Continuous positive airway pressure in managing acute respiratory distress in children in district hospitals: evidence for scale-up
In children, acute respiratory distress (ARD) is a clinical presentation requiring emergency management, including mechanical ventilation. Mechanical ventilators are lacking in sub-Saharan Africa. Continuous Positive Airway Pressure (CPAP) is an alternative form of non-invasive respiratory support that has been used in high-income countries for over four decades. Its use in sub-Saharan Africa is, however, limited and often restricted to neonates. Controlled trials in Ghana have shown that the use of CPAP in children younger aged 1-12 months reduces 2-week all-cause mortality from ARD by 60% (RR 0·40, 0·19–0·82; p=0·01). The absolute reduction in mortality of 4% implies one infant life saved for every 25 children treated with CPAP. This paper reviews the findings of the trials in Ghana and
contrasts the findings with those of trials in Bangladesh and Malawi. It makes the case that implementation research (rather than more controlled trials) is now needed to support the routine, safe and effective use of CPAP in managing ARD in older infants in district hospitals in Ghana.
Articles published in the Ghana Medical Journal may not be published elsewhere without the consent of the publishers. Request for consent for reproduction of material published in the Ghana Medical Journal should be addressed to the Editor-in-Chief. The publisher of this Journal reserves the right of copyright of all articles published in the Journal. It should also be understood by all authors that articles approved for publication in the journal are also deemed for publication online by the publisher.
Ghana Medical Journal is an Open Access journal and applies the Creative Commons Attribution (CC BY) license (Creative Commons Attribution License) 4.0 International. See details on the Creative Commons website (https://creativecommons.org/licenses/by/4.0/) to articles and other content published in the Journal.