Table 2

Description of interventions of included studies

StudyIntervention components
Duke11Equipment and maintenance
  • Technical specifications of eight different oxygen concentrators were compared for suitability of use in children’s ward

  • Fifteen AirSep oxygen concentrators (5 Elite and 10 Intensity models) were procured, distributed, commissioned and installed across the 5 hospitals

  • One handheld pulse oximeter and several replacement probes procured for each hospital

  • Flow splitters, tubing and nasal prongs for various child age groups procured and a regimen developed for cleaning, testing and reusing accessories

  • At least one oxygen cylinder available as back-up

  • Follow-up technical equipment evaluations conducted at 14 and 28 months after installation

Capacity building
  • Hospital engineers, clinicians and nurses involved in commissioning and installation of equipment as means of training

  • Multiple didactic and small group hands-on trainings were also conducted to cover all clinical and technical staff

Leadership and oversight
  • Multidisciplinary national oxygen team consisting of paediatricians and biomedical engineers led implementation and conducted regular visits to facilities

Evaluations and assessments
  • Baseline assessments of facility infrastructure, power requirements, personnel, patient capacity and availability of existing oxygen equipment and other healthcare commodities

  • Preintervention and postintervention data extracted from child ward admission books to evaluate case-fatality rates

  • Prospectively collected all costs related to implementing the programme, including equipment, consumables, training, supervision, repairs and maintenance, and assessments

Gray13Equipment and maintenance
  • Approximately four Airsep VisionAire concentrators and comprehensive set of spare parts procured for each hospital

  • One Bitmos tabletop pulse oximeter and 12 replacement probes of various sizes procured for each hospital

  • Flow splitters, tubing, prongs, oxygen analysers and installation materials

  • Multidisciplinary team from MOH, engineers and clinicians visited each hospital for 1 week to check the equipment, instal the oxygen system, and provide training on its use and maintenance

  • Additional training sessions were conducted for engineers and technicians at central, provincial and district levels on installation and servicing

  • Repairs made to one-third (of concentrators after 1 year. Seven failed after 2 years

Capacity building
  • Lao-specific training materials such as videos, guidelines, lectures and case-based teaching adapted from the WHO Pocketbook training were developed

  • The WHO publication ‘The Clinical Use of Oxygen: Guidelines for healthcare workers, hospital engineers and managers.’ was translated into Lao language

  • A Digital Video Disc (DVD) was produced using the five-part oxygen therapy video from the WHO Pocketbook of Hospital Care for Children training compact disc (CD)

  • Laminated one-page documents were produced in Lao language to support the correct use of the oxygen equipment

  • Practical sessions included using oximeters, nasal prongs, oxygen masks and catheters with dummies and guided examinations of patients with respiratory diseases

  • Clinical training was provided over 2 days at each of the 10 intervention hospitals

  • Hospitals decided to make oxygen from concentrators freely available to all patients

Leadership and oversight
  • Lao National Oxygen Team consisting of staff from the MOH and Medical Products Supply Centre, national clinicians, provincial and district health staff, and international staff from the WHO and Centre for International Child Health at University of Melbourne

  • Supervision visits by coordinators (at 3, 12 and 24 months)

Evaluations and assessments
  • Preintervention and postintervention evaluation using retrospective data collection using a standardised data abstraction form for medical records

  • Prospective data collection on all patients who receive oxygen at intervention and control hospitals throughout the duration of the project

  • Routine hospital data were collected during the intervention including number of admissions, admission diagnosis, oxygen use and cost

Graham14Equipment and maintenance
  • Lifebox pulse oximeters and training introduced to all hospitals prior to full oxygen system strengthening interventions

  • Oxygen concentrators (Airsep Elite 5LPM), tubing and delivery devices, and maintenance materials were installed collaboratively by project and hospital technicians

  • Solar-power systems with battery storage and/or petrol generators installed

  • Hospital technicians and clinical staff trained on basic maintenance and given responsibility for various aspects of weekly and quarterly equipment checks and preventive maintenance

  • Ongoing support from project team to assist with troubleshooting and repairs

Capacity building
  • Clinical training based on the WHO guidelines for Clinical Use of Oxygen in Children and WHO Hospital Care for Children

  • Local healthcare workers, with support from project team, were trained as Master Trainers and led training sessions for their colleagues. Encouraged to do additional training for new and rotating staff.

  • Initial clinical training conducted at hospitals, using practical, group-discussion based educational methods over 3–4 hour sessions.

  • Hospital technicians trained at a central 3-day workshop, led by project staff and experienced UK-based engineer, and were involved in all aspects of equipment testing, installation, maintenance and repair.

  • Wall charts, checklists and quick summary guidelines disseminated

Leadership and oversight
  • Oxygen Implementation Project team worked with hospital administrators to implement the programme, with governance support from federal and state health agencies.

  • Project team visited health facilities every 3 months to provide supportive supervision, feedback, and collect user feedback. Quality improvement approach taken to strengthen project implementation using multidisciplinary hospital oxygen teams.

Evaluations and assessments
  • Unblinded, stepped-wedge cluster-randomised trial design taken to evaluate primary outcome of mortality between pulse oximetry alone arm to full oxygen system arm

  • Retrospective admissions and discharge register data collected for extended analysis comparing preintervention to postintervention arms

  • Mixed-methods design used to collect both quantitative and qualitative data on clinical and implementation outcomes

Duke12Equipment and maintenance
  • Design and installation of solar power system including battery backup system for 3 days

  • Airsep Elite 5 L/min concentrators (two or three concentrators per facility) and Lifebox pulse oximeters

  • Project teams spent 2–3 days at each facility to instal solar system and commission oxygen equipment

  • Healthcare workers trained to conduct preventative maintenance and monitoring of equipment performance using Maxtec O2 analysers

  • Province and district technicians and engineers provided spare parts and trained on repair and maintenance

Capacity building
  • Curriculum based on the WHO guidelines for Clinical Use of Oxygen in Children and WHO Hospital Care for Children

  • Clinical and technical content delivered through 5-day workshop-based training sessions that include direct facilitator and peer-to-peer teaching modalities

  • Follow-up site visits used to reinforce both clinical and technical skills and knowledge

Leadership and oversight
  • Continuous quality improvement approach taken by provincial supervisory teams consisting of a paediatrician and a technician conducting site reviews every 4–6 months. Visits included on-site training, data collection and troubleshooting of problems identified and feedback given to facility and provincial staff

Evaluations and assessments
  • Health facility admission and discharge registers were reviewed, and mortality rates estimated between preintervention and postintervention period