Feasibility and acceptability of bubble continuous positive airway pressure oxygen therapy for the treatment of childhood severe pneumonia and hypoxemia in Bangladeshi children

Mohammod Jobayer Chisti*, Trevor Duke, Ahmed Ehsanur Rahman, Tahmeed Ahmed, Shams E Arifeen, John D Clemens, Md F Uddin, Abu SMMH Rahman, Md m Rahman, Tapash K Sarker, Nazim S M Uddin, K M Shahunja, Abu SMSB Shahid, A S G Faruque, Supriya Sarkar, Md Jahurul Islam, Muhammad Shariful Islam, Md. Farhad Kabir, Kathrin M Cresswell, John NorrieAziz Sheikh, Harry Campbell, Harish Nair, Steve Cunningham

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Effective management of hypoxemia is key to reducing pneumonia deaths in children. In an intensive care setting within a tertiary hospital in Bangladesh, bubble continuous positive airway pressure (bCPAP) oxygen therapy was beneficial in reducing deaths in this population. We investigated the feasibility of introducing bCPAP in this population in non-tertiary/district hospitals in Bangladesh, to inform a future trial.
Methods: A qualitative assessment was conducted using a descriptive phenomenological approach to understand the structural and functional capacity of the non-tertiary hospitals (Institute of Child and Maternal Health and Kushtia General Hospital) for the clinical use of bCPAP. This was achieved by interviews and focus group discussions (23 nurses, 7 physicians, 14 parents). We retrospectively (12 months) and prospectively (3 months) measured the prevalence of severe pneumonia and hypoxemia in children attending the two study sites. For the feasibility phase, we enrolled 20 patients with severe pneumonia (age 2-24 months) to receive bCPAP. Safeguards were put in place to identify risk.
Results: Retrospectively whilst 747/3012 (24.8%) children had a diagnosis of severe pneumonia, no pulse oxygen saturation information was available. Of 3008 children prospectively assessed with pulse oximetry when attending the two sites, 81 (3.7%) had severe pneumonia and hypoxaemia. The main structural challenges to implementation were considered: inadequate number of pulse oximeters; lack of power generator back-up; high patient load with inadequate number of hospital staff; and inadequate and non-functioning oxygen flow meters. Functional challenges were rapid turnover of trained clinicians of the hospitals, limited post admission routine care for in-patients by hospital clinicians due to their extreme workload (particularly after official hours). The study implemented a minimum 4 hourly clinical review and provided oxygen concentrators (with back-up oxygen cylinder), and automatic power generator back-up.
20 children aged 6.7(mean) ±5.0(SD) months with severe pneumonia and hypoxemia (median SpO2 87% in room air, IQR 85,88) with cough (100%) and severe respiratory difficulties (100%) received bCPAP oxygen therapy for a median 16 hours (IQR 6,16). There were no treatment failure or deaths.
Conclusions: Low cost bCPAP oxygen therapy is feasible to implement in non-tertiary/district hospitals when additional training and resources are allocated.
Original languageEnglish
Article number04040
JournalJournal of Global Health
Publication statusPublished - 26 May 2023


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