ABSTRACT
SETTING: Six hospitals in four sub-Saharan African countries. OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models. DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality. RESULTS: During 2018–2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (− 575 vaccinations, P < 0.0001), outpatient visits (− 700 visits, P < 0.0001) and hospital admission (− 102 admission, P = 0.001);however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period;however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals. CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.
ABSTRACT
BACKGROUND AND OBJECTIVE Healthcare providers should use personal protective equipment (PPE) when performing aerosol generating medical procedures during highly infectious respiratory pandemics. We aimed to compare the timing of neonatal resuscitation procedures with or without PPE for prevention of SARS-CoV-2 transmission in a manikin model. METHODS A randomized controlled crossover (AB/BA) trial of resuscitation with or without PPE in a neonatal resuscitation scenario. Forty-eight participants were divided in 12 consultant-nurse teams and 12 resident-nurse teams (Figure 1). The primary outcome measure was the time of positive pressure ventilation (PPV) initiation. The secondary outcome measures were: duration of tracheal intubation procedure, time of initiation of chest compressions, correct use of PPE, and discomfort/limitations using PPE. RESULTS Timing of PPV initiation (consultant-nurse teams: mean difference 6.0 seconds, 95% confidence interval, CI 1.1-10.9;resident- nurse teams: mean difference 11.0 s, 95% CI 1.9-20.0), duration of tracheal intubation (consultant-nurse teams: mean difference 22.0 s, 95% CI 7.0-36.9;resident-nurse teams: mean difference 9.1 s, 95% CI 0.1-18.1) and chest compressions (consultant- nurse teams: mean difference 32.3 s, 95% CI 14.4-50.1;resident-nurse teams: mean difference 9.1 s, 95% CI 0.1-18.1). Twelve participants completed the dressing after entering the delivery room. PPE was associated with visual limitations (43/48 participants), discomfort in movements (42/48), limitations in communication (32/48) and thermal discomfort (29/48) (Table 1). DISCUSSION In our trial, the use of PPE increased the time of PPV initiation, the duration of tracheal intubation procedure and the initiation of chest compressions. In the simulation, all participants wore PPE (with some breaches of the dressing protocol) and more than half reported some PPE-related limitations or discomfort. The strengths of the study include the use of a high-fidelity manikin and the videorecording, the participation of both inexperienced and experienced healthcare providers, and the cross-over design. However, the reader should be aware of some limitations of the study. The simulation using a manikin implied that the procedures were performed under safe and secure conditions in a lower stress environment, although the trial simulated the exposure to a highly contagious neonate. CONCLUSIONS In a manikin model, using PPE delayed neonatal resuscitation procedures with potential clinical impact. Healthcare workers reported limitations and discomfort when wearing PPE.