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Pediatric COVID-19 in Lesotho and Post-pandemic Implications on Lower Respiratory Infections in Children
Kristen S Joseph1,2, Tiiso D Lekhela3, Michael R Rose1
1Global Program for Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.
Insights
Pediatric COVID-19 hospitalizations in Lesotho were low, with most children receiving oxygen. However, healthcare worker training revealed knowledge gaps in identifying severe pediatric respiratory illness, impacting post-pandemic care.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- Respiratory Medicine
Background:
- The USAID RISE program supported Lesotho's COVID-19 response, including two national treatment centers.
- Evaluating post-pandemic pediatric respiratory care status in Lesotho was crucial.
- This study analyzed pediatric patient data and healthcare worker (HCW) training performance.
Purpose of the Study:
- To assess the burden of severe pediatric COVID-19 disease in Lesotho.
- To evaluate the effectiveness of pediatric COVID-19 training for HCWs.
- To identify potential gaps in pediatric respiratory care post-pandemic.
Main Methods:
- Retrospective cohort study of pediatric patients (<15 years) hospitalized between May 2020 and April 2022.
- Analysis of patient data from hospital files.
- Assessment of HCW knowledge using pre- and post-training examinations on pediatric COVID-19.
Main Results:
- Pediatric hospitalizations (<15 years) represented 1.2% of total admissions (18/1,448).
- Hypoxemia was present in 22% within 24 hours and 44% during hospitalization; oxygen use increased significantly.
- HCW training showed significant improvement in post-training scores (average 32.2% increase), indicating knowledge gaps were addressed.
Conclusions:
- Lesotho experienced a low burden of severe pediatric COVID-19.
- Significant knowledge gaps among HCWs in identifying and referring critically ill children were identified.
- These gaps may negatively affect ongoing post-pandemic care for children with severe lower respiratory infections.
Abstract:
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.
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