Decreasing Acute Respiratory Mortality at the District Hospital Level
This study evaluated the effectiveness of continuous positive airway pressure (CPAP), a form of non-invasive ventilation, in decreasing all-cause mortality in children presenting with undifferentiated respiratory distress at two district-level hospitals in the Bono East and Ashanti Regions in Ghana. After adjusting for clinically important variables, the study found a significant decrease in two-week mortality for children 1-year-old and younger in the CPAP group versus the control group. In children at all ages, respiratory rate was significantly lower in the CPAP group at 4 hours, 8 hours, 12 hours, and 24 hours. These outcomes demonstrate CPAP is both effective and safe to use in district hospital-level hospitals by nurses whose work is primarily carried out without direct physician supervision. These and other results of the study were published in The Lancet Global Health as continuous positive airway pressure for children with undifferentiated respiratory distress in Ghana: an open-label, cluster, crossover trial. The article was named Editor’s Choice for this issue.
One outcome of this study was to determine the etiology of respiratory pathogens in children 1 month to 5 years of age, presenting with undifferentiated acute respiratory distress in 2 district-level hospitals in Ghana. By using malaria rapid diagnostic tests, malaria parasite smears, full blood counts, and viral PCR testing. Rhinovirus and/or enterovirus was detected in 36% of the assays, respiratory syncytial virus in 11%, and parainfluenza in 7% as well as coronaviruses at 5% and others.