Dr. Arthur Kwizera has won a £533,825 (about 2billion shillings) from Wellcome Trust for a clinical trial to assess whether low cost, high-flow oxygen therapies reduce need for intensive care admission and death in patients with acute hypoxemic respiratory failure (AHRF) in Uganda.
The award falls within the Wellcome Innovation for Impact in Lower- and Middle-Income Countries Flagship which aims to support innovations and new technologies to prevent and treat disease.
Kwizera, a senior lecturer in Makerere University’s Department of Anaesthesia and PhD student with Training of Health Workers into Vocational Excellence in East Africa (THRiVE), will assess the efficacy of high-flow oxygen through a nasal cannula or continuous positive airway pressure (CPAP) system in improving survival of AHRF patients.
This is in comparison with the commonly used mechanical ventilator. AHRF, a condition characterized by inadequate oxygen in one’s blood, is the commonest reason for intensive care unit (ICU) admission and death globally.
“The first step in improving critical care in Africa is to tackle the burden of mortality from AHRF. I believe that death can be reduced by use of cost-effective innovations in diagnosis and oxygen delivery such as CPAP and high flow nasal cannulas. This multicenter prospective trial will determine whether these low-cost interventions can reduce death among patients,” Dr Kwizera said in an interview.
A high-flow nasal cannula works by delivering heated and humidified oxygen, as much as 60 litres per minute, through nasal cannulas whereas CPAP therapy works by a machine pumping a gentle and steady pressure of air through a mask fitted over one’s nose and mouth into the lungs’ airways. Both these techniques are affordable and non-invasive (do not require introduction of instruments into the body) unlike the mechanical ventilator. In patients with AHRF, the need for invasive mechanical ventilation is associated with high mortality, especially in low-income countries like Uganda.
Moreover, owing to the inadequate ICU equipment and personnel to care for the critically ill in Uganda, he says there is need for affordable strategies to optimize patient oxygenation therapy and survival outcomes.
“Doing this will create a cascade of quality improvement in African acute care units to manage other conditions such as septic shock where fluid resuscitation management equally depends on management of AHRF,” Kwizera explained.
The clinical trial, Adult Respiratory InterventionS Evaluation in Africa (ARISE), will be conducted at six Ugandan hospitals and evaluate 470 patients for 16 months.
Participating hospitals are: Mulago National Referral Hospital; St. Mary’s Hospital Lacor in Gulu district; Mbarara; Jinja; Masaka and Mbale Regional Referral Hospitals. These were selected based oxygen availability. For the trial, Dr. Kwizera has secured 25 cost-effective High Flow Nasal Cannulas and 250 CPAP masks from New Zealand based manufacturer – Fisher and Paykel.
“ARISE is the first step of an ambitious program to tackle AHRF in Africa. Lessons learned will help streamline efforts in future large scale multi-national studies in Africa,” Dr Kwizera remarked.
The trial builds on his PhD research focused on determining the prevalence of acute respiratory failure in Uganda and effect of respiratory interventions to improve outcomes.