Joseph Kristen S, Lekhela Tiiso D, Rose Michael R, Gersz Lawrence, Mungati More, Shoba Matsosane, Montsi Sello, Leluma Sebaki F, Oyewusi Lawrence, Hansoti Bhakti, Mirembe Justine, Shilkofski Nicole A, Mahachi Nyikadzino, McCollum Eric D
Global Program for Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.
Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2024 Aug 1;16(8):e65938. doi: 10.7759/cureus.65938. eCollection 2024 Aug.
Background The United States Agency for International Development (USAID) Reaching Impact, Saturation, and Epidemic Control (RISE) program funded Jhpiego to support the Government of Lesotho's COVID-19 response, including two national COVID-19 treatment centers. To evaluate the status of post-pandemic pediatric respiratory care in Lesotho, we analyzed pediatric treatment center data and healthcare worker (HCW) performance on pediatric COVID-19 training offered to HCWs at COVID-19 treatment centers. Methods We conducted a retrospective cohort study of patients 15 years of age or less hospitalized at two COVID-19 treatment centers in Lesotho from May 1, 2020, to April 30, 2022. Patient data were extracted from hospital files. We used the independent sample t-test, Mann-Whitney U test, or Fisher's exact test to evaluate associations between exposure variables and death. We also assessed differences between pre- and post-training examination scores of three one-day HCW training on pediatric COVID-19 using paired t-tests. Results Overall, <15-year-olds comprised 18/1,448 (1.2%) hospitalizations. Twenty-two percent (4/18) of children were hypoxemic (oxyhemoglobin saturation <94%) within the first 24 hours and 44% (8/18) at any point in the hospitalization. Oxygen utilization increased over the two-year period (p=0.004) and all eight children with hypoxemia received oxygen (p<0.001). Four of 18 (22%) patients died. For HCW training, pre- and post-training examinations were completed by 76/82 (92.7%) participants. The overall mean pretraining score was 44.6% (standard deviation (SD) 15.7%). Mean scores improved by an average of 32.2% (95% confidence interval (CI) 27.7%, 36.6%, p<0.001) on the same day post-training examination. Conclusions National COVID-19 treatment center data indicate a low burden of severe pediatric COVID-19 disease in Lesotho. However, recognized HCW knowledge gaps suggest deficiencies in identifying and referring severely ill children, which may detrimentally impact the ongoing post-pandemic care of children with severe lower respiratory infections.
背景 美国国际开发署（USAID）的“实现影响、饱和与疫情控制”（RISE）项目资助了杰hpiego组织，以支持莱索托政府应对新冠疫情，包括两个国家级新冠治疗中心。为评估莱索托疫情后儿科呼吸护理的状况，我们分析了儿科治疗中心的数据以及在新冠治疗中心为医护人员提供的儿科新冠培训中医护人员（HCW）的表现。方法 我们对2020年5月1日至2022年4月30日期间在莱索托两个新冠治疗中心住院的15岁及以下患者进行了一项回顾性队列研究。患者数据从医院档案中提取。我们使用独立样本t检验、曼-惠特尼U检验或费舍尔精确检验来评估暴露变量与死亡之间的关联。我们还使用配对t检验评估了针对儿科新冠的为期三天的医护人员培训前后考试成绩的差异。结果 总体而言，15岁以下儿童占住院病例的18/1448（1.2%）。22%（4/18）的儿童在入院后的头24小时内出现低氧血症（氧合血红蛋白饱和度<94%），44%（8/18）的儿童在住院期间的任何时间出现低氧血症。在两年期间，氧气使用率有所增加（p = 0.004），所有八名低氧血症儿童均接受了氧气治疗（p<0.001）。18名患者中有4名（22%）死亡。对于医护人员培训，76/82（92.7%）的参与者完成了培训前后的考试。培训前的总体平均成绩为44.6%（标准差（SD）15.7%）。在培训后同一天的考试中，平均成绩平均提高了32.2%（95%置信区间（CI）27.7%，36.6%，p<0.001）。结论 国家级新冠治疗中心的数据表明，莱索托严重儿科新冠疾病的负担较低。然而，已认识到的医护人员知识差距表明在识别和转诊重症儿童方面存在不足，这可能会对重症下呼吸道感染儿童的疫情后持续护理产生不利影响。
