Dataset Information

Changes in children's surgical services during the COVID-19 pandemic at a tertiary-level government hospital in a lower middle-income country.

ABSTRACT:

Objective

The aim of this study was to quantify the changes that occurred in the surgical services of children during the COVID-19 pandemic from the perspective of a low/middle-income country.

Design

A case-control study was conducted at a large referral centre in Bangladesh among patients aged ≤12 years. Comparisons were made between cases admitted during a period of 'April to September 2020' (Pandemic period) and controls during a similar period in 2019 (Reference period). The number of admissions and outpatient department (OPD) attendances, age and sex distribution, diagnosis, number and types of surgeries performed (elective vs emergency), variations in treatment of acute appendicitis, types of anaesthesia and mortality were compared.

Results

Admissions were only 41% of previous year (635 vs 1549), and OPD attendances were only 28% of previous year (603 vs 2152). Admission of children reduced by 65.8%, but neonatal admission reduced only by 7.6%. The median age of the admitted patients was significantly lower during the pandemic period (3 vs 4 years, p<0.01). Acute appendicitis (151, 9.8%) and trauma (61, 9.6%), respectively, were the the most common causes of admission during the reference and the pandemic period. Elective surgeries were only 17% and emergency surgeries were 64% of previous year (p<0.01). Appendectomy (88, 9.1%) and laparotomy (77, 17.6%), respectively, were the most common surgeries performed during the reference and the pandemic period. Conservative treatment of acute appendicitis was more during the pandemic period (47.5% vs 28.5%, p=0.01), but patients who underwent appendectomies had more complicated appendicitis (63.3% vs 42.1%, p=0.01). In all, 90.4% of surgeries were performed by resident doctors. There were no COVID-19- related deaths.

Conclusion

Trauma became the most common cause of admission during the pandemic, and neonatal surgical conditions remained almost unchanged with high mortality rates. Elective procedures and laparoscopy remained low and resident doctors played a major role in providing surgical services.

SUBMITTER: Farooq MAA

PROVIDER: S-EPMC8015790 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Background/introductionCOVID-19 pandemic has been at its peak for the past 6months and has affected more than 215 countries around the world. India is now the 2nd most-affected nation with more than 48,00,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation the number of deaths is almost 1/3rd of the USA and ½ of Brazil. There has, however, been no experience published from non-COVID designated hospitals where the aim is to manage non-infected cases with neurosurgical ailments while keeping the number of infected cases to a minimum.MethodsWe analyzed the number of neurosurgical cases (non-trauma) done in the past 5 months (March- July 2020) in our institute which is the largest neurosurgical center by volume in southern India and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time.ResultsWe operated a total of 630 cases(non-trauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (p=0.002) reduction in the number of cases operated as compared to the same 5 months in the preceding year. We employed a dual strategy of Rapid Antigen testing and surgery for cases needing emergency intervention and Reverse Transcriptase-Polymerase chain reaction test for elective cases. The hospital was divided into three zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists.ConclusionWe present a patient management protocol for non-COVID designated hospitals in high volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.

Project description:BackgroundIn low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair.MethodsAll cases of PAH related to left-to-right shunt CHD repairs from 2015-2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019-2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth's correction and restricted mean survival time were used for survival analysis.ResultsOf the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m2). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had -476.1 days (95% confidence interval [CI]: -714.4, -237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups.ConclusionIn low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.

Project description:Background: Knowledgeable in child development, primary school teachers in low- and middle-income countries (LMICs) have the potential to identify their students needing mental health care. Objective: We evaluated whether teachers in Darjeeling, India can accurately nominate school-aged children for mental health services after training and aided by a novel tool. Methods: In 2018, 19 primary school teachers from five low-cost private (LCP) schools in rural Darjeeling were trained to nominate children needing care. Teachers evaluated all of their students aided by a novel tool, 'Behavior Type and Severity Tool' (BTST), completed the Achenbach Teacher Report Form (TRF) as a mental health status reference standard, and nominated two students for care. Sensitivity and specificity of being nominated compared to TRF overall and subdomain scores were calculated. BTST performance was determined by comparing BTST and TRF scores and creating Receiver Operating Characteristic curves to determine optimal cutoffs. Multivariable regression models were used to identify demographic predictors of teacher accuracy using the BTST. Results: For students demonstrating a clinical or borderline score in at least one TRF subdomain, the sensitivity (72%) and specificity (62%) of teacher nomination were moderately high. BTST overall scores and TRF Total Problem scores were correlated (Spearman's ρ = 0.34, p < 0.0001), as were all subdomains. For the TRF Total Problem score, a maximum Youden's J of 0.39 occurred at BTST cutoff >4 for borderline struggles and 0.54 at the BTST cutoff >6 for clinical struggles. Younger teacher age, less education, less formal education training, and more years of experience were positively associated with teacher accuracy. Conclusions: With training and a simple decision support tool, primary school teachers in an LMIC nominated students for mental health services with moderate accuracy. With the BTST being weakly accurate, teachers' judgment largely accounted for the moderate accuracy of nominations.