African Journal of Respiratory Medicine received 855 citations as per google scholar report
Background: Home based oxygen therapy (HOT) is often required in children with chronic respiratory conditions. Whereas this has become a standard practice in resource rich regions of the world it remains a major challenge in sub-Saharan Africa. Benefits of HOT include shorter duration of hospital stay with both reduced nosocomial infections and health care costs. It further allows the family to be economically productive as the child recuperates at home and not in a hospital setting. There remains in Kenya a large number of children in public hospitals who require HOT but due to its cost restrictions are unable to be discharged home, and so we initiated the first private funded program in 2016 whose outcomes are yet to be evaluated. Study objectives: The objective of this study was to determine the outcomes and challenges among children discharged from the Kenyatta National Hospital on HOT. Methods: This was a hospital based retrospective cohort study carried out among 22 children aged less than 16 years from January 2016 to April 2020. A standard questionnaire was used for data collection. Data was stored and analysed in MS-EXCEL and STATA 12. Results: A total of 22 children were sequentially enrolled for this program of which 10 (45.5%) have been successfully weaned off oxygen in a home setting. The overall mortality was 8(36.4%) of which 7 (87.5%) died in hospital after readmission and 1(12.5%) died at home. In the patients who died there was no statistical differences in term of their ages, sex, underlying lung pathology, distances from hospital, housing structure types or caregiver ages as compared to those who survived. The mean duration of hospital stay prior to discharge on HOT was 112 days and the mean duration of HOT use was 117 days. Major challenges faced by the caregivers included power outages at home, delayed initiation of HOT due to inability to pay hospital bills, increased electricity costs at home and inability to pay for transport to clinic visits whilst dealing with fears of “oxygen addiction in their children”. The authors dealt with poor quality concentrators, unanticipated maintenance costs, increased oxygen cylinder use and difficulty in reaching slum dwellings. The lack of pulse oximeters at home led to either overuse or underuse of oxygen flow in almost all patients. Conclusion This has been a successful beginning of a sustainable HOT program with minimal complications and no HOT related morbidity and mortality allowing needy children to be discharged earlier. The challenges we faced were not insurmountable and we feel this program can be similarly adopted in other resource restricted settings.
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