Feasibility of high-flow nasal cannula implementation for children with acute lower respiratory tract disease in rural Kenya.

Background: High-flow nasal cannula (HFNC) is a well-established respiratory support device in high-income countries, but to our knowledge, its use in sub-Saharan Africa has not been reported. This feasability study describes the implementation process of HFNC in rural Kenya. Methods: HFNC was implemented in intensive care and high dependency units at Kijabe Hospital, Kenya for children with acute lower respiratory disease. Rate of intubation was compared with historical controls and challenges of implementation described. Results: Fifteen patients received HFNC between January and November 2016, and compared to 25 historical control patients. Both groups had many comorbidities, and control patients were significantly younger. There were no significant differences in clinical outcome between the groups: 5 (33%) HFNC vs 12 (48%) controls required intubation; 10 (67%) HFNC vs 22 (88%) controls survived to discharge; and the HFNC required 3 vs the controls' 4 days on respiratory support. The greatest technical issues encountered were large pressure differences between air from a wall outlet (wall air) and oxygen and an inability to automatically refill humidifier water chambers. Conclusion: HFNC in limited-resource settings is feasible but there were technical challenges and concern about the increased workload. The small sample size, heterogeneous population, availability of oxygen and blending of wall air at the study site limit inferences for other sites in low- and middle-income countries. Abbreviations: ALRI, acute lower respiratory infection; CPAP, continuous positive airway pressure; ETAT, emergency triage, assessment and treatment; HDU, high dependency unit; HFNC, high-flow nasal cannula; HIC, high-income country; HR, heart rate; ICU, intensive care unit; LMIC, low- and middle-income countries; PSI, pounds per square inch; RR, respiratory rate; mRISC, modified Respiratory Index of Severity in Children.

Effect of Treatment of Premature Infants with Respiratory Distress Using Low-cost Bubble CPAP in a Rural African Hospital.

BACKGROUND: Kenya's neonatal mortality rate remains unacceptably high, at 22 deaths per 1000 live births, with a third of those attributable to prematurity. Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in the premature neonate. Continuous positive airway pressure (CPAP) is a proven modality of therapy but is rarely used in low-resource settings. We report on the introduction of bubble CPAP (BCPAP), a low-cost method of delivering CPAP appropriate to our setting, by comparing survival-to-discharge before and after the technology was introduced. METHODS: The inpatient hospital records of all preterm infants (<37 weeks) diagnosed with RDS in the AIC Kijabe Hospital Nursery during two 18-month periods before and after the introduction of BCPAP (46 infants enrolled from 1 November 2007 to 30 April 2009 vs. 72 infants enrolled from 1 November 2009 to 30 April 2011) were reviewed. Differences in survival-to-discharge rates between the two time periods were analyzed. RESULTS: The survival-to-discharge rate was higher in Period 2 (after the introduction of BCPAP) than in Period 1 (pre-BCPAP) (85% vs. 61%, p = 0.007). Similarly, there were lower referral rates of preterm infants with RDS in Period 2 than Period 1 (4% vs. 17%, p = 0.037). CONCLUSION: BCPAP has contributed significantly to favorable outcomes for preterm infants with RDS at AIC Kijabe Hospital. The use of this simple technology should be considered and studied for expansion to all hospitals in Kenya that care for preterm infants.