniversity of Papua New Guinea · PG

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPneumonia is the largest cause of child deaths in low-income countries. Lack of availability of oxygen in small rural hospitals results in avoidable deaths and unnecessary and unsafe referrals.

methodWe evaluated a programme for improving reliable oxygen therapy using oxygen concentrators, pulse oximeters and sustainable solar power in 38 remote health facilities in nine provinces in Papua New Guinea. The programme included a quality improvement approach with training, identification of gaps, problem solving and corrective measures. Admissions and deaths from pneumonia and overall paediatric admissions, deaths and referrals were recorded using routine health information data for 2-4 years prior to the intervention and 2-4 years after. Using Poisson regression we calculated incidence rates (IRs) preintervention and postintervention, and incidence rate ratios (IRR).

resultsThere were 18 933 pneumonia admissions and 530 pneumonia deaths. Pneumonia admission numbers were significantly lower in the postintervention era than in the preintervention era. The IRs for pneumonia deaths preintervention and postintervention were 2.83 (1.98-4.06) and 1.17 (0.48-1.86) per 100 pneumonia admissions: the IRR for pneumonia deaths was 0.41 (0.24-0.71, p<0.005). There were 58 324 paediatric admissions and 2259 paediatric deaths. The IR for child deaths preintervention and postintervention were 3.22 (2.42-4.28) and 1.94 (1.23-2.65) per 100 paediatric admissions: IRR 0.60 (0.45-0.81, p<0.005). In the years postintervention period, an estimated 348 lives were saved, at a cost of US$6435 per life saved and over 1500 referrals were avoided.

conclusionsSolar-powered oxygen systems supported by continuous quality improvement can be achieved at large scale in rural and remote hospitals and health care facilities, and was associated with reduced child deaths and reduced referrals. Variability of effectiveness in different contexts calls for strengthening of quality improvement in rural health facilities. TRIAL REGISTRATION NUMBER: ACTRN12616001469404.

Indexed as

AdolescentChildChild, PreschoolCost-Benefit AnalysisDeveloping CountriesHealth FacilitiesHospitalizationHospitals, RuralHumansIncidenceInfantInfant, NewbornMortalityOximetryOxygenOxygen Inhalation TherapyOxygenhealth services researchmortality

Identifiers

PMID33067311
PMCPMC7907560
OpenAlexW3092937810

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.