Oxygen therapy for newborn, child, and maternal health

Pneumonia remains the leading infectious cause of child mortality worldwide, responsible for an estimated 15 percent of all deaths of children under age five. Pneumonia, preterm birth complications, and intrapartum-related complications collectively contribute to 45 percent of global under-five mortality, with the vast majority of these deaths occurring in areas with limited access to lifesaving treatment and prevention.

Notable progress has been made in fighting childhood pneumonia, with mortality falling by 47 percent between 2000 and 2015. However, gains remain uneven across countries, with much of the progress occurring outside of the high-burden areas that account for more than half of all child pneumonia deaths.

Impact of oxygen

Hypoxemia, or low levels of oxygen in the blood, is a lifethreatening condition that contributes to morbidity and mortality associated with newborn and pediatric respiratory diseases. Hypoxemia is a fatal complication of pneumonia that increases the risk of mortality fivefold for sick children in low- and middle-income countries (LMICs).

Oxygen is an essential treatment for hypoxemia, which requires early detection and monitoring with pulse oximetry for safe provision. Hypoxemia often goes undiagnosed, and many deaths occur when monitoring is infrequent or absent. Improving access to oxygen and pulse oximetry has demonstrated a 35 percent reduction in the risk of childhood pneumonia death in certain high-burden settings.

Adequate tools and regular training are essential to providing safe oxygen. Such tools include:

• Pulse oximetry: critical for diagnosing hypoxemia and monitoring oxygen saturation to prevent toxicity.
• Sources of oxygen: including concentrators, cylinders, or pipelines, provide the most consistent and cost-effective supply of oxygen in health facilities.
• Devices for respiratory support: including continuous positive airway pressure (CPAP), mechanical ventilators, and self-inflating bags, recommended for newborns and children with severe respiratory conditions.
• Delivery methods: including airway interfaces, tubing, flowmeters, humidifiers, and blenders, used to deliver oxygen to the patient.

The challenge

Historically, oxygen was included on the World Health Organization (WHO) Model List of Essential Medicines (EML), but listed only under “anesthetics” with no specification for use as a treatment for hypoxemia. Lack of such global endorsement and normative guidance serves to limit the use of oxygen therapy, which remains inaccessible to a large proportion of patients admitted to health facilities in LMICs.

Furthermore, when oxygen technologies are available, their use is often complicated by inadequate maintenance, missing equipment, or lack of proper staff training on safe use and/or treatment guidelines. As a result, newborns, children, and pregnant women in need of oxygen often do not receive it or receive it unsafely, creating a serious barrier to improving health outcomes, and putting particularly vulnerable patients at risk.

Reliable provision of oxygen therapy and accurate identification of hypoxemia is essential in reducing mortality. Identifying barriers to access and ensuring inclusion of oxygen and pulse oximetry in current normative policies, treatment guidelines, health budgeting, and system infrastructure (e.g. maintenance and supply chain management) are key to improving oxygen availability.

Increasing access to oxygen through normative policy change

PATH is implementing a comprehensive approach to increase access to oxygen in low- and middle-income countries, including supporting normative policy change by the World Health Organization (WHO), helping strengthen markets for oxygen concentrators and pulse oximeters, raising awareness about the importance of oxygen through its HO2PE: Oxygen Gives Life campaign, partnering with the United for Oxygen alliance, and developing a suite of evidence-based materials to help advocates and policymakers drive change at the national level.