Original article
Utility of solar-powered oxygen delivery in a resource-constrained setting
N. Conradia, K. Masumbuko Claudeb,c, B.E. Leea, A. Salehd, P. Mandhanea, M. Hawkesa,c,e,f,g,
Corresponding author
mthawkes@ualberta.ca
Corresponding author at: Department of Pediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.
Corresponding author at: Department of Pediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.
a Department of Pediatrics, University of Alberta, Edmonton, Canada
b Université Catholique du Graben, Butembo, Democratic Republic of Congo
c School of Public Health, University of Alberta, Edmonton, Canada
d Department of Surgery, University of Alberta, Edmonton, Canada
e Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada
f Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, AB, Canada
g Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada
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"apellidos" => "Conradi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 1 => array:3 [ "nombre" => "K. Masumbuko" "apellidos" => "Claude" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] ] ] 2 => array:3 [ "nombre" => "B.E." "apellidos" => "Lee" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Saleh" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0004" ] ] ] 4 => array:3 [ "nombre" => "P." 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"apellidos" => "Hawkes" "email" => array:1 [ 0 => "mthawkes@ualberta.ca" ] "referencia" => array:6 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0005" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0006" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0007" ] 5 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Department of Pediatrics, University of Alberta, Edmonton, Canada" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Université Catholique du Graben, Butembo, Democratic Republic of Congo" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "School of Public Health, University of Alberta, Edmonton, Canada" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Department of Surgery, University of Alberta, Edmonton, Canada" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada" "etiqueta" => "e" "identificador" => "aff0005" ] 5 => array:3 [ "entidad" => "Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, AB, Canada" "etiqueta" => "f" "identificador" => "aff0006" ] 6 => array:3 [ "entidad" => "Member, Women and Children's Research Institute, University of Alberta, Edmonton, AB, Canada" "etiqueta" => "g" "identificador" => "aff0007" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Department of Pediatrics, University of Alberta, 3-588D Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0002" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3654 "Ancho" => 3250 "Tamanyo" => 528888 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Stratified analysis of mortality differences amongst 100 infants and children hospitalized with hypoxaemia pre- and post-SP02 installation. Across all strata, there was a decrease in mortality in post-SPO2 compared to pre-SPO2. * - significantly different (<span class="elsevierStyleItalic">p</span> < 0.05); ** - significantly different (<span class="elsevierStyleItalic">p</span> < 0.01).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Introduction</span><p id="para0007" class="elsevierStylePara elsevierViewall">Pneumonia is a leading cause of mortality among children under 5 years of age, accounting for more than 800,000 deaths annually.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Oxygen (O<span class="elsevierStyleInf">2</span>) is an essential therapy for hypoxaemic illnesses, including pneumonia; however, O<span class="elsevierStyleInf">2</span> is often not available on paediatric wards in resource-constrained hospitals.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> In the current COVID-19 pandemic, O<span class="elsevierStyleInf">2</span> demand is expected to increase dramatically in low- and middle-income countries, exacerbating this pre-existing shortage.</p><p id="para0008" class="elsevierStylePara elsevierViewall">In resource-constrained settings, methods of delivering O<span class="elsevierStyleInf">2</span> include O<span class="elsevierStyleInf">2</span> cylinders and grid-powered O<span class="elsevierStyleInf">2</span> concentrators,<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> both of which are limited by cost and logistical issues.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Studies conducted in Uganda and Kenya reported that < 20% of paediatric wards in district hospitals have access to functional O<span class="elsevierStyleInf">2</span> delivery systems,<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> with facilities experiencing power outages 7% of the time.<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a></p><p id="para0009" class="elsevierStylePara elsevierViewall">Improved O<span class="elsevierStyleInf">2</span> delivery systems can lead to significant improvements in mortality from childhood pneumonia.<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> We have previously detailed the design and implementation of a novel method of O<span class="elsevierStyleInf">2</span> delivery capable of implementation in remote locations with limited access to consistent electrical supplies: solar powered oxygen (SPO2).<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Solar powered O<span class="elsevierStyleInf">2</span> involves photovoltaic cells to collect solar energy, which is then stored in a battery bank and used to power an O<span class="elsevierStyleInf">2</span> concentrator for the production of medical grade O<span class="elsevierStyleInf">2</span>. The feasibility, safety, and efficacy of SPO2 has been demonstrated through a proof-of-concept study and a randomized controlled trial, showing non-inferiority compared to cylinder O<span class="elsevierStyleInf">2</span> in terms of hospital length of stay, duration of O<span class="elsevierStyleInf">2</span> therapy, and recovery time.<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> An evaluation of the impact of SPO2 on mortality is warranted.</p><p id="para0010" class="elsevierStylePara elsevierViewall">The objective of this study was to compare the mortality among infants and children admitted with acute hypoxaemic respiratory illness at two resource-constrained hospitals in the Democratic Republic of the Congo (DRC) before and after installation of SPO2. We hypothesized that the introduction of a reliable source of O<span class="elsevierStyleInf">2</span> would be associated with a reduction in mortality, relative to the existing practice, in which the O<span class="elsevierStyleInf">2</span> supply was scarce and inconsistent.</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Study design</span><p id="para0011" class="elsevierStylePara elsevierViewall">This was a pragmatic, quasi-experimental study comparing the mortality amongst children under 5 years of age admitted with acute hypoxaemic respiratory illness before (pre-SPO2) and after (post-SPO2) the installation of SPO2 in two resource-constrained hospitals. Before-after designs have been used in several recent trials evaluating O<span class="elsevierStyleInf">2</span> systems in resource-constrained settings,<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> novel O<span class="elsevierStyleInf">2</span> delivery methods,<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> other respiratory therapies,<a class="elsevierStyleCrossRefs" href="#bib0013"><span class="elsevierStyleSup">13-15</span></a> and childhood infections.