# Survival of hypoxaemic patients treated with solar-powered oxygen in rural Somalia hospitals: a prospective, observational study

## TL;DR

Solar-powered oxygen systems in rural Somalia hospitals improved survival for hypoxaemic patients during the pandemic, especially when treatment started early.

## Contribution

Demonstrates the effectiveness of solar-powered oxygen concentrators in improving survival in conflict-affected, low-resource settings.

## Key findings

- 1460 hypoxaemic patients were treated with solar-powered oxygen, resulting in 103 deaths.
- Patients aged 1–11 months and those with birth asphyxia had significantly higher death risks.
- Higher oxygen saturation levels on admission were linked to better survival outcomes.

## Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, solar-powered oxygen concentrator systems were established in rural hospitals of conflict-affected, hard-to-reach regions in Somalia to address acute gaps in oxygen access. We assessed the outcome of treatment of patients and risk factors for death among patients receiving oxygen for hypoxaemia in these settings in Somalia.

We analysed data on all patients receiving medical oxygen for hypoxaemia in six rural hospitals in Somalia equipped with solar-powered oxygen concentrator systems during the pandemic. The endpoint of the analysis was death. We used the Kaplan–Meier survival analysis and the log-rank test to compare survival curves. We used Cox proportional hazard model to determine the predictors of death.

We included 1460 patients (age from 1 day to 90 years) with hypoxaemia (peripheral blood saturation level <90%) treated with solar-powered oxygen concentrator systems in six rural hospitals in Somalia between February 2021 and December 2023. There were 103 deaths, 22 of which occurred within 24 h of detection of hypoxaemia in the hospital. The Kaplan–Meier survival analysis showed the cumulative hazard of death at 1.5% (95% CI 1.1–2.3%) during the first 24 h of admission, 11.9% (95% CI 8.1–17.3%) on day 7 post-admission conditional on surviving the first 24 h. Patients aged 1–11 months had a significantly increased hazard of death (aHR 7.71 [95% CI 2.54–23.41]) while those admitted with birth asphyxia were 4 times more likely to die compared to patients with pneumonia (aHR 3.83 [95% CI 1.12–13.06]). Improved patient outcomes were associated with higher oxygen saturation levels on admission. One unit increase in SpO2 level was associated with nearly 10% decrease in the hazard ratio of death (aHR 0.9 [95% CI 0.88–0.92]).

The availability of solar-powered oxygen concentrator systems can be a reliable solution to address oxygen insecurity in fragile, vulnerable health systems and conflict-affected countries, and can be associated with improved patient outcomes. Early detection and rapid initiation of oxygen therapy for hypoxaemic illness can support improved survival in patients of all ages, and with different conditions, if health care facilities without reliable electricity are fitted with solar-powered oxygen concentrator systems.

The authors have received no funding for this study.