New Research Highlights Urgent Need for Better Oxygen Care in Sub-Saharan Africa
A new multi-country study has revealed a stark and sobering truth: too many critically ill patients in Sub-Saharan Africa are suffering—and dying—from low oxygen levels due to inconsistent and inadequate care. The findings, published in the Annals of the American Thoracic Society, highlight a pressing need to improve how we monitor and manage oxygen therapy in hospitals.
Researchers tracked nearly 25,000 adult patients admitted to five hospitals in Kenya, Malawi, and Rwanda. They found that 7% of patients were hypoxemic (had dangerously low oxygen levels) on admission. Of the hypoxemic patients, 35% died during their hospital stay.
Surprisingly, over half of these patients experienced at least one day where their oxygen levels remained too low despite being in hospital. At the same time, more than 80% of oxygen therapy days showed signs of “over-oxygenation”—where patients received more oxygen than necessary. Both under- and over-oxygenation can be harmful and, in this study, 35% of hypoxemic patients died during their hospital stay.
What’s causing these gaps? A major issue is the lack of consistent documentation and monitoring. Only 18% of patients had full records of their oxygen levels and therapy on admission. Without this basic information, it’s incredibly difficult for clinicians to make informed decisions about treatment. And while some patients did receive advanced care like mechanical ventilation, nearly half of them still died—underscoring that we can’t rely on high-tech interventions alone.
“While the attributable mortality of hypoxemia itself is not known, the high prevalence and associated mortality of this condition suggest that interventions in oxygen therapy might improve outcomes for a large number of patients. The observed lack of systematic monitoring and titration of oxygen therapy further raises the possibility that implementation of protocols for oxygen titration could improve patient outcomes and conserve oxygen”
This is exactly where Essential Emergency and Critical Care (EECC) comes in.
EECC is a package of low-cost, high-impact interventions that any hospital, anywhere, can implement. It includes exactly the kinds of practices that were missing in this study: regular monitoring of vital signs like oxygen saturation (SpO₂), training health workers to recognize early signs of critical illness, and ensuring oxygen therapy is available and appropriately given.
The beauty of EECC is that it’s not about expensive equipment or specialist teams. It’s about doing the basics well and consistently. For example, using a pulse oximeter to monitor SpO₂, adjusting oxygen flow to keep levels in a safe range (usually 90–94%), and documenting these decisions clearly. These steps can mean the difference between life and death.
This study underscores a serious problem—but it also points to a practical solution. With support, training, and commitment to essential care, hospitals across Sub-Saharan Africa can dramatically improve outcomes for patients with hypoxemia and other life-threatening conditions.
At EECC Global, we’re working with partners around the world to make this vision a reality. Because no one should die for lack of oxygen—or the knowledge of how to use it wisely.