The Epidemiology and Impact of Hypoxemia in Sub-Saharan Africa: Prevalence, Practices, and Outcomes

Sulani, Innocent, Onofrey, Lauren A., Trevisi, Letizia, Beane, Abi, Brotherton, B. Jason, Condo, Jeanine, Dula, Dingase, Ely, E. Wes, Goel, Swati, Gordon, Stephen B, Haniffa, Rashan, Hedt-Gauthier, Bethany, Medline, Alexandra, Njoki, Carolyne, Oduor, Peter, Otieno, George, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611, Twagirumugabe, Theogene, Umutoni, Nathalie, Uwamahoro, Doris, Vanderburg, Sky, Waweru-Siika, Wangari and Riviello, Elisabeth (2025) 'The Epidemiology and Impact of Hypoxemia in Sub-Saharan Africa: Prevalence, Practices, and Outcomes'. Annals of the American Thoracic Society. (In Press)

Text sulani-et-al-2025-the-epidemiology-and-impact-of-hypoxemia-in-sub-saharan-africa-prevalence-practices-and-outcomes.pdf - Published Version Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (507kB)

Abstract

Rationale: The epidemiology of hypoxemia in Sub-Saharan Africa is largely unknown.
Objectives: Determine the prevalence, clinical care, and outcomes for hospitalized hypoxemic adults in Sub-Saharan Africa.
Methods: We prospectively screened all adults admitted to five hospitals in Kenya, Malawi, and Rwanda over four months; identified those with hypoxemia (defined as SpO2<90% or receipt of oxygen therapy); and followed hypoxemic patients to discharge.
Measurements and Main Results: Of the 24,724 adult patients admitted, 1,739 (7%) were hypoxemic on admission. Median imputed PaO2/FiO2 was 168. Of all patients screened, 4,546 (18%) had complete oxygenation domains (SpO2, device, and quantity) documented in their charts on admission. Among hypoxemic patients, 44% of in-hospital days (6,890/15,553) had chart documentation of all three oxygenation domains. Of 1,508 unique hypoxemic patients, 770 (51%) had at least one day with subtherapeutic oxygen (SpO2<90%). Of patient-days with patients on oxygen therapy, 84% indicated supratherapeutic oxygen therapy (SpO2>94%). Of all
hypoxemic adults, 35% died in-hospital. Sixteen percent of patients were mechanically ventilated during their stay, and in-hospital mortality in this subgroup was 49%.
Conclusions: Hypoxemia is common and associated with high mortality in five referral hospitals in three countries in Sub-Saharan Africa. Monitoring and titration practices for oxygen therapy are inconsistent. Subtherapeutic and supratherapeutic oxygen therapy are common. Mortality is high among the few patients who receive mechanical ventilation. These findings suggest the urgent need to study interventions to improve survival for hypoxemic patients in Sub-Saharan Africa. Prioritized investigations include the development and implementation of oxygen monitoring and titration protocols, as well as studies of advanced oxygen therapies other than
mechanical ventilation.

Item Type:	Article
Subjects:	WF Respiratory System > WF 20 Research (General) WG Cardiovascular System > WG 20 Research (General) WH Hemic and Lymphatic Systems > WH 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1513/annalsats.202410-1092oc
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	19 Mar 2025 11:51
Last Modified:	19 Mar 2025 11:51
URI:	https://archive.lstmed.ac.uk/id/eprint/26315

Statistics

View details

Actions (login required)

Edit Item