Solar-powered oxygen efficacious and cost-effective option for supplying oxygen in low resource settings, reports study
In low-income and middle-income countries (LMICs), Supplemental O2 is not always available at health facilities. Solar-powered O2 delivery can overcome gaps in O2 access, generating O2 independent of grid electricity.
According to a recent study published in the Lancet, solar-powered oxygen is an effective and cost-efficient solution for providing oxygen in low—and middle-income countries where access to supplemental oxygen is not commonly available.
Researchers in the present study hypothesized that installing solar-powered O2 systems in the paediatrics ward of rural Ugandan hospitals would reduce mortality among hypoxaemic children.
In this nationwide, stepped-wedge, cluster RCT solar-powered O2 systems (i.e., photovoltaic cells, battery bank, and O2 concentrator) were sequentially installed at twenty rural health facilities in Uganda. The sites were chosen based on specific criteria, including being a District Hospital or Health Centre IV with pediatric inpatient services, having unavailable or unreliable supplemental O2 on the pediatric ward, and having enough space to install solar panels, a battery bank, and electrical wiring.
Allocation concealment was achieved for sites up to two weeks before installation, but the study was not masked overall. The trial included children under the age of five who were admitted to the hospital with hypoxemia and respiratory signs. The primary outcome measure was mortality within forty-eight hours of the hypoxemia detection. The statistical analysis utilized a linear mixed effects logistic regression model, accounting for the cluster as a random effect and calendar time as a fixed effect.
Key findings from the study are:
• Between June 28, 2019, and Nov 30, 2021, 2409 children were enrolled across 20 hospitals.
• After applying exclusion criteria, 2405 children were analysed.
• 964 children were enrolled before site randomisation, and 1441 were enrolled after site randomisation.
• There were 104 deaths reported, 91 of these within 48 hours of hypoxaemia detection.
• The 48 hour mortality was 49/964 children before randomisation and 42 /1440 after randomisation with an adjusted odds ratio of 0·50.
• Results were sensitive to alternative parameterisations of the secular trend.
• The relative risk reduction was 48·7%
• A number needed to treat with solar-powered O2 of 45 to save one life.
• O2 use increased from 484/964 children before randomisation to 1424/1441 children after randomisation.
• Adverse events were similar before and after randomisation and were not considered to be related to the intervention.
• The estimated cost-effectiveness was US$25 per disability-adjusted life-year saved.
Further, they said that this study assessed the impact of installing solar-powered oxygen systems in 20 rural health facilities in Uganda, including inpatient pediatric care and unreliable oxygen supplies. The study analyzed data from 2405 pediatric patients with hypoxemia and found that using solar-powered oxygen led to a 48.7% reduction in mortality rate. The cost-effectiveness was estimated to be $25 per disability-adjusted life-year saved. The authors suggest that solar-powered oxygen is a practical and cost-effective solution for providing oxygen in low- and middle-income countries where it is not readily available.
Grand Challenges Canada and The Women and Children's Health Research Institute funded the study.
Reference:
Conradi, N., Opoka, R. O., Mian, Q., Conroy, A. L., Hermann, L., Olaro, C., Amone, J., Nabwire, J., Lee, B. E., Saleh, A., Mandhane, P. J., Namasopo, S., & Hawkes, M. (2024). Solar-powered O2 delivery for the treatment of children with hypoxaemia in Uganda: a stepped-wedge, cluster randomised controlled trial. The Lancet, 403(10428), 756–765. https://doi.org/10.1016/s0140-6736(23)02502-3
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