Bubble CPAP and oxygen for child pneumonia care in Malawi

a CPAP IMPACT time motion study

Kristen L. Sessions, Tisungane Mvalo, Davie Kondowe, Donnie Makonokaya, Mina C. Hosseinipour, Alfred Chalira, Norman Lufesi, Michelle Eckerle, Andrew G. Smith, Eric McCollum

Research output: Contribution to journalArticle

Abstract

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. TRIAL REGISTRATION: Clinicaltrials.gov NCT02484183 , June 29, 2015.

Original languageEnglish (US)
Number of pages1
JournalBMC health services research
Volume19
Issue number1
DOIs
StatePublished - Jul 31 2019

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Malawi
Continuous Positive Airway Pressure
Time and Motion Studies
Child Care
Pneumonia
Oxygen
Mortality
Delivery of Health Care
Nose
Equipment and Supplies
Maintenance
District Hospitals
Malnutrition
HIV Infections
Observation
HIV

Keywords

  • Bubble continuous positive airway pressure
  • Child pneumonia
  • Oxygen
  • Sub-Saharan Africa
  • Time motion study

ASJC Scopus subject areas

  • Health Policy

Cite this

Bubble CPAP and oxygen for child pneumonia care in Malawi : a CPAP IMPACT time motion study. / Sessions, Kristen L.; Mvalo, Tisungane; Kondowe, Davie; Makonokaya, Donnie; Hosseinipour, Mina C.; Chalira, Alfred; Lufesi, Norman; Eckerle, Michelle; Smith, Andrew G.; McCollum, Eric.

In: BMC health services research, Vol. 19, No. 1, 31.07.2019.

Research output: Contribution to journalArticle

Sessions, KL, Mvalo, T, Kondowe, D, Makonokaya, D, Hosseinipour, MC, Chalira, A, Lufesi, N, Eckerle, M, Smith, AG & McCollum, E 2019, 'Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study', BMC health services research, vol. 19, no. 1. https://doi.org/10.1186/s12913-019-4364-y
Sessions, Kristen L. ; Mvalo, Tisungane ; Kondowe, Davie ; Makonokaya, Donnie ; Hosseinipour, Mina C. ; Chalira, Alfred ; Lufesi, Norman ; Eckerle, Michelle ; Smith, Andrew G. ; McCollum, Eric. / Bubble CPAP and oxygen for child pneumonia care in Malawi : a CPAP IMPACT time motion study. In: BMC health services research. 2019 ; Vol. 19, No. 1.
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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

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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. TRIAL REGISTRATION: Clinicaltrials.gov NCT02484183 , June 29, 2015.

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. TRIAL REGISTRATION: Clinicaltrials.gov NCT02484183 , June 29, 2015.

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