Cantab Oxygen Telemetry Analytics Project - COTAP

A mobile telemetry technology to significantly increase the supply of medical oxygen from oxygen concentrator machines deployed in Africa.  

Rupert Pearce Gould

Medical oxygen is a first line of defence in many diseases and pandemics as has been demonstrated by the Covid-19 pandemic.

In Low and Middle Income (LMI) countries medical oxygen provision is woefully inadequate and hypoxemia contributes to the avoidable deaths of over 800,000 m people in Africa. Many of these are children. Overall, 1 in 6 children under 5 and 1 in 5 newborns admitted to hospitals have hypoxemia. If medical oxygen was more widely available, particularly in rural areas then many of these deaths would be avoided. 

Much of the oxygen supply is provided by many small volume oxygen concentrator machines which purify air to medical grade oxygen.  We estimate that there are over 10,000 oxygen concentrators deployed in sub-Saharan Africa.

However, many of these units are non-functional often due to inadequate maintenance; in one country’s hospitals and clinics studied, between 30% and 70% of oxygen concentrators were unserviceable.

The problem COTAP aims to address is to increase the oxygen output of the installed base of oxygen concentrators where it is desperately needed, by monitoring, collecting and analysing equipment performance and then disseminating corrective actions to local maintenance service centres.

There are four groups whom the COTAP project will serve:

Symptomatic hypoxemic patients in Africa, many of whom will be children or new born, who require oxygen therapy to survive.

Doctors and medical staff who desperately need oxygen to treat their hypoxemic patients and where often there is none due to unserviceable equipment.

Medical facility managers and maintenance service organisations who will receive specific location and instructions to enable the oxygen concentrator installed base to be a reliable source of medical oxygen.

Regional and national public health authorities who will have a reliable, immediate and dynamic information system relating to medical oxygen usage and an ability therefore to plan ahead.

During the development of COTAP, CHL will develop in conjunction with WHO and oxygen concentrator manufacturers a standard for the integration of oxygen concentrator sensor electrical outputs for integration into a Data Telemetry Module (DTM) type device and also a standard format for transmission of data recorded from sensors in a DTM via mobile telephony to a receiving database.

It is anticipated that once the value of the COTAP technology and systems is recognised by healthcare providers and authorities then further purchases of oxygen concentrators will have the COTAP technology specified by funding bodies using the COTAP equipment and database standards developed during this programme.

The solution provides Oxygen from c 10 litres per min up to 100 litres per min in a monitored and reported manner.

Experts will be on hand that could analyse the data from a recognised centre such as Royal Papworth Hospital without having to visit the country concerned.  

It will also provide statistics to users and national health authorities.

The primary tangible impact of the COTAP programme if implemented will be the increased productivity of the existing inventory of oxygen concentrators in terms of the average volume of oxygen produced per machine and the total medical grade oxygen made available in initially pilot study regions and latterly countries in sub-Saharan African countries. 

The secondary tangible outcome will be the saving of thousands of lives of patients in Africa who suffer from hypoxemia and who desperately need medical oxygen to survive.

It will also enable better and more flexible control of oxygen supplies and also enable the early use of oxygen in rural and out of hospital areas such as care homes. This will provide an early relief of symptoms and this should lead to a reduction in hospitalisations.  

It can be used with oxygen concentrators when used for other lung sufferers. 

Starting with a Pilot Study in Lagos State, Nigeria in year 1, the programme will scale in two dimensions.

Firstly, once any improvements identified during the Lagos pilot Study are identified and implemented in a second version, the COTAP operation will be successively trialled in Nigeria’s other states, subject to security constraints and establishing local maintenance service arrangements.

Secondly, a Pilot Study will be launched successively in Rwanda, Uganda and Kenya, utilising the expertise and contacts in those countries which have been developed by our supporter CHAI.

Thirdly, taking cognisance of the results from the Pilot Studies in Rwanda, Uganda and Kenya, national programmes will be rolled out in those three countries using experience and knowledge gained in Nigeria. Fourthly, using experience gained in Nigeria, the technical and database standards developed at that point will be made public; to 

Engineering World Health, www//ewh.org, has managed a programme of short term assignments of American student engineers to carry out site visits in sub-Saharan African medical setting to examine and repair oxygen concentrators.  This database of equipment status and operating efficiency will be compared with data compiled at the end of the 6 month Pilot Study in each country.

The comparators will be:

• the total percentage of concentrators operating at specified capacity and oxygen purity
• the difference in total medical grade oxygen capable of being produced (in litres/minute)
• the number of people treatable with oxygen that the difference represents

Finance is required to develop and demonstrate the value and power of the data and information the COTAP programme can provide to doctors, hospital administrators and healthcare authorities.  We believe that once the impact of COTAP is demonstrated then healthcare authorities will be disposed to adopt the technology in order to gain maximum productivity from their existing capital equipment.  As many oxygen concentrators are funded or donated by NGOs and charities, such funders should be receptive to specifying COTAP technology on new purchases specifically to achieve and demonstrate the impact of their investments.

COTAP will require access to local maintenance service teams in each operational area.  We intend to address this challenge by utilising our supporter CHAI’s local knowledge and contacts to make assessments and introductions to qualified service companies. Once a repair or service is completed, the Central Station Database will be automatically updated by the Data Telemetry Module, which in turn will record the details of the work and make the reimbursement  for the work; we anticipate that this will encourage a high degree of responsiveness in the service organisation.

Finally we will require Health Authority acceptance of our Data for projecting future oxygen supply capability. 

Prodrive

The Trinity Challenge has already introduced CHL to CHAI and we have developed a valuable relationship with them.  There are a number of advisory roles that the TTC could assist in by introductions to partners who will be well placed to give top level advice on our choice of database, cybersecurity and potentially governmental contacts in target countries when the time comes. The immediate reason for applying to the Trinity Challenge is to gain pump priming funding, and in country connections to take the project to Pilot Study phase and demonstration of impact

We have a good working relationship with CHAI which has invaluable experience and assets in our countries of interest.

We would like to take advice at a strategic level from experienced database developers, such as Microsoft, Google or Palantir to inform the design of our Central Station Database.

We would like to take advice from the Institute of Health Metrics to inform our security, government relations and governance considerations.