Wandi Francis, Peel David, Duke Trevor
Department of Paediatrics, Kundiawa Hospital, Simbu Province, Papua New Guinea.
Ann Trop Paediatr. 2006 Dec;26(4):277-84. doi: 10.1179/146532806X152791.
To support a national approach to oxygen systems in Papua New Guinea, we conducted a study to document the incidence of hypoxaemia, its geographical distribution, epidemiological determinants and resource availability in several regions of the country. We also established baseline mortality rate data for all children admitted to five hospitals, for children with a diagnosis of pneumonia and for neonates to evaluate a future intervention.
Data were collected prospectively from over 1300 hospital admissions in five hospitals in 2004. To establish the baseline case fatality rates, data on outcome were collected retrospectively over 3 years (2001-2003) for over 20,000 children admitted to five hospitals.
A total of 1313 admissions were studied prospectively in the five hospitals. Altogether, 384 (29.25%, 95% CI 26.8-31.8) had hypoxaemia, defined as SpO(2) <90%. The incidence of hypoxaemia was much greater in highland hospitals (40% of all admissions) than on the coast (10% of all admissions). This large difference in incidence persisted when the uniform definition of hypoxaemia was adjusted for altitude, and was largely because of differences in the incidence of acute respiratory tract infection. Oxygen was not available on the day of admission for 22% of children (range between hospitals, 3-38), including 13% of all children with hypoxaemia. Oxygen was less available in remote rural district hospitals than in provincial hospitals in regional towns. Clinical signs proposed by WHO as indicators for oxygen would have missed 29% of children with hypoxaemia and, if these clinical signs were used, 30% of children without hypoxaemia would have been considered in need of supplemental oxygen.
Based on this study, an approach to improving the detection of hypoxaemia and the availability of oxygen has been trialled in these five hospitals where a programme of clinical and technical training in the use and maintenance of pulse oximetry and oxygen concentrators has been introduced.
为支持巴布亚新几内亚全国性的氧气系统方案，我们开展了一项研究，记录该国多个地区低氧血症的发病率、地理分布、流行病学决定因素及资源可获得性。我们还建立了五家医院所有入院儿童、诊断为肺炎的儿童及新生儿的基线死亡率数据，以评估未来的干预措施。
2004年，前瞻性收集了五家医院1300多例住院病例的数据。为确定基线病死率，回顾性收集了五家医院20000多名入院儿童在3年（2001 - 2003年）期间的转归数据。
对五家医院共1313例住院病例进行了前瞻性研究。共有384例（29.25%，95%可信区间26.8 - 31.8）出现低氧血症，定义为血氧饱和度（SpO₂）<90%。高地医院低氧血症的发病率（占所有入院病例的40%）远高于沿海地区（占所有入院病例的10%）。当根据海拔对低氧血症的统一定义进行调整后，这种发病率的巨大差异依然存在，且主要是由于急性呼吸道感染发病率的差异。22%的儿童在入院当天无法获得氧气（各医院之间的范围为3% - 38%），其中包括13%的所有低氧血症儿童。偏远农村地区医院的氧气供应比地区城镇的省级医院少。世界卫生组织提议作为氧气使用指标的临床体征会漏诊29%的低氧血症儿童，而如果使用这些临床体征，30%没有低氧血症的儿童会被认为需要补充氧气。
基于这项研究，在这五家医院试行一种改善低氧血症检测及氧气可获得性的方法，其中引入了关于脉搏血氧饱和度仪和制氧机使用及维护的临床和技术培训方案。