<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Although subject to limitations such as temporal trends, before-after study designs are effective research tools that, in some cases, have changed practice.<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> To mitigate potential biases inherent in this study design, we used prospective data collection with consistent reporting criteria and multivariable statistical methods to correct for potential confounding factors.</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Setting</span><p id="para0012" class="elsevierStylePara elsevierViewall">The DRC ranks 179<span class="elsevierStyleSup">th</span> out of 188 countries in terms of the human development index and 88% of the population lives on less than US $1.25 per day.<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> The mortality under five years of age is 300,000/year, with 45,000 deaths/year due to pneumonia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The delivery of health services is complicated by ongoing armed conflicts and security concerns, which contribute to the elevated mortality rates in these regions.<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> The DRC has also experienced outbreaks of Ebola virus, with the most recent outbreak in North Kivu beginning in August 2018, during this study's implementation. Availability of O<span class="elsevierStyleInf">2</span> remains poor across rural parts of the DRC.<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a></p><p id="para0013" class="elsevierStylePara elsevierViewall">The study enrolled hypoxaemic children admitted to two hospitals in Butembo, DRC. Matanda Hospital is a 260-bed facility, with a 6-bed intensive care unit. The solar powered O<span class="elsevierStyleInf">2</span> concentrator was installed in the intensive care unit during the present study. The Centre Hospitalier Universitaire du Graben is a 178-bed facility, with dedicated pediatric and neonatal wards. The solar powered O<span class="elsevierStyleInf">2</span> concentrator was installed in the neonatal ward during the present study. Of note, the solar powered O<span class="elsevierStyleInf">2</span> concentrators were not present during the pre-SPO2 period at either site. The two hospitals have a high ratio of patients to healthcare providers (approximately one nurse for every 20 patients). Each site was staffed by one general practitioner and one pediatrician. Fingertip pulse oximeters (ChoiceMMmed brand, 2018Beijing Choice Electronic Tech Co., Beijing, China) were used for spot checks of O<span class="elsevierStyleInf">2</span> saturation. Use of pulse oximetry was individualized and guided by the individual clinicians, according to clinical judgement.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Participants</span><p id="para0014" class="elsevierStylePara elsevierViewall">Patients presenting to selected sites meeting the following criteria were included: (1) age < 5 years; (2) hypoxaemia (O<span class="elsevierStyleInf">2</span> saturation < 90%); (3) warranted hospital admission based on clinical judgement.</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Intervention and Study procedures</span><p id="para0015" class="elsevierStylePara elsevierViewall">The solar powered O<span class="elsevierStyleInf">2</span> system has been previously described.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> In brief, the system consisted of locally sourced solar panels, charge controller, battery bank, DC/AC current inverter, and a 300 W O<span class="elsevierStyleInf">2</span> concentrator (model 525 KS, DeVilbiss, Healthcare LLC, Somerset, PA, USA).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> The system components were purchased from and installed by a Congolese non-profit association providing essential medicines and equipment throughout the DRC (Association Régionale D'Approvisionnement en Médicaments Essentiels, ASRAMES, Goma, DRC).</p><p id="para0016" class="elsevierStylePara elsevierViewall">Eligible participants’ parents or legal guardians were approached for written informed consent to participate in the study. The study's purpose, benefits, risks, confidentiality, and alternatives were explained to parents or legal guardians in the appropriate language. Patients received standard care for their underlying illness. Fifty patients were recruited in both in the pre- and post- implementation periods, a sample size similar to previous before-after designs in the field.<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">Demographic information and clinical data were collected from the medical records. After discharge, follow-up was done by telephone to determine vital status 30 days after admission (primary outcome). The need for O<span class="elsevierStyleInf">2</span> therapy was evaluated daily using standard operating procedures for weaning O<span class="elsevierStyleInf">2</span>. The final disposition of the patients was recorded (discharged with or without disability, transferred to another facility, absconded, death), and the length of stay was calculated amongst survivors.</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Outcome measures</span><p id="para0018" class="elsevierStylePara elsevierViewall">Our primary endpoint was mortality at 30 days post-admission. Secondary outcomes were in-hospital mortality (time to death), length of hospital stay among survivors, duration of O<span class="elsevierStyleInf">2</span> therapy (time to wean O<span class="elsevierStyleInf">2</span>), and O<span class="elsevierStyleInf">2</span> delivery system failure(s).</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Statistical considerations</span><p id="para0019" class="elsevierStylePara elsevierViewall">Descriptive statistics used number and percentage for binary variables and median with interquartile range for continuous variables. Comparative statistics used chi-squared or Fisher's exact test, as appropriate, for binary variables and Mann-Whitney U-test for continuous variables. Kaplan-Meier survival analysis was used to compare the time to death pre- and post-SPO2. We used stratified analysis to examine mortality across strata that could confound the association of SPO2 and mortality. There was no missing data pertaining to the primary outcome. We used logistic regression models to examine the effect of SPO2 on mortality while adjusting for clinical and statistical co-variates (R version 4.0.0, R Computing, Vienna, Austria). Model selection was guided by both biological and statistical considerations. Models were restricted to a maximum of five independent variables for parsimony and to avoid overfitting (limited sample size with 45 deaths).</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Ethics approval</span><p id="para0020" class="elsevierStylePara elsevierViewall">The study was approved by the Comité d’Éthique du Nord Kivu (Centre Hospitalier Universitaire du Graben, Butembo, DRC, Protocol number 005/TEN/2017) and by the Research Ethics Board of the University of Alberta (Study ID Pro00061203).