COVID-19 assistance to soum health centers assessment of service capacity and oxygen demand

Abstract

Background: The disease was diagnosed by the World Health Organization (WHO) on March 11, 2020 in Wuhan, Hubei Province, China.1 As of March 26, a total of 480.1 million cases were registered worldwide, of which 6.1 million were deaths, while a total of 467’957 cases were registered in Mongolia, of which 2’177 cases were deaths.3,4 The interim guidelines for the diagnosis and treatment of new coronavirus infections (COVID-19) approved by order A/33 of the Minister of Health provide for titration of oxygen therapy according to the scheme.5,6 According to the survey, the oxygen supply of aimag general hospitals is 14% or unsatisfactory.7 Therefore, there is need to study availability of oxygen in soum health centers. Aim: Assess COVID-19 care capacity and availability of oxygen therapy in soum health centers and improve results. Objectives: 1. Assess the availability of oxygen treatment in soum health centers. 2. Assess the oxygen availability of soum health centers. 2. Develop a model to evaluate and improve oxygen treatment. Materials and Methods: The study was funded by the Japan Aid Foundation and co-sponsored by the Center for Health Development and the Aimag Health Department. Oxygen availability and accessibility surveys of 329 soum health centers in Mongolia were conducted in accordance with the SARA and Primary Care Assessment Questionnaire.8,9 The data analyzed from the survey were based on SPSS 24 software. Results: The number of deaths in COVID19 in the aimags is directly related to the average distance between the aimag general hospital and the soum health center (p value=0.036 or statistically significant). Inadequate oxygen therapy in COVID19 is strongly correlated with mortality. The Peerson correlation coefÏcient is 0.776 (p value=0.0004 or statistically significant). Oxygen cylinders (PCC=0.721, p value=0.0001), pulse oximeter (PCC=0.423, p value=0.027), reducer (PCC=0.576, p value=0.008), flow meter, humidifier (PCC=) required for oxygen therapy 0.605, p value=0.005), oxygen connector (PCC=0.647, p value=0.002), nasal tube (PCC=0.709, p value=0.0006), face mask (PCC=0.602, p value=0.001), backpack mask (PCC=0.686, p value=0.001) is directly related to mortality. Inadequate oxygen therapy in COVID-19 is directly related to the number of oxygen-equipped vehicles. The Peerson correlation coefÏcient is 0.461 (p value=0.041 or statistically significant). 13.9% (286’151) of the soum population became ill with Covid-19 infection, of which 23.7% (67’817) were transported to the aimag. Out of 329 soum health centers, 163 soums were hospitalized. There are no medical specialists in 299 soum health centers (90.8%) who can transport patients and provide oxygen therapy during the Kovid-19 epidemic. Soum health centers have an average oxygen supply of 12.5%. Selenge and Umnugovi aimags have a 20% deficit. Dundgovi, Bulgan, Khovd, Sukhbaatar and Khuvsgul aimags have 56% -95%, and soums in 14 other aimags have no oxygen bombs at all. 119 soums (36%) have ambulances equipped with oxygen support to transport patients from the soum to the next level health facility.38, 100 km 63 (19%), 200 km 129 (40%), 300 km 54 (17%) and 400 km 10 (3%) are 50 km away from the general hospital of aimag. Discussion: As a result of the Ministry of Health’s response, a mini-oxygen plant was established in the aimag’s general hospitals to improve the results.10,11 This will further improve the oxygen supply to primary care units, especially soum health centers.12 Depending on the distance to remote soums 13 For example, if a 200 km road is supplied with oxygen at a flow of 15 l/min for 6 hours, it is assumed that 2 bombs of 20 liters are oxygen. 14.15 Conclusion: The soum health center has a high mortality rate due to the lack of doctors, medical professionals, oxygen supply, equipment, and knowledge of oxygen therapy during COVID-19 infection, vehicles equipped for emergency care, and lack of transport readiness. In order to improve the availability and availability of oxygen bombs in the soums, it is necessary to increase the supply of oxygen bombs in the soums, assuming that one bomb per 100 km will be used.