TY - JOUR
T1 - Bubble CPAP and oxygen for child pneumonia care in Malawi
T2 - A CPAP IMPACT time motion study
AU - Sessions, Kristen L.
AU - Mvalo, Tisungane
AU - Kondowe, Davie
AU - Makonokaya, Donnie
AU - Hosseinipour, Mina C.
AU - Chalira, Alfred
AU - Lufesi, Norman
AU - Eckerle, Michelle
AU - Smith, Andrew G.
AU - McCollum, Eric D.
N1 - Funding Information:
KS received funding for this work through a Doris Duke Charitable Foundation grant (2016177) supporting the Doris Duke International Clinical Research Fellows Program at the University of North Carolina Chapel Hill. CPAP IMPACT is supported in part by a grant from the Bill and Melinda Gates Foundation (OPP1123419), a CIPHER grant from the International AIDS Society (141022), supported by founding sponsor ViiV Healthcare, and Health Empowering Humanity. The views expressed in this manuscript do not necessarily reflect the official policies of the International AIDS Society or ViiV Healthcare. The funders did not have a role in study design and collection, analysis, interpretation of the data and the writing of the manuscript.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/7/31
Y1 - 2019/7/31
N2 - Background: In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial). Methods: Eligible participants were 1-59 months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm. Results: Overall, bCPAP required an average of 34.71 min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18 min (standard deviation (SD) 42.73 min); oxygen, 83.47 min (SD, 20.18 min), p < 0.01). During initiation, HCWs spent, on average, 12.45 min longer per patient setting up bCPAP equipment (p < 0.01) and 11.13 min longer per patient setting up the bCPAP nasal interface (p < 0.01), compared to oxygen equipment and nasal cannula set-up. During maintenance care, HCWs spent longer on average per patient adjusting bCPAP, compared to oxygen equipment (bCPAP 4.57 min (SD, 4.78 min); oxygen, 1.52 min (SD, 2.50 min), p = 0.03). Conclusion: Effective bCPAP implementation in low-resource settings will likely create additional HCW burden relative to usual pneumonia care with oxygen.
AB - Background: In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial). Methods: Eligible participants were 1-59 months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm. Results: Overall, bCPAP required an average of 34.71 min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18 min (standard deviation (SD) 42.73 min); oxygen, 83.47 min (SD, 20.18 min), p < 0.01). During initiation, HCWs spent, on average, 12.45 min longer per patient setting up bCPAP equipment (p < 0.01) and 11.13 min longer per patient setting up the bCPAP nasal interface (p < 0.01), compared to oxygen equipment and nasal cannula set-up. During maintenance care, HCWs spent longer on average per patient adjusting bCPAP, compared to oxygen equipment (bCPAP 4.57 min (SD, 4.78 min); oxygen, 1.52 min (SD, 2.50 min), p = 0.03). Conclusion: Effective bCPAP implementation in low-resource settings will likely create additional HCW burden relative to usual pneumonia care with oxygen.
KW - Bubble continuous positive airway pressure
KW - Child pneumonia
KW - Oxygen
KW - Sub-Saharan Africa
KW - Time motion study
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U2 - 10.1186/s12913-019-4364-y
DO - 10.1186/s12913-019-4364-y
M3 - Article
C2 - 31366394
AN - SCOPUS:85070921292
SN - 1472-6963
VL - 19
JO - BMC health services research
JF - BMC health services research
IS - 1
M1 - 533
ER -