A rapid facility-level assessment of oxygen systems in 39 low-income and middle-income countries: a cross-sectional study.

Background: Unequal access to medical oxygen is a key driver of global inequities in morbidity and mortality. We aimed to describe reliable oxygen availability (ie, whether availability is uninterrupted) and functional availability (ie, whether oxygen system components are in working order) in 39 low-income and middle-income countries and to compare across WHO subregions.

Methods: We report cross-sectional survey data from primary, secondary, and tertiary level health facilities across six WHO subregions. Facilities were selected via purposive and stratified random sampling. Data collectors visited facilities from September 2022, to February 2023, to administer a standardised questionnaire to facility leadership. All approached facilities responded. Questions assessed reliable oxygen availability over the preceding 3 months and the functional availability of system components: oxygen sources (ie, cylinders, concentrators, plants, and liquid oxygen), distribution systems (ie, piping, cylinder transport, and respiratory tubing), delivery devices (ie, nasal interfaces, face masks, and advanced modalities), monitoring devices (ie, pulse oximeters and multiparameter monitors), and quality assurance (ie, oxygen concentration control and maintenance schedule). We report descriptive statistics and compare across subregions using χ² and Fisher exact tests.

Findings: Of 2884 surveyed facilities, 304 (24·5%) of 1241 primary facilities, 558 (52·4%) of 1064 secondary facilities, and 387 (66·8%) of 579 tertiary facilities reported reliable oxygen availability. Facilities across levels and subregions lacked system components, with statistically significant (p<0·05) differences in functional availability of all oxygen system components across subregions at all levels. For example, functional availability of cylinders ranged from 56·7% to 100·0%, piping from 7·5% to 94·6%, nasal cannulae from 56·3% to 96·4%, and pulse oximeters ranged from 47·8% to 96·4%, depending on level and subregion.

Interpretation: Reliable oxygen availability was low across facility levels and subregions. There were significant disparities in the functional availability of oxygen system components across subregions, with important implications for global health equity and financing.

Funding: The Global Fund to Fight AIDS, Tuberculosis, and Malaria; the Yale National Clinician Scholars Program; the US National Center for Advancing Translational Sciences; the US National Heart, Lung, and Blood Institute; and the Yale Institute for Global Health.

Translations: For the French translation of the abstract see Supplementary Materials section.