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[DHAKA] A new way to deliver oxygen to children with severe pneumonia, called bubble-continuous positive airway pressure (bubble-CPAP), has been shown to have better outcomes than low-flow oxygen therapy which is standard in resource-poor settings.

Results of open, randomised trials of the new method, conducted by scientists of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and the University of Melbourne, published in The Lancet last month (August), showed decreased  mortality rate among under-five children on bubble-CPAP.

Mohammod Jobayer Chisti, a scientist at icddr,b who developed bubble-CPAP, tells SciDev.Net that the low-cost method holds promise for the treatment of children with severe pneumonia and hypoxaemia (low levels of blood oxygen) in areas with limited medical facilities.

The simple device — the trials involved no more than a discarded, plastic shampoo bottle and ordinary respiration tubes linked to an oxygen concentrator — works by maintaining sustained oxygen pressure to prevent lung collapse.

Regular CPAP equipment has been in use in middle and high-income countries for many years, but its high cost has kept it out of reach for most healthcare facilities in developing countries. In contrast bubble-CPAP is cheap and can be set up anywhere.
The team randomly picked 225 under-five children for the study that was conducted between August 2011 and July 2013. Subjects were placed into three study groups – one on bubble-CPAP, a second on standard low-flow oxygen and a third on high-flow oxygen therapy.

Mortality in children placed on bubble-CPAP therapy was significantly lower (four per cent) compared to those given standard low-flow oxygen therapy (15 per cent).

“If the death rate for severe pneumonia exceeds 10 per cent in our hospital and others, then we need to keep researching for better alternatives of treatment,” Chisti tells SciDev.Net. “This intervention with bubble-CPAP therapy could be a solution.”

Chisti said he was hopeful that the new device would be placed on the list of WHO recommended treatments for severe pneumonia and hypoxemia in under-five children in the near future.

Pneumonia is a leading cause of under-five childhood deaths globally and results from the inability of a child stricken with the condition to absorb enough oxygen from ambient air. A child with pneumonia and hypoxemia needs 100 per cent oxygen while ambient air has an oxygen concentration of only 20 per cent. 

Lutful Kabir, head of paediatrics at the Mitford Hospital, Dhaka, tells SciDev.Net that if the new device can be made available to most hospitals in poor countries it would “significantly reduce the number of deaths of children every year.”

Chisti, however, admits that to “scale up use of the low-cost bubble-CPAP in smaller hospitals with limited resources, a wider effectiveness trial may be required.”

>Link to full paper in The Lancet

This article has been produced by SciDev.Net's South Asia desk.