Oxygen is a matter of life and breath

November 9, 2016 by Bonnie Keith

Why is oxygen, an essential element of human life, so difficult to access and provide in some settings?

A woman smiles at a child she is sitting next to.

Watch this video to see why oxygen therapy could make the difference between life and death, especially for the most vulnerable—newborns, children, and mothers during childbirth. Health advisors, practitioners, and partners: be an advocate and elevate oxygen as a priority intervention and lifesaving treatment to country decision-makers.

Oxygen is one of the most basic treatments a health facility can offer, yet it is often not available to everyone fighting for breath. Health facilities in low-resource settings, particularly primary care facilities, may lack the appropriate technology, utilities, or health care workers to provide oxygen in an emergency. Oxygen gives life, and can save lives, especially for those most vulnerable: newborns, children, and pregnant women.

Oxygen makes the difference

Consider the importance of oxygen in treating pneumonia, the number one cause of death for children under five years old. Many cases of pneumonia are easily treated through affordable medicines, such as antibiotics. However, by the time many children in low- and middle-income countries (LMICs) reach a health facility and are diagnosed, their pneumonia is severe, and antibiotics may not be enough. At this stage, children may be hypoxic and struggling to breathe, requiring swift oxygen treatment.

Hypoxemia occurs when there are low levels of oxygen in the blood, which means a person’s blood is not providing the oxygen his or her body needs. Hypoxemia can be treated through the therapeutic administration of oxygen, but if left untreated, the results can be fatal. When children with pneumonia-related hypoxemia receive oxygen, it can make the difference between life and death. Oxygen therapy has been associated with reducing childhood pneumonia deaths by 35 to 55 percent in high-burden, low-resource settings.

A woman smiles at a child she is sitting next to.

The lives of up to 122,000 children and thousands of pregnant women could be saved each year if oxygen treatment was readily available. Photo: PATH/Teresa Guillien.

Oxygen is elemental

While pneumonia threatens children everywhere, they are particularly at risk in South Asia and sub-Saharan Africa. Half of child pneumonia deaths occur in just five countries: the Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan. Health systems in these countries face many challenges addressing the health needs of their populations, including ensuring adequate access to oxygen for the poorest and most vulnerable.

Despite oxygen being an indispensable medicine, health systems often fail to ensure it is both available and accessible. Roughly half of health facilities in LMICs, including many hospitals, lack access to reliable supplies of oxygen gas, as well as functional pulse oximeters—critical technology for diagnosing hypoxemia and monitoring oxygen treatment. Patients, health care providers, policymakers, and advocates are left to ask, Why is oxygen, an essential element of human life, so difficult to access and provide in some settings?

We know that systemic issues—such as inadequate maintenance, insufficient provider training, and a lack of policies and guidelines—contribute to access limitations for oxygen therapy. Integrating oxygen into efforts to improve the quality of care for children, as well as newborns and mothers, can reduce death and disability due to hypoxemia. But this will require investments into country health systems to ensure that there are policies and guidelines to support oxygen availability and access, that providers are trained in proper diagnosis and administration, and that facilities are able to adequately maintain oxygen-related technologies.

What PATH is doing

We’re working to increase access to oxygen through advocacy, policy change, improved markets for oxygen concentrators and pulse oximeters, and development and scale-up of innovative technologies. Our Elevating Oxygen project is collaborating with the World Health Organization to revise the way oxygen is listed in the Model List of Essential Medicines. In Kenya and other LMICs, project staff are working closely with policymakers and advocates to raise awareness, increase commitment to improve access to oxygen, and foster systems improvements.

Read more about our work to increase access to oxygen therapy for newborns, children, and pregnant women here.

But the work doesn’t stop there. Our HO2PE campaign will increase awareness about oxygen’s use and availability and its impact on saving precious breath and life around the world. Our aim is to elevate oxygen access as a priority health issue for decision-makers in LMICs.

Accessing oxygen therapy for severe pneumonia and other indications should not be a matter of location or luck. Together, we can put oxygen on the front lines of global health. Discuss access to oxygen with your country decision-makers and counterparts, and encourage them to prioritize oxygen access for the most vulnerable. Join us in sharing hope, and help us spread the word about the importance of oxygen therapy.