Background:

a.     Burden: Hypoxemia, characterized by low blood oxygen levels, is a global health concern, further intensified by the COVID-19 pandemic. This condition, which affects all age groups and accounts for 14% of severe infections, can lead to increased mortality. Its causes range from respiratory infections and cardiovascular disorders to neonatal conditions. The 2017 Global Burden of Diseases Study highlights the widespread nature of chronic respiratory diseases, which affect 545 million people worldwide and are the third leading cause of death across all age groups. However, these diseases disproportionately impact South Asia, especially in low- and middle-income countries (LMICs), where children are at a higher risk. In these regions, 10-15% of hospitalized children and 20% of sick newborns suffer from hypoxemia, primarily due to limited oxygen access.

b.     Knowledge gap: Despite the recognized global impact of hypoxemia, a knowledge gap impedes a comprehensive understanding. Current research often concentrates on specific diseases or patient groups, thereby restricting a broader perspective necessary for effective interventions. The appropriateness of the World Health Organization’s (WHO) SpO₂ threshold of 90% as a hospital admission criterion is under scrutiny, especially in regions like Malawi, where children under five may face mortality risks even with SpO₂ levels above 90%. Moreover, there is a significant lack of attention towards the accessibility and security of oxygen supply in LMICs.

c.     Relevance: This study is particularly relevant in the context of the ongoing COVID-19 pandemic. By assessing the readiness of oxygen delivery systems in LMICs such as India, the research addresses vital gaps in healthcare infrastructure. The insights gained from this evaluation can benefit healthcare providers, policymakers, and the general population. The timing of the study coincides with the pressing need for efficient healthcare delivery during public health emergencies. The results can guide strategies to improve oxygen security and accessibility, which are essential for reducing the impact of hypoxemia and enhancing healthcare outcomes in resource-constrained settings.

Hypothesis (if any):

N/A

Objectives:

The objective of the proposed study is to assess the readiness of oxygen security and availability, with a particular emphasis on improving healthcare delivery for respiratory symptoms in primary, secondary and tertiary level healthcare facilities in 10 districts of Uttar Pradesh. The study will investigate various aspects, including accessibility, equipment functionality, infrastructure, training needs, adherence to protocols, and financial feasibility.

Methods:

This study adopts a mixed-methods approach to evaluate the preparedness of oxygen delivery systems in Uttar Pradesh, India. It uses a cross-sectional health facility assessment survey, a healthcare provider survey, and key informant interviews. The study is structured into five domains. The domain 1 investigates governance, policies, and strategies. The domain 2 examines oxygen access through a representative sample of health facilities. The domain 3 assesses healthcare provider knowledge and patient/caregiver perception. The domain 4 scrutinizes documented oxygen uses and demand. The domain 5 explores the cost implications of oxygen delivery.

The aim of the study is to provide a comprehensive understanding of the current state of oxygen delivery systems in Uttar Pradesh. It seeks to inform strategies for improvement and enhance healthcare outcomes. The study’s comprehensive approach ensures a thorough examination of all aspects of oxygen delivery systems, laying a solid foundation for future research and intervention strategies. The findings of the study will be crucial in informing policy decisions and interventions aimed at improving healthcare outcomes in Uttar Pradesh, India.

Outcome measures/variables:

The study aims to assess oxygen delivery system readiness in Uttar Pradesh, India across five domains. Domain 1 focuses on analyzing existing policies and strategies. Domain 2 evaluates the impact of oxygen delivery system components’ availability on overall therapy capacity. In Domain 3a, the outcome variable measures healthcare providers’ knowledge, attitude, and skills in using oxygen therapy. Domain 3b assesses patient, parent, and caregiver perceptions and their influence on treatment acceptance. Domain 4 examines documented oxygen use and demand in healthcare facilities. Domain 5 estimates the cost of implementing and maintaining oxygen systems, considering both facility and patient financial perspectives. These outcome variables collectively offer insights into system readiness and guide strategies for improving oxygen security and availability.