</p></span></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Results</span><p id="para0021" class="elsevierStylePara elsevierViewall">Fifty patients were recruited between 1 September 2017 and 19 March 2018 (pre-SPO2). Solar-powered oxygen systems were installed in both hospitals from 5-8 October, 2018. Fifty patients were then recruited between 10 October 2018 and 1 August 2019 (post-SPO2). <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> shows the demographic and clinical features of the pre-SPO2 and post-SPO2 groups. Most differences between the pre-SPO2 and post-SPO2 groups were not statistically significant, with key data presented in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>. <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a> shows the treatment and outcome for patients enrolled pre- and post-SPO2.</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0022" class="elsevierStylePara elsevierViewall">The 30-day mortality among hypoxaemic infants and children was 30/50 (60%) pre-SPO2 and 15/50 (30%) post- SPO2 (<span class="elsevierStyleItalic">p</span> = 0.0049). This represents a relative risk reduction of 50% (95% CI 19 – 69%) and a number needed to treat of 3.3 (95% CI 2.1 – 8.8). The survival curves pre- and post-SPO2 differed significantly (hazard ratio 0.39 [95%CI 0.20-0.74], <span class="elsevierStyleItalic">p</span> = 0.0043, <a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>).</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0023" class="elsevierStylePara elsevierViewall">There was a significant reduction in the number of patients experiencing interruptions to their O<span class="elsevierStyleInf">2</span> therapy from 26/50 (52%) pre-SPO2 and 1/50 (2%) post-SPO2 (<span class="elsevierStyleItalic">p</span> < 0.0001). More specifically, there were fewer interruptions due to fuel shortages (12/50 [24%] to 0/50 [0%], <span class="elsevierStyleItalic">p</span> = 0.00023) and decreased need to share O<span class="elsevierStyleInf">2</span> therapy among multiple patients (14/50 [28%] to 1/50 [2%], <span class="elsevierStyleItalic">p</span> = 0.00039). The duration of O<span class="elsevierStyleInf">2</span> therapy and the total volume of O<span class="elsevierStyleInf">2</span> administered increased significantly from pre-SPO2 to post-SPO2 (<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>)</p><p id="para0024" class="elsevierStylePara elsevierViewall">Because of the quasi-experimental design, several potential confounding factors were identified to be different in the pre-SPO2 and post-SPO2 periods including site, markers of disease severity (presence of cough, tachycardia, deep breathing), primary diagnosis (malaria <span class="elsevierStyleItalic">versus</span> pneumonia, sepsis and other conditions), and co-treatments (intravenous glucose, third-generation cephalosporin, ampicillin, metronidazole, and antipyretics) (<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>). We performed a stratified analysis, examining the difference in mortality pre- and post- SPO2 in these subgroups (<a class="elsevierStyleCrossRef" href="#fig0002">Fig. 2</a>). We found a consistent reduction in mortality across multiple subgroups, suggesting that there was no confounding that would have affected the observed mortality difference pre- and post-SPO2.</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0025" class="elsevierStylePara elsevierViewall">We next constructed multivariable logistic regression models to adjust for potential effects of co-variates (Supplemental e-Table 1). Model 1 adjusted for disease severity (RISC, coded as a continuous variable) and diagnosis (categorical variable with four levels, pneumonia, sepsis, malaria, and other), and showed that the association between lower mortality post-SPO2 remained statistically significant (adjusted odds ratio 0.31 [95%CI 0.12-0.77], <span class="elsevierStyleItalic">p</span> = 0.013). Model 2 adjusted for potential factors affecting mortality based on statistical considerations. Cough and malaria were both statistically significantly associated with reduced mortality and were more frequent post-SPO2. In addition, although not statistically significant, treatment with cefotaxime/ceftriaxone and intravenous glucose were associated with reduced mortality and were more frequent post-SPO2. Model 2, adjusting for cough, malaria, cefotaxime/ceftriaxone, and intravenous glucose treatment, showed that the association between lower mortality post-SPO2 remained statistically significant (adjusted odds ratio 0.30 [95%CI 0.095-0.89], <span class="elsevierStyleItalic">p</span> = 0.033). In summary, the post-SPO2 period was consistently and robustly associated with decreased mortality in statistical models adjusting for potential factors associated with mortality that were different pre- and post-SPO2 (Supplemental e-Table 2).</p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Discussion</span><p id="para0026" class="elsevierStylePara elsevierViewall">This study found that implementation of SPO2 systems was associated with a 50% decrease in 30-day mortality in children with hypoxaemic respiratory illness. Installation of SPO2 systems was associated with a reduced frequency of interruptions to O<span class="elsevierStyleInf">2</span> therapy due to fuel shortages or need to share systems among multiple patients, suggesting an improvement in the quality of care being delivered.</p><p id="para0027" class="elsevierStylePara elsevierViewall">Oxygen availability remains a challenge in many resource-constrain settings around the world. In a survey conducted in Kenya, approximately 20% of rural healthcare facilities lacked O<span class="elsevierStyleInf">2</span> equipment. Of those with equipment, a third of their patients faced interruptions lasting a median of 11 minutes, with less than 20% having access to backup O<span class="elsevierStyleInf">2</span> cylinders.<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> In Uganda, only 18% of paediatric wards had access to functional O<span class="elsevierStyleInf">2</span> delivery systems.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Similar shortages have been reported in other resource-constrained settings across Africa.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> Similarly, in the current study, prior to SPO2 installation, 52% of patients experienced interruptions to their O<span class="elsevierStyleInf">2</span> therapy, half of which were due to fuel shortages leading to concentrator failure. After installing SPO2, only a single patient (2%) experienced an interruption to their O<span class="elsevierStyleInf">2</span> therapy, in their case due to multiple paediatric patients requiring the O<span class="elsevierStyleInf">2</span> concentrator simultaneously. Among survivors, the duration of O<span class="elsevierStyleInf">2</span> therapy and the total volume of O<span class="elsevierStyleInf">2</span> delivered were statistically significantly greater after SPO2 installation (<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>), reflecting fewer interruptions and greater O<span class="elsevierStyleInf">2</span> availability. Overall, these findings suggest that the lack of available O<span class="elsevierStyleInf">2</span> equipment together with frequent power interruptions contribute to the elevated mortality associated with hypoxaemic respiratory illnesses.