An evaluation of oxygen therapy and respiratory support practices among hospitals in the African Neonatal Network
Keywords:
Neonatal care; Oxygen therapy; Respiratory support; Continuous Positive Airway Pressure (CPAP); Neonatal mortality; Pulse oximetry; Surfactant therapy; Resource-limited settings.Abstract
Background: Neonatal respiratory support, including oxygen therapy, is critical for reducing neonatal mortality in sub- Saharan Africa, where neonatal outcomes remain poor due to infrastructure and resource limitations.
Methods: Fourteen hospitals in the African Neonatal Network responded to an annual facility survey and a health facility survey co-developed by faculty in the African Neonatal Network and Vermont Oxford Network. All analyses use descriptive statistics.
Results: While oxygen was universally available, only 78% of hospitals had pulse oximeters and 21% had blood gas analysis capabilities. CPAP was available in 77% of hospitals, but only 36% had surfactant and 14% offered blended oxygen to all neonates. Protocols for oxygen use varied, with just 64% having target saturation guidelines and 43% using pulse oximeter alarms. Oxygen supply interruptions were common, and equipment gaps, like compressed air and monitoring tools, were prevalent.
Conclusion: Major deficiencies in neonatal respiratory care and oxygen use persist across ANN hospitals, including limited access to monitoring tools, standardized protocols, and advanced therapies. Addressing these gaps through infrastructure investments, protocol development and standardization, training, and supply chain improvements is essential to advancing neonatal care through
optimal respiratory support in resource-limited African settings.
References
World Health Organization.Newborn mortality [Internet]. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/newbornmortality. Accessed on: June 13, 2025.
Steenhoff AP, Coffin SE, Kc A, Nakstad B. Editorial: Neonatal health in low- and middle- income countries. Now is the time. Front Pediatr. 2023 Apr 13;11:1168915. 3. UNICEF. Neonatal mortality [Internet]. 2025. Available from: https://data.unicef.org/topic/child-survival/neonatalmortality/. Accessed on: June 13, 2025.
Nkundabaza C, Rukundo G, Sinayobye J d’A, Ntaganira J, Mukamurigo J. Neonatal mortality and associated factors at a provincial hospital, Western Province of Rwanda: A facility based cross-sectional study, 2019-2021. JIEPH. 2024;7 (3):3.
Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388 (10063):3027-3035.
Zaidi AKM, Darmstadt GL, Stoll BJ. Neonatal infections: a global perspective. In: Wilson CB, Nizet V, Maldonado Y, Remington JS, Klein JO, editors. Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant, 8th ed. Saunders; 2015.
Ekhaguere OA, Okonkwo IR, Batra M, Hedstrom AB. Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022. Front Pediatr. 2022;10:961509.
Lategan I, Price C, Rhoda NR, Zar HJ, Tooke L. Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa. Front Glob Womens Health. 2022;3:817817.
Kakibibi P, Marangu-Boore D, Murila F. Missed opportunity for nasal continuous positive airway pressure in preterm neonates admitted at a tertiary-level hospital newborn unit in Kenya: a mixed method study. BMJ Open. 2025;15(1):e085026
Graham HR, Kamuntu Y, Miller J, et al. Hypoxaemia prevalence and managementamong children and adults presenting to primary care facilities in Uganda: A prospective cohort study. PLOS Glob Public Health. 2022;2 (4):e0000352.
Bee M, Shiroor A, Hill Z. Neonatal care practices in sub -Saharan Africa: a systematic review of quantitative and qualitative data. J Health PopulNutr. 2018;37(1):9.
Hansen A, Magge H, Labrecque M, et al. The development and implementation of a newborn medicine program in a resource-limited setting. Public Health Action. 2015;5 (1):17-22.
Morgan MC, Maina B, Waiyego M, et al. Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resourcelimited hospital in Kenya. J Paediatr Child Health. 2018;54(3):260-266.
Sodero S, Dhungana N, Sandoe F. Vital mobilities of medical oxygen: Theorising oxygen justice. Soc Sci Med.2025;364:117464.
Bhatt N, Nepal S, Pinder RJ, Lucero-Prisno DE, Budhathoki SS. Challenges of hospital oxygen management during the COVID-19 pandemic in rural Nepal. Am J Trop Med Hyg. 2022;106 (4):997-999.
Stevenson AG, Abayneh M, Bolaji O, et al. Characteristics, interventions, and status of infants discharged from 14 hospitals in the African Neonatal Network, 2024. J African Neonatology.
Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R.Pulse oximetry in pediatric care: Balancing advantages and limitations. World J Clin
Pediatr. 2024;13(3):96950.
Castro D, Patil SM, Zubair M, Keenaghan M. Arterial blood gas. In: StatPearls. StatPearls Publishing, 2024.
Banerjee S, Fernandez R, Fox GF, et al. Surfactant replacement therapy for respiratory distress syndrome in preterm infants: United Kingdom national consensus. Pediatr Res. 2019;86(1):12-14.
Aggarwal V, Bhatia R, Tan K. Oxygen saturation levels and retinopathy of prematurity in extremely preterm infants - a case control study. BMC Pediatr. 2023;23 (1):449.
Gilbert C, Malik ANJ, Nahar N, et al. Epidemiology of ROP update - Africa is the new frontier. Sem Perinatol. 2019;43(6):317-322.
Pretto JJ, Roebuck T, Beckert L, Hamilton G. Clinical use of pulse oximetry: official guidelines from the Thoracic Society of Australia and New Zealand. Respirology. 2014;19(1):38-46.
Graham HR, King C, Rahman AE, et al. Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security. Lancet Glob Health. 2025;13 (3):e528-e584.
Smith V, Changoor A, McDonald C, et al. A comprehensive
approach to medical oxygen ecosystem building: an implementation case study in Kenya, Rwanda, and Ethiopia. Glob Health Sci
Pract. 2022;10(6):e2100781.
Pong KM, Teo JT, Cheah FC. Simulation-based education in the training of Newborn Care Providers-A Malaysian Perspective. Front
Pediatr. 2021;9:619035.
Inglis R, Ayebale E, Schultz MJ. Optimizing respiratory management in resourcelimited settings. Curr Opin Crit Care. 2019;25(1):45-53.
Thukral A, Sankar MJ, Chandrasekaran A, Agarwal R, Paul VK. Efficacy and safety of CPAP in low- and middle-income countries. J
Perinatol. 2016;36(Suppl1):S21-S28.
Ehret DEY, Worku B, Demtse A, et al. Remote mentorship to improve continuous positive airway pressure use in the Ethiopian Neonatal Network. Pediatrics. 2025:e2024067985.
Erhabor GE. Respiratory health in Africa: strides and challenges. JPATS. 2021;2 (1):11-17.
Sheffel A, Andrews KG, Conner R, et al. Human resource challenges in health systems: evidence from 10 African countries. Health
Policy Plan. 2024;39(7):693-709.
Conradi N, Claude KM, Lee BE, Saleh A, Mandhane P, Hawkes M. Utility of solar powered oxygen delivery in a resource-constrained setting. Pulmonology. 2023;29 (4):315-322.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 JOURNAL OF AFRICAN NEONATOLOGY
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.