SynthesisBMJ global health2021
Oxygen systems strengthening as an intervention to prevent childhood deaths due to pneumonia in low-resource settings: systematic review, meta-analysis and cost-effectiveness.
Synthesis in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
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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.
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.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The prevalence of hypoxaemia in paediatric and adult patients in health-care facilities in low-income and middle-income countries: a systematic review and meta-analysis.The Lancet. Global health · 2025Pooled it
- Design and maintenance of medical oxygen concentrators in Sub-Saharan Africa: a systematic review.BMC health services research · 2025Pooled it
- Survival of hypoxaemic patients treated with solar-powered oxygen in rural Somalia hospitals: a prospective, observational study.EBioMedicine · 2026Observational
- Acute Respiratory Infections in Ghanaian Children: Epidemiology, Antimicrobial Resistance, and Prevention Strategies.Pathogens (Basel, Switzerland) · 2026Review
- A cost-consequence analysis of the children's administration oxygenation strategies trial (COAST) in severe pneumonia.PLOS global public health · 2026Article
- Pre-Hospital Pulse-Oximetry and Supplemental Oxygen Utilization in Malawi: An Exploratory Cost-Effectiveness Analysis.Pediatric pulmonology · 2025Article
- Design, implementation and outcomes of a national oxygen distribution network in Lesotho.BMJ global health · 2025Observational
- Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security.The Lancet. Global health · 2025Review
- Hypoxemia detection and oxygen therapy practices in neonatal and pediatric wards across seven district and referral hospitals in Rwanda.Frontiers in pediatrics · 2025Article
- Understanding pulse oximetry adoption in primary healthcare facilities in Nigeria: a realist process evaluation of the INSPIRING-Lagos stabilisation room project.BMJ public health · 2024Article
- Article
- Improving effective coverage of medical-oxygen services for neonates and children in health facilities in Uganda: a before-after intervention study.The Lancet. Global health · 2024Article
- Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers.JMIR human factors · 2024Article
- Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia.Journal of global health · 2024Article
- Strategies for Oxygen Ecosystems in Middle-Income Countries: A Review and Case Study from Lebanon.Emergency medicine international · 2024Review
- Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania.PharmacoEconomics - open · 2023Article
- Oxygen Inequity in the COVID-19 Pandemic and Beyond.Global health, science and practice · 2023Article
- Pathogens associated with hospitalization due to acute lower respiratory tract infections in children in rural Ghana: a case-control study.Scientific reports · 2023Article
- A Comprehensive Approach to Medical Oxygen Ecosystem Building: An Implementation Case Study in Kenya, Rwanda, and Ethiopia.Global health, science and practice · 2022Article
- Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019.The Lancet. Infectious diseases · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectivesIncreasing access to oxygen services may improve outcomes among children with pneumonia living in low-resource settings. We conducted a systematic review to estimate the impact and cost-effectiveness of strengthening oxygen services in low-income and middle-income countries with the objective of including oxygen as an intervention in the Lives Saved Tool.
designWe searched EMBASE and PubMed on 31 March 2021 using keywords and MeSH terms related to 'oxygen', 'pneumonia' and 'child' without restrictions on language or date. The risk of bias was assessed for all included studies using the quality assessment tool for quantitative studies, and we assessed the overall certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluations. Meta-analysis methods using random effects with inverse-variance weights was used to calculate a pooled OR and 95% CIs. Programme cost data were extracted from full study reports and correspondence with study authors, and we estimated cost-effectiveness in US dollar per disability-adjusted life-year (DALY) averted.
resultsOur search identified 665 studies. Four studies were included in the review involving 75 hospitals and 34 485 study participants. We calculated a pooled OR of 0.52 (95% CI 0.39 to 0.70) in favour of oxygen systems reducing childhood pneumonia mortality. The median cost-effectiveness of oxygen systems strengthening was $US62 per DALY averted (range: US$44-US$225). We graded the risk of bias as moderate and the overall certainty of the evidence as low due to the non-randomised design of the studies.
conclusionOur findings suggest that strengthening oxygen systems is likely to reduce hospital-based pneumonia mortality and may be cost-effective in low-resource settings. Additional implementation trials using more rigorous designs are needed to strengthen the certainty in the effect estimate.
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