Oxygen therapy in acutely unwell adults in low resource settings

Oxygen is a basic requirement for life. But complex issues arise in critically unwell patients who need oxygen supplementation as part of their clinical care. These issues relate to: physiology (how much oxygen is enough); clinical therapy (how should this oxygen be delivered); health systems (how can we provide appropriate oxygen resource and how should this be targeted to need). This project picks up these questions to inform care at a patient and a health systems level. 

Where does this project lie in the translational pathway?


What are the methodological aspects (including quantitative skills training elements if appropriate) of the PhD project?

Longitudinal analysis of oxygen requirement in critically unwell patients to inform clinical care. This involves intensive data collection of non-invasive patient observations, and modelling of oxygen need according to disease presentation, and trajectory.

Modelling of demand and supply of oxygen at a hospital level, to inform logistical and resource decisions.


What are the expected outputs (publications, funding, and impact) of the PhD project?

Publications: Would be expected to provide 3/4* REF-returnable papers

Impact: There is significant paediatric literature on oxygen therapy. In adults, very little has been done. Every hospital everywhere needs to provide oxygen, but in resource limited settings, there is a large evidence gap, and international policy is driven by opinion. We can rectify this.

What external industry links or training opportunities will be available (eg. industry, health agencies)?

Qualitative skills in Malawi (acceptability work surrounding resource allocation decisions)

Health systems / modelling of complex patient flow situations

Required skills/experience/aptitudes

Different facets of the project are accessible to medical professionals, and social science researchers

Publications that relate to this proposed project


Duke T, Wandi F, Jonathan M, Matai S, Kaupa M, Saavu M, et al. Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea. Lancet. 2008;372(9646):1328-33.


Evans H-GT, Mahmood N, Fullerton DG, Rylance J, Gonani A, Gordon SB, et al. Oxygen saturations of medical inpatients in a Malawian hospital: cross-sectional study of oxygen supply and demand. Pneumonia. 2012;1(1):3-6.


Aston SJ, Rylance J. Community-Acquired Pneumonia in Sub-Saharan Africa. Seminars in respiratory and critical care medicine. 2016;37(6):855-67.


Wheeler I, Price C, Sitch A, Banda P, Kellett J, Nyirenda M, et al. Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in Blantyre, Malawi: a prospective cohort study. PLoS One. 2013;8(3):e59830.


Catto AG, Zgaga L, Theodoratou E, Huda T, Nair H, El Arifeen S, et al. An evaluation of oxygen systems for treatment of childhood pneumonia. BMC Public Health. 2011;11 Suppl 3:S28.




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