Bubble CPAP and oxygen for child pneumonia care in Malawi: a CPAP IMPACT time motion study.
BACKGROUND
In some low-resource settings bubble continuous positive airway pressure (bCPAP) is increasingly used to treat children with pneumonia. However, the time required for healthcare workers (HCWs) to administer bCPAP is unknown and may have implementation implications. This study aims to compare HCW time spent administering bCPAP and low-flow nasal oxygen care at a district hospital in Malawi during CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial).


METHODS
Eligible participants were 1-59 months old with WHO-defined severe pneumonia and HIV-infection, HIV-exposure, severe malnutrition, or hypoxemia and were randomized to either bCPAP or oxygen. We used time motion techniques to observe hospital care in four hour blocks during treatment initiation or follow up (maintenance). HCW mean time per patient at the bedside over the observation period was calculated by study arm.


RESULTS
Overall, bCPAP required an average of 34.71 min per patient more than low-flow nasal oxygen to initiate (bCPAP, 118.18 min (standard deviation (SD) 42.73 min); oxygen, 83.47 min (SD, 20.18 min), p < 0.01). During initiation, HCWs spent, on average, 12.45 min longer per patient setting up bCPAP equipment (p < 0.01) and 11.13 min longer per patient setting up the bCPAP nasal interface (p < 0.01), compared to oxygen equipment and nasal cannula set-up. During maintenance care, HCWs spent longer on average per patient adjusting bCPAP, compared to oxygen equipment (bCPAP 4.57 min (SD, 4.78 min); oxygen, 1.52 min (SD, 2.50 min), p = 0.03).


CONCLUSION
Effective bCPAP implementation in low-resource settings will likely create additional HCW burden relative to usual pneumonia care with oxygen.


TRIAL REGISTRATION
Clinicaltrials.gov NCT02484183 , June 29, 2015.
['Sessions|Kristen L|KL|http://orcid.org/0000-0003-2062-8746', 'Mvalo|Tisungane|T|', 'Kondowe|Davie|D|', 'Makonokaya|Donnie|D|', 'Hosseinipour|Mina C|MC|', 'Chalira|Alfred|A|', 'Lufesi|Norman|N|', 'Eckerle|Michelle|M|', 'Smith|Andrew G|AG|', 'McCollum|Eric D|ED|']
D002675:Child, Preschool D045422:Continuous Positive Airway Pressure D005260:Female D006302:Health Services Research D006767:Hospitals, District D006801:Humans D007223:Infant D008295:Malawi D008297:Male D008505:Medical Staff, Hospital D010102:Oxygen Inhalation Therapy D011014:Pneumonia D013997:Time Factors D013996:Time and Motion Studies D016526:Workload
Oxygen Child pneumonia Time motion study Bubble continuous positive airway pressure Sub-Saharan Africa