Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial

Graham, Hamish R.; Ayede, Adejumoke I.; Bakare, Ayobami A.; Oyewole, Oladapo B.; Peel, David; Gray, Amy; McPake, Barbara; Neal, Eleanor; Qazi, Shamim; Izadnegahdar, Rasa; Falade, Adegoke G.; Duke, Trevor

doi:10.1186/s13063-017-2241-8

Trials

Table 2 Characteristics of 12 secondary-level hospitals in southwest Nigeria: paediatric and neonatal wards (adapted from baseline needs assessment [8])

From: Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial

	1	2	3	4	5	6	7	8	9	10	11	12
Hospital type	State	Mission	Mission	State	State	State	State	State	Mission	Mission	Mission	State
Beds (child + neonatal)	13 (9 + 4)	32 (20 + 12)	63 (38 + 25)	36 (26 + 10)	46 (22 + 24)	60 (44 + 16)	48 (20 + 28)	36 (16 + 20)	20 (15 + 5)	14 (12 + 2)	70 (40 + 30)	25 (21 + 4)
Admissions (annual)	185	507	2343	238	791	849	3431	1945	431	344	2345	744
Child	180	444	1649	231	552	679	1959	1111	292	325	972	683
Neonate	5	63	693	7	239	170	1473	834	139	19	1373	61
Staffing
Access to paediatrician	No^a	No^a	Yes^b	No^a	No	Yes	Yes	Yes	Yes	Yes^b	Yes^b	Yes
Medical (entire hospital)	7	4	6	7	12	17	16	11	5	6	4	2
Nursing (paediatric)	11	7	18	26	31	62	26	33 (3)	9 (2)	4	18	16 (2)
Power supply (h/day) power interruptions	6–12 hourly	6–12 hourly	12–18 hourly	6–12 hourly	6–12 hourly	12–18 hourly	12–18 hourly	6–12 hourly	>18 > daily	>18 > daily	12–18 hourly	6–12 hourly
Oxygen supply	Poor	Poor	Poor	Poor	Fair	Poor	Poor	Poor	Fair	Poor	Poor	Poor
Oxygen cylinders	Yes^d	Yes^d	Yes	Yes^d	Yes	Yes	Yes^c	Yes	Yes^d	Yes^d	Yes^d	Yes^d
Oxygen concentrators	No	No	Yes^e	No	No	No	Yes^e	Yes^e	Yes	Yes^e	Yes^e	Yes^e
Pulse oximeters	No	No	No	No	No	Yes	No	No	Yes	Yes	No	No
Maintenance capacity and procedures	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Fair	Fair
Clinical guidelines, education and review	Poor	Fair	Poor	Poor	Fair	Poor	Good	Fair	Fair	Poor	Fair	Poor
Care systems
Clinical records	Fair	Fair	Fair	Fair	Fair	Fair	Fair	Fair	Fair	Fair	Fair	Fair
Administrative records	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Poor	Fair	Fair	Poor
Medication and supplies	Good	Good	Good	Good	Good	Good	Good	Good	Good	Good	Good	Good
Infection control	Good	Good	Good	Good	Good	Good	Good	Good	Good	Good	Good	Good
Neonatal resuscitation	Poor	Poor	Poor	Poor	Poor	Good	Good	Poor	Poor	Poor	Poor	Poor

Notes: ^aFamily medicine consultant, ^bpart-time, ^cpiped system connected to large oxygen cylinder, ^dnot present in paediatric areas, ^epresent but not fit for use. Summary indicators of oxygen supply and care systems include composite measures for oxygen supply reliability (presence of oxygen source, access to resupply, quantity to meet need), oxygen delivery devices (nasal prongs/catheter presence, access to resupply, quantity to meet need), clinical records (quality of case note and admission book documentation), administrative records (quality of medical record summary statistics procedures, documentation, and reporting), medication and supplies (checklist of essential items), infection control (availability and visible use of water and soap in clinical areas, reported infection control procedures), neonatal resuscitation (presence of resuscitation bag, neonatal mask, resuscitation table/cot)

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ISSN: 1745-6215

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