Solar-powered solutions to oxygen delivery challenges in Uganda: the next steps

The COVID-19 pandemic re-emphasised the necessity of O2 delivery as a component of quality medical care.1 However, a number of other conditions require O2 therapy to improve outcomes, such as pneumonia, chronic obstructive pulmonary disease, and post-operative atelectasis.2 Although O2 availability and delivery systems in low-income and middle-income countries have become a topic of increasing research interest, few novel delivery systems have been implemented.3 The stepped-wedge, cluster randomised, controlled trial by Nicholas Conradi and colleagues is one such effort; the authors were involved in both the development of the solar-powered O2 delivery model, and in studying its mortality benefit.4 The researchers installed solar panels at 20 sites over the course of 2 years; the time preceding (referred to as before randomisation) and following (referred to as after randomisation) installation served as the comparison periods for each hospital. The primary outcome was mortality within 48 h. The study found that solar powered O2 delivery provided a relative risk reduction of 48·7% (95% CI 8·5–71·5) for 48-h mortality, and a number needed to treat of 45 (28–230) to save one life; the cost-effectiveness estimate was US $25 (6–505) for every disability-adjusted life-year (DALY) saved.4 The authors' conclusion, that increased availability of reliable O2 significantly reduces mortality in young children experiencing hypoxaemia, is unsurprising to those involved in clinical care.5,6 However, harnessing solar power as a more reliable form of energy to power O2 concentrators might be a crucial solution for hospitals with unreliable access to electricity. [...]the cost of $25 per DALY saved is similar to many low-cost and high-efficacy interventions currently funded by international philanthropy organisations.8 The goal put forth by the authors, that this technology be scaled up for increased O2 availability throughout low-resource settings, might prove more challenging.