</p><p id="para0028" class="elsevierStylePara elsevierViewall">While hypoxaemia is known to be associated with an increased risk of mortality in patients with acute respiratory illnesses, the mortality rate seen in our study before the implementation of SPO2 (60%) was higher than many past reports.<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> This may reflect the remote, rural, and severely resource-constrained hospitals selected for this study (e.g., lack of reliable access to O<span class="elsevierStyleInf">2</span> as well as ventilators). Danger signs (i.e., not able to drink, persistent vomiting, convulsions, lethargy, stridor at rest, or severe malnutrition)<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> were common in our cohort and were associated with subsequent mortality (Supplemental e-Table 1), consistent with previous studies. Of note, the frequency of danger signs and the RISC scores did not differ between the pre- and post-SPO2 periods, suggesting that the severity of presenting illness was comparable pre- and post-SPO2.</p><p id="para0029" class="elsevierStylePara elsevierViewall">There were a number of differences, besides mortality, in patients enrolled in the post-SPO2 period, relative to the pre-SPO2 period: higher proportion of patients from the CHU Graben; higher frequency of cough and deep breathing; lower frequency of tachycardia; and higher proportion diagnosed with malaria (<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>). Of these factors, only the presence of cough and a diagnosis of malaria were associated with decreased 30-day mortality (Supplemental e-Table 1). In a multivariable logistic regression model including these variables (Model 2, Supplemental e-Table 2), the association between SPO2 and decreased mortality remained statistically significant, suggesting that the higher proportion of children with cough and malaria post-SPO2 did not explain the observed mortality reduction.</p><p id="para0030" class="elsevierStylePara elsevierViewall">This study builds on our group's previous work evaluating SPO2 in resource-constrained settings. Previously, we have demonstrated proof-of-concept,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> non-inferiority relative to cylinder O<span class="elsevierStyleInf">2</span>,<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> and cost-effectiveness<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> of SPO2. The current study provides quasi-experimental evidence of mortality reduction associated with SPO2. Additional experimental evidence from cluster-randomized controlled trials will be needed to conclusively show that SPO2 reduces mortality. Currently, we are conducting a stepped-wedge cluster-randomized controlled trial of SPO2 at 20 sites across Uganda.<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0031" class="elsevierStylePara elsevierViewall">The median length of hospital stay was 6 days (interquartile range [IQR] 5-7) pre-SPO2 and 8 days (IQR 5-10) post-SPO2, a difference that approached statistical significance (<span class="elsevierStyleItalic">p</span> = 0.054). The possible prolongation of duration of admission may be due to delay in discharge with improved recognition of clinically apparent hypoxaemia that resulted from increased use of pulse oximeters with our study. Of note, one previous randomized controlled trial demonstrated that SPO2 was not associated with prolonged length of stay, relative to cylinder O<span class="elsevierStyleInf">2</span>.<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">Our study has several limitations. Quasi-experimental before-after designs are subject to the confounding effects of time and lack a distinct control group.<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Indeed, imbalance in co-treatments (e.g., intravenous glucose) pre- and post-SPO2 were directly attributable to improvements in patient care that arose as a result of our study. Potential confounding variables were examined through stratified analyses (<a class="elsevierStyleCrossRef" href="#fig0002">Fig. 2</a>) and multivariable modelling (Supplemental e-Table 2). Nonetheless, further investigation is required to conclusively show mortality benefit of SPO2. The limited samples size (50 patients in each group) restricted the number of co-variates that could be included in multivariable models. This sample size is small relative to the burden of disease globally and relative to the patient volumes treated at the participating facilities. A larger study would be desirable to comprehensively adjust for co-variates. Moreover, replication of these findings in other resource-constrained settings would be needed to demonstrate the generalizability of these findings.</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Conclusions</span><p id="para0033" class="elsevierStylePara elsevierViewall">SPO2 installation was associated with a marked reduction in mortality among children hospitalized with hypoxaemia in two resource-constrained hospitals. SPO2 is an innovative and simple approach to providing therapeutic O<span class="elsevierStyleInf">2</span> to resource-constrained settings. Its ease-of-use, cost-effectiveness, and efficacy in decreasing childhood mortality make it an accessible and effective solution to the high burden of childhood pneumonia. O<span class="elsevierStyleInf">2</span> requirements have spiked globally during the ongoing COVID-19 pandemic, and SPO2 can provide a useful countermeasure in resource-constrained settings.</p></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Conflict of interest</span><p id="para0034" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Funding</span><p id="para0035" class="elsevierStylePara elsevierViewall">This study was funded by <span class="elsevierStyleGrantSponsor" id="gs0001">The Rotary Foundation</span> (Rotary Global Grant <span class="elsevierStyleGrantNumber" refid="gs0001">GG1755779</span>). The funder had no role in the study design, analysis and interpretation or results, or decision to publish the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Prior Abstract Publication/ Presentation</span><p id="para0036" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1924423" "titulo" => "Abstract" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Research question" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Study design" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "abss0005" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "abss0006" "titulo" => "Interpretation" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1659284" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0002" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0004" "titulo" => "Setting" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Participants" ] 3 => array:2 [ "identificador" => "sec0006" "titulo" => "Intervention and Study procedures" ] 4 => array:2 [ "identificador" => "sec0007" "titulo" => "Outcome measures" ] 5 => array:2 [ "identificador" => "sec0008" "titulo" => "Statistical considerations" ] 6 => array:2 [ "identificador" => "sec0009" "titulo" => "Ethics approval" ] ] ] 4 => array:2 [ "identificador" => "sec0010" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0011" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0012" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0013" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "sec0014" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0015" "titulo" => "Prior Abstract Publication/ Presentation" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-06-28" "fechaAceptado" => "2021-11-20" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1659284" "palabras" => array:7 [ 0 => "Pediatrics" 1 => "Oxygen" 2 => "Oxygen delivery" 3 => "Solar power" 4 => "Pneumonia" 5 => "HYPOXIA" 6 => "Global health" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Background</span><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Pneumonia is a leading cause of childhood mortality globally. Children with severe pneumonia associated with hypoxaemia require oxygen (O<span class="elsevierStyleInf">2</span>) therapy, which is scarce across resource-constrained countries. Solar-powered oxygen (SPO2) is a novel technology developed for delivering therapeutic O<span class="elsevierStyleInf">2</span> in resource-constrained environments.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Research question</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Is the introduction of SPO2 associated with a reduction in mortality, relative to the existing practice?</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Study design</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">This was a pragmatic, quasi-experimental study comparing mortality amongst children < 5 years of age with hypoxaemic respiratory illness before and after the installation of SPO2 in two resource-constrained hospitals.</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Methods</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Participants were children < 5 years old admitted with acute hypoxaemic respiratory illness. The intervention was SPO2, installed at two resource-constrained hospitals. The primary outcome was 30-day mortality. Secondary outcomes included in-hospital mortality (time to death), length of hospital stay among survivors, duration of O<span class="elsevierStyleInf">2</span> therapy (time to wean O<span class="elsevierStyleInf">2</span>), and O<span class="elsevierStyleInf">2</span> delivery system failure(s).</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Results</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">Mortality amongst children admitted with acute hypoxaemic respiratory illness decreased from 30/50 (60%) pre-SPO2 to 15/50 (30%) post-SPO2 (relative risk reduction 50%, 95%CI 19 – 69, <span class="elsevierStyleItalic">p</span> = 0.0049). The post-SPO2 period was consistently associated with decreased mortality in statistical models adjusting for potential confounding factors. Likewise, survival curves pre- and post- SPO2 differed significantly (hazard ratio 0.39, 95% CI 0.20 – 0.74, <span class="elsevierStyleItalic">p</span> = 0.0043). A reduction in the frequency of O<span class="elsevierStyleInf">2</span> delivery interruptions due to fuel shortages and multiple patients needing the concentrator at once was observed, explaining the mortality reduction.</p></span> <span id="abss0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Interpretation</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Solar-powered oxygen installation was associated with decreased mortality in resource-constrained settings.</p></span>" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Research question" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Study design" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "abss0005" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "abss0006" "titulo" => "Interpretation" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 859 "Ancho" => 1667 "Tamanyo" => 74895 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Survival analysis of 100 infants and children hospitalized with hypoxaemia. The survival curves were significantly different pre- and post-SPO2 implementation (hazard ratio 0.39 [95% CI 0.20-0.74], <span class="elsevierStyleItalic">p</span> = 0.0043).</p>" ] ] 1 => array:8 [ "identificador" => "fig0002" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3654 "Ancho" => 3250 "Tamanyo" => 528888 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Stratified analysis of mortality differences amongst 100 infants and children hospitalized with hypoxaemia pre- and post-SP02 installation. Across all strata, there was a decrease in mortality in post-SPO2 compared to pre-SPO2. * - significantly different (<span class="elsevierStyleItalic">p</span> < 0.05); ** - significantly different (<span class="elsevierStyleItalic">p</span> < 0.01).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Values represent n (%) unless otherwise specified</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (<span class="elsevierStyleItalic">N</span> = 100) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-SPO2 (<span class="elsevierStyleItalic">N</span> = 50) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Post-SPO2 (<span class="elsevierStyleItalic">N</span> = 50) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0006"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Demographics</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age [months] median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 (0-8.2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.2 (0-10) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 (0-4.8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> <2 months \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42 (42) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">19 (38) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">23 (46) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> 2-59 months \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">58 (58) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">31 (62) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27 (54) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">48 (48) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">22 (44) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">26 (52) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Site \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.0088 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> CHU Graben \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">44 (44) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (30) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29 (58) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Matanda Hospital \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">55 (55) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">35 (70) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">21 (42) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0046"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Clinical features</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Cough \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">72 (72) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">26 (52) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">46 (92) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Fever prior to admission \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">68 (68) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29 (58) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39 (78) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.054 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Unable to feed or drink \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">70 (70) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36 (72) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">34 (68) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0066"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Vomiting everything \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">10 (10) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 (12) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Lethargic \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">79 (79) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">40 (80) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39 (78) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0076"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Convulsions \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">28 (28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 (28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 (28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Physical findings</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0086"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Severely underweight<a class="elsevierStyleCrossRef" href="#tb1fn1"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">33 (33) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">19 (38) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 (28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Mid-upper arm circumference [mm], median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">110 (100-130) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">110 (100-130) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">120 (100-130) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0096"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">SpO<span class="elsevierStyleInf">2</span> [%], median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">70 (60-78) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">70 (60-77) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">71 (60-80) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0101"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Temperature [°C], median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38 (36-38) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38 (36-38) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38 (36-38) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Tachycardia<a class="elsevierStyleCrossRef" href="#tb1fn2"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24 (24) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">17 (34) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">7 (14) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.035 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Tachypnea<a class="elsevierStyleCrossRef" href="#tb1fn2"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">28 (28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12 (24) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">16 (32) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0116"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Chest indrawing \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">80 (80) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37 (74) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">43 (86) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0121"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Deep breathing \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">69 (69) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27 (54) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">42 (84) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.0025 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0126"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Composite clinical severity score</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0131"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">RISC, median (IQR)<a class="elsevierStyleCrossRef" href="#tb1fn3"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 (5-6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 (5-6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 (5-6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0136"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Laboratory</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Haemoglobin [g/L], median (IQR)<a class="elsevierStyleCrossRef" href="#tb1fn4"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">110 (90-130) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">110 (90-120) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">110 (90-130) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0146"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Glucose [mmol/L], median (IQR)<a class="elsevierStyleCrossRef" href="#tb1fn5"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4.4 (3-7.2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6.7 (3.4-9.9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3.2 (3-4.5) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.037 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Primary diagnosis</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0155"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0156"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">33 (66) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">16 (32) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">17 (34) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0161"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Sepsis \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29 (29) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18 (36) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">11 (22) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0166"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Malaria \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20 (20) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5 (10) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (30) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0171"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Neonatal respiratory distress syndrome \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 (18) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4 (8) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5 (10) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0176"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Bronchiolitis \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 (4) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0181"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Congenital heart disease \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 (3) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3 (6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0186"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Ebola virus disease \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0189"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0190"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0191"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Other<a