https://orcid.org/0000-0002-4691-492X
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ABSTRACT
Access to therapeutic oxygen in low-resource settings remains a significant global problem. Solar powered oxygen (SPO2) delivery is a reliable and cost-effective solution. We followed implementation research methodology to gather data on engineering parameters (remote monitoring), nurse training (before and after knowledge questionnaire), patients treated with SPO2 (descriptive case series), and qualitative user feedback (focus group discussions). In January 2021, SPO2 was installed at Hanano General Hospital in Dusamareb, Galmudug State, Somalia, in a conflict-affected region. Daily photovoltaic cell output (median 8.0 kWh, interquartile range (IQR) 2.6–14) exceeded the electrical load from up to three oxygen concentrators (median 5.0 kWh, IQR 0.90–12). Over the first six months after implementation, 114 patients (age 1 day to 89 years, 54% female) were treated for hypoxaemic illnesses, including COVID-19, pneumonia, neonatal asphyxia, asthma, and trauma. Qualitative end user feedback highlighted SPO2 acceptability. Violent conflict was identified as a contextual factor affecting local oxygen needs. We provide the preliminary findings of this implementation research study and describe the feasibility, fidelity, rapid adoption, usefulness, and acceptability of SPO2 in a low-resource setting characterized by violent conflict during the COVID-19 pandemic. Our findings demonstrated the lifesaving feasibility of SPO2 in volatile settings.
Data availability statement
Data are available upon request to the corresponding author.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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Notes on contributors
Qaasim Mian
Qaasim Mian, MD MBA, is a senior pediatric resident at the University of Alberta. He is a Masters of Public Health candidate at Johns Hopkins Bloomberg School of Public Health. His research interests are focused on underserved populations and economic evaluation of health interventions.
Sk Md Mamunur Rahman Malik
Sk Md Mamunur Rahman Malik is currently the WHO Country Representative for Somalia. A medical epidemiologist by training, he has special interest on building health systems in fragile countries including prevention and control of emerging infectious diseases outbreaks. Planning, designing and operationalizing resilient health systems for health security and developing essential public health functions for health security are his key competencies and skills.
Mohamed Adam Alinor
Mohamed Adam Alinor is a Medical Doctor (MD) and Master of Biostatistics and Epidemiology, works at World Health Organization (WHO) Somalia since 2018 as Public health officer. He completed his undergraduate degree at Benadir University and MS degree at Kesmonds International University. He played a role in response for COVID19 outbreak and gave a huge technical support for GMoH. Mr Adam represents WHO in Galmudug State, also is the Chair of GLM subnational monthly Health Cluster meetings.
Md Shajib Hossain
Shajib Hossain is currently serving as Planning Officer in the WHO Somalia country office. He holds a MBBS degree and an MPH with a focus on applied health economics and primary health care. He comes with a vast experience and background of working in fragile contexts during health and humanitarian emergencies.
Jitendar Kumar Sharma
Jitendar Kumar Sharma heads the Healthcare Technology Division at National Health Systems Resource Center, a technical support institution under Ministry of Health & Family Welfare. Since October 2015, he is also Advisor to the government of Andra Pradesh for Health and Medical Technology.
Osman Moallim Hassan
Osman Moallim Hassan is a dedicated and enthusiastic development professional and policy adviser with over thirteen years of experience in community development and the education sector in the United Kingdom and Somalia. Proficient in ensuring on-time deliverables by making sure effective strategic coordination between various stakeholders, He is results-oriented, dependable and flexible professional.
Abdiwali Mohamed Ahmed
Abdiwali Mohamed Ahmed is Medical Doctor, public health expert and Director General (DG) of Galmudug Ministry of Health for the last 5 Years, with a background in working across local, national, government and international NGOs. Dr. Abdiwali is graduate of Medical University with MBBS and Master of Public Health.
Abdiweli Abdullahi Jama
Abdiweli Abdullahi Jama was born October 15th, 1982. A Doctor of Pharmacy and politician. He is a graduate of Doctor of Pharmacy from the University of Karachi, Karachi, Pakistan. He is now persuing an MBA in healthcare management and administration. He was appointed as the Minister of Health in the President Ahmed Abdi Karie administration in April 2020. Prior to his appointment as the Hon. Minister of Health, Dr. Abdiweli Jama served at various times as public health coordinator in several Organizations from November 2010 to March 2016. As the Minister of the Ministry of Health of the Galmudug state of Somalia, Hon. Abdiwelli Jama is committed to implementing the principle of good governance at the Ministry and tries to ensure that all the people living in any part of Galmudug receive quality health services in the light of health principles and national values without any discrimination.
Andrew J. Okello
Andrew J. Okello is a Physician, the Director of the Centre for International Programs and Linkages at Somali International University in Somalia, and a Research Fellow at The Jassa Centre -a research foundation in Nairobi, Kenya. Andrew has worked with Healthcare and Higher Education institutions in Somalia for the last eight years. His work focuses mainly on Health System Improvement, Partnerships and Internationalization in Healthcare and Higher Education, and the Epidemiology of Non-Communicable Diseases. He also works mainly in Kenya and Uganda.
