OPT-bCPAP

The challenge

Pneumonia is responsible for the deaths of an estimated 750,000 children under 5 years of age every year, 14% of all deaths in this age group. Countries in sub-Saharan Africa have some of the highest mortality rates from pneumonia, including Nigeria (first) and Ethiopia (fourth). 

Pneumonia is caused by a range of bacterial and viral pathogens and is responsible for a huge number of deaths, which are preventable if the condition is recognised early and care is optimised. The main challenge in pneumonia is hypoxaemia – low bloodstream oxygen levels – and providing children with supplementary oxygen can make the difference between life and death.

In severe cases in high-income countries, mechanical ventilators are used to deliver oxygen under pressure to the lungs, which ensures that air sacs in the lungs (alveoli) remain inflated. In low-resource settings, a lower-cost alternative is provided by bCPAP (bubble continuous positive airway pressure), which uses simple, readily available materials to deliver oxygen under pressure. Oxygen is delivered via modified nasal prongs, which can be fitted by nurses. 

Although several studies in low- and middle-income countries have demonstrated dramatic improvements in survival associated with bCPAP use, in some cases by up to a third, a trial in Malawi found an increased risk of harm. This likely reflects an issue with the implementation of the new approach, highlighting the importance of conducting implementation research to identify key factors associated with the successful introduction of bCPAP into routine clinical practice. 

The project

The OPT-bCPAP project is supporting the introduction of bCPAP (bubble continuous positive airway pressure) at sites in high-burden countries (Ethiopia and Nigeria) and in Malawi. It is drawing on the experience of trials that have been carried out in Bangladesh, Ethiopia and Ghana, which demonstrated the potential survival benefits associated with bCPAP use.

During rollout, the project team is monitoring a range of factors that could potentially affect the success of bCPAP. These include adherence to treatment guidelines, healthcare-seeking behaviour and timeliness of treatment, the prevalence of respiratory syncytial virus (RSV, an important non-bacterial cause of pneumonia), levels of resistance to commonly used antibiotics, and the pharmacodynamics/pharmacokinetics of antibiotic treatments. Antibiotic resistance or inadequate antibiotic treatments could be factors contributing to poor clinical outcomes. 

The project is being carried out in close collaboration with national policymakers, and data is also being generated on the cost-effectiveness of the bCPAP approach. 

Impact

The OPT-bCPAP project is generating data on one of the biggest killers of young children in sub-Saharan Africa. It will: 

• Provide policymakers with key evidence on the clinical impact of bCPAP (bubble continuous positive airway pressure) on child survival and its cost-effectiveness.
• Identify the main factors associated with the successful implementation of bCPAP in routine care in a range of sub-Saharan African countries.
• Generate guidance and other materials that could be used to support implementation in other settings.
• Reveal other potential factors affecting survival, including those linked to antibiotic use, that could be used to optimise the treatment of pneumonia.

By identifying key factors associated with the implementation of bCPAP, the OPT-bCPAP project will increase the likelihood of successful introduction of an affordable technology that could potentially save the lives of thousands of young children every year.