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Abstract

Background: Supplemental oxygen (O2) is not always available at health facilities in low- and middle-45 income countries (LMICs). Solar-powered oxygen (SPO2) delivery can overcome gaps in O2 46 access, generating O2 independent of grid electricity. Methods: In a stepped wedge cluster randomized controlled trial, SPO2 systems (photovoltaic cells, 49 battery bank, and O2 concentrator) were sequentially installed at 20 rural health facilities in 50 Uganda. Children under five years of age hospitalized with hypoxemia and respiratory signs 51 were included. The primary outcome was mortality within 48-hours of detection of 52 hypoxemia. The statistical analysis used a linear mixed effects logistic regression model 53 accounting for cluster as random effect and calendar time as fixed effect. The trial is 54 registered, ClinicalTrials.gov Identifier: NCT03851783. Findings: Between 28 June 2019 and 30 November 2021, 2405 children were recruited and included: 57 964 pre-randomisation and 1441 post-randomisation. Use of O2 increased from 484/964 58 (50%) pre-randomisation to 1426/1441 (99%) post-randomisation (p