Sophie Namasopo
Sophie Namasopo holds a Master’s of Medicine in Paediatrics and Child Health and a Master’s of Public Health from Makerere University, Postgraduate Diploma in Public Administration and Management of Uganda management institute, an AFYABORA fellow currently an MBA candidate. She is a Hospital Director and Consultant Paediatrician involved and interested in public health delivery, policy implementation, program management, research, reproductive health, maternal, adolescent, newborn and child health, nutrition, paediatric infectious diseases, emergencies, global health, advocacy and leadership. At Kabale Hospital, Dr Namasopo established the Neonatal unit and revitalized 5S/KAIZEN(CQI)/TQM which improved health service delivery and sustained first position for four years. At Jinja Hospital established paediatric HIV clinic, Neonatal unit, EID Care point for follow up of HIV exposed infants and Nutrition unit with demonstration garden. Dr. Namasopo supported China Uganda Friendship Hospital-Naguru to establish the Department of Paediatrics. She has been involved in novel research of using Solar Powered Oxygen delivery to children requiring oxygen in Uganda and Somalia. She worked Ministry of Health and partners including UNICEF, WHO, USAID and PEPFAR funded organizations to improve health service delivery. She is involved in research on Malaria and severe anaemia in children.
Robert O. Opoka
Robert O. Opoka is a clinician, researcher and an epidemiologist presently faculty (Senior Lecturer) at the College of Health Sciences, Makerere University, Kampala, Uganda. He heads the Emergency Unit of Mulago National Referral and Teaching hospital, Uganda and also holds an appointment at the Division of Global Pediatrics, at Indiana University as an Adjunct Assistant Professor. He is also the Executive Director of Global Health Uganda, a not for profit grants management unit in Uganda. In the past twenty years he has been a key investigator on several NIH funded grants, focusing on promotion of child health in resource-limited communities. His clinical area of interest is tropical infectious diseases (especially malaria, pneumonia, and acute malnutrition) and anemia.
Nicholas Conradi
Nicholas Conradi is currently a medical resident in General Pediatrics at the University of Alberta, with an interest in complex care and global health. He is pursuing a PhD through the University’s Department of Pediatrics, researching the mortality benefit of a solar-powered oxygen delivery system being implemented across low-resource settings in north-east Africa. Ultimately, Dr. Conradi plans to marry his interest in clinical practice and research through the Clinical Investigators Program, a speciality training scheme through the Royal College of Physicians and Surgeons of Canada. Previously, Nick has also completed a Master’s of Public Health at King’s College London and worked as a management consultant within KPMG’s Healthcare Strategy & Operations division. Leveraging his diverse background, Dr. Conradi works to fuse clinical practice, research, and managerial acumen in an effort to design and implement impactful healthcare strategies.
Abdullah Saleh
Abdullah Saleh is a skilled pediatric general surgeon proficient in open and laparoscopic/thoracoscopic techniques in paediatric and adult patient populations. He has established and managed five non-profit organizations in innovation and social change in low- and middle-income countries (LMICs) He has received grants from academic and venture capital investors in support of international development portfolio. He has co-founded two technology companies focusing on 3-D printing, crowdsourcing, software, design, and manufacturing solutions to address health systems challenges in LMICs. He has built partnerships between the University of Alberta’s Department of Surgery, non-profit groups, and other institutional partners; developed institutional capacity (Office of Global Surgery) in postgraduate medical training, global health research, academic exchange, and conference management.
Andrea L. Conroy
Andrea L. Conroy is an Assistant Professor at Indiana University with the Ryan White Center for Pediatric Infectious Disease and Global Health and is an affiliate Faculty member with the Indiana University Center for Global Health. Dr. Conroy is the Director of a Biomedical research laboratory in Kampala, Uganda in collaboration with investigators from Global Health Uganda and Makerere University. Dr. Conroy’s research centers on understanding the impact of infections on global women’s and children’s health. Her goal is to develop new tools to identify patients at risk of adverse clinical outcomes who may benefit from targeted therapies.
Michael T. Hawkes
Michael T. Hawkes (BEng, McGill U; MD, U of Alberta; PhD, U of Toronto; DTM&H, Peru; FRCPC, Pediatrics and Infectious Diseases; Distinguished Researcher, Stollery Science Lab) is a clinician-scientist at the University of Alberta. In addition to a clinical practice in consultant Pediatric Infectious Diseases at the Stollery Children’s Hospital, he leads a translational research program in global pediatric infections. Diseases of focus include some of the leading infectious disease killers of children in the world today: malaria, pneumonia, Ebola, and HIV. He holds peer reviewed grants (CIHR, Grand Challenges Canada, Women and Children’s Health Research Institute, Li Ka Shing Institute of Virology) that support basic science research, epidemiologic studies, and clinical trials. He operates field sites in Uganda and the Democratic Republic of Congo. He has more than 130 peer-reviewed publications, which have been cited over 3000 times in the medical literature. His research is improving outcomes in children with serious infections in some of the least developed areas of the globe.