Continuous positive airway pressure in managing acute respiratory distress in children in district hospitals: evidence for scale-up

  • Frank Baiden Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
  • Patrick T Wilson Department of Paediatrics, Division of Critical Care Medicine, Columbia University Medical Center/New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, New York, NY 10032, United States of America.
Keywords: Respiratory distress, CPAP, district hospitals, Ghana, Africa


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.


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print ISSN: 0016-9560