class="elsevierStyleCrossRef" href="#tb1fn6"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 (4) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0195"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:6 [ 0 => array:3 [ "identificador" => "tb1fn1" "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="notep0002">Less than 3 standard deviations below the mean weight for age<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a></p>" ] 1 => array:3 [ "identificador" => "tb1fn2" "etiqueta" => "2" "nota" => "<p class="elsevierStyleNotepara" id="notep0003">Less than 99<span class="elsevierStyleSup">th</span> percentile of the vital sign for age</p>" ] 2 => array:3 [ "identificador" => "tb1fn3" "etiqueta" => "3" "nota" => "<p class="elsevierStyleNotepara" id="notep0004">Respiratory Index of Severity in Children<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p>" ] 3 => array:3 [ "identificador" => "tb1fn4" "etiqueta" => "4" "nota" => "<p class="elsevierStyleNotepara" id="notep0005">Hemoglobin was measured in 89 (89%) of children</p>" ] 4 => array:3 [ "identificador" => "tb1fn5" "etiqueta" => "5" "nota" => "<p class="elsevierStyleNotepara" id="notep0006">Glucose was measured in 40 (40%) of children</p>" ] 5 => array:3 [ "identificador" => "tb1fn6" "etiqueta" => "6" "nota" => "<p class="elsevierStyleNotepara" id="notep0007">Other primary diagnoses: malformation, meningitis</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Characteristics at admission of 100 children under 5 years of age hospitalized with hypoxaemia.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0004" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0196"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0197"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Overall (<span class="elsevierStyleItalic">N</span> = 100) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0198"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Pre-SPO2 (<span class="elsevierStyleItalic">N</span> = 50) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0199"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Post-SPO2 (<span class="elsevierStyleItalic">N</span> = 50) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0200"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0201"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Oxygen treatment</span></td></tr><tr title="table-row"><a name="en0202"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Duration of O<span class="elsevierStyleInf">2</span> therapy [hours], median (IQR)<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">16 (9.7-48) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0204"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6.5 (4.0-24) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20 (12-57) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.0049 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0207"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Total volume of O<span class="elsevierStyleInf">2</span> delivered [× 1000 L], median (IQR)<a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">39 (22-110) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (9.0-68) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">50 (31-120) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0211"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.0049 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0212"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> SpO<span class="elsevierStyleInf">2</span> at last encounter [%], median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0213"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">91 (52-95) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">81 (55-96) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">94 (42-95) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0217"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Interruptions to O<span class="elsevierStyleInf">2</span> therapy \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0218"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27 (27) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0219"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">26 (52) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0220"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0221"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0222"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>  Fuel shortages \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0223"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12 (12) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0224"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12 (24) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0225"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0226"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.00023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0227"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>  Multiple patients \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0228"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (15) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0229"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">14 (28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0230"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0231"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.00039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0232"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Antibiotic Use</span></td></tr><tr title="table-row"><a name="en0233"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Ampicillin \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0234"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 (9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0235"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8 (16) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0236"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0237"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0238"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Gentamicin \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0239"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">59 (59) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0240"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29 (58) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0241"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">30 (60) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0242"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">>0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0243"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Cefotaxime or Ceftriaxone<a class="elsevierStyleCrossRef" href="#tb2fn2"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0244"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">93 (93) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0245"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">43 (86) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0246"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">50 (100) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0247"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0248"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Metronidazole \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0249"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">10 (10) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0250"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 (18) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0251"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1 (2) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0252"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0253"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Other<a class="elsevierStyleCrossRef" href="#tb2fn3"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0254"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9 (9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0255"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">7 (14) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0256"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2 (4) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0257"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0258"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Other Treatments</span></td></tr><tr title="table-row"><a name="en0259"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Intravenous glucose \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0260"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">73 (73) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0261"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">26 (52) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0262"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">47 (94) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0263"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0264"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> Antipyretics \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0265"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">60 (60) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0266"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24 (48) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0267"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">36 (72) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0268"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.025 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0269"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Length of Stay, median (IQR)</span><a class="elsevierStyleCrossRef" href="#tb2fn1"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0270"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">7 (5-9) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0271"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">6 (5-7) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0272"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">8 (5-10) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0273"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.054 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0274"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Mortality</span></td></tr><tr title="table-row"><a name="en0275"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> At 48 hours after admission \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0276"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">30 (30) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0277"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">18 (36) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0278"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">12 (24) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0279"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0280"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> In hospital \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0281"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">43 (43) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0282"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">30 (60) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0283"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">13 (26) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0284"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.0012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0285"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span> At follow-up 30 days after admission \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0286"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">45 (45) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0287"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">30 (60) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0288"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (30) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0289"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.0049 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tb2fn1" "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="notep0008">Among survivors (<span class="elsevierStyleItalic">N</span> = 55)</p>" ] 1 => array:3 [ "identificador" => "tb2fn2" "etiqueta" => "2" "nota" => "<p class="elsevierStyleNotepara" id="notep0009">As ceftriaxone or as combination ceftriaxone-tazobactam (brand name Tazex®)</p>" ] 2 => array:3 [ "identificador" => "tb2fn3" "etiqueta" => "3" "nota" => "<p class="elsevierStyleNotepara" id="notep0010">Other antibiotics included azithromycin (2), amoxicillin (1), amoxicillin-clavulanate (1), cefpodoxime (1), clindamycin (1), vancomycin (1), levofloxacin (1), and antituberculous medications (1)</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Clinical management and outcomes of 100 children under 5 years of age hospitalized with hypoxaemia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C Troeger" 1 => "M Forouzanfar" 2 => "PC Rao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2017" "volumen" => "17" "numero" => "11" "paginaInicial" => "1133" "paginaFinal" => "1161" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oxygen availability and nursing capacity for oxygen therapy in ugandan paediatric wards" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J Nabwire" 1 => "S Namasopo" 2 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 7 | 21 |
| 2024 October | 74 | 52 | 126 |
| 2024 September | 77 | 46 | 123 |
| 2024 August | 75 | 52 | 127 |
| 2024 July | 60 | 42 | 102 |
| 2024 June | 57 | 30 | 87 |
| 2024 May | 52 | 35 | 87 |
| 2024 April | 41 | 39 | 80 |
| 2024 March | 50 | 28 | 78 |
| 2024 February | 50 | 24 | 74 |
| 2024 January | 73 | 33 | 106 |
| 2023 December | 51 | 22 | 73 |
| 2023 November | 56 | 55 | 111 |
| 2023 October | 58 | 48 | 106 |
| 2023 September | 73 | 45 | 118 |
| 2023 August | 149 | 42 | 191 |
| 2023 July | 225 | 83 | 308 |
| 2023 June | 36 | 14 | 50 |
| 2023 May | 58 | 33 | 91 |
| 2023 April | 29 | 31 | 60 |
| 2023 March | 73 | 24 | 97 |
| 2023 February | 52 | 18 | 70 |
| 2023 January | 36 | 26 | 62 |
| 2022 December | 69 | 26 | 95 |
| 2022 November | 63 | 37 | 100 |
| 2022 October | 63 | 44 | 107 |
| 2022 September | 42 | 44 | 86 |
| 2022 August | 34 | 38 | 72 |
| 2022 July | 62 | 67 | 129 |
| 2022 June | 36 | 35 | 71 |
| 2022 May | 44 | 39 | 83 |
| 2022 April | 51 | 48 | 99 |
| 2022 March | 56 | 59 | 115 |
| 2022 February | 76 | 46 | 122 |
| 2022 January | 100 | 104 | 204 |
| 2021 December | 48 | 33 | 81 |
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