ABSTRACT
Objective: To describe the case frequency, incidence, and case fatality rate attributed to COVID-19 in children and adolescents in Barbados for the period March 2020-December 2021. Method(s): Using published case registries over the 22-month study period, incidence and case fatality rates of COVID-19 cases and deaths were classified by sex in the 0 to 18 years age group. Logistic regression was used to examine associations between post COVID-19 symptoms and age, sex and clinical classification. Result(s): A total of 6248 COVID-19 confirmed cases were documented in the 0 to 18-year age group, represented 21.7% of all reported cases, and constitutes 22.1% of the Barbadian population. Eighteen (0.3%) cases required hospital or specialist paediatric care. There was one fatality among hospitalized cases and one fatality attributed to multisystem inflammatory syndrome in children (MIS-C). In our sample of 292 children followed up at a pediatric clinic after discharge from isolation, the mean age was 8.8 years and 139 (47.6%) were male. Of 292, 37.5% were asymptomatic, 62.5% had mild/moderate symptoms. Post- COVID-19 symptoms were reported in 16 (5.5%, (95% 2.9%, 8.1%)) children. There were no significant differences in post-COVID-19 symptoms by gender or age. Children with mild/moderate symptoms were 9.7 times (95% CI 1.3, 74.5) more likely to have post-COVID-19 symptoms than those who were asymptomatic. Conclusion(s): In Barbados, case frequency and case fatality rate in children and adolescents was similar to reported incidence in North America. Despite school closures, children's infection rate was similar to their population proportion.
ABSTRACT
Objective: The COVID-19 pandemic has caused significant disruption to medical education and clinical training. This not only affected delivery of the clinical curriculum but also resulted in stressors which may impede learning. This study aimed to assess the impact of a modified on-line curriculum in selected clinical clerkships in the Faculty of Medical Sciences, UWI, Cave Hill Campus, during the COVID-19 pandemic. Design and Methods: Fourth and Fifth year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy (Online Learning Self-Efficacy Scale) and perceived effectiveness of online versus face-to-face learning. Students who agreed/strongly agreed to the statement "Overall, I was highly satisfied with the clerkship placement" were classified as satisfied. Result(s): 88 of 131 students completed the survey (response rate = 67 %). More than half of students (51%) were satisfied with online clerkship delivery. Fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% for face-to-face learning. Perception of effectiveness of online learning and face-to-face teaching of clinical skills was 18% and 89%, respectively (p < 0.0001). Fewer students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). Students satisfied with online learning were more likely to be female (OR = 2.6) and older respondents. Mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and social competencies. Students' perception of online learning was strongly associated with online selfefficacy. Conclusion(s): Students perceived online learning to be least effective for enhancing clinical skills. Students' perception of effectiveness of online learning was strongly associated with online self-efficacy. Further research to examine how the perception of online delivery impacts student performance in online learning is recommended. Educators have been challenged to design online programmes that facilitate development of clinical and social skills. Understanding medical students' experiences and identifying unmet needs will help improve clerkship curriculum and support medical students during and after the COVID-19 pandemic.
ABSTRACT
Objective: To describe the role of non-pharmacological interventions (NPIs) to the spread of COVID-19 in children and adolescents in Barbados for the period March 2020- December 2021. Design and Methods: A descriptive cross-sectional study utilizing published case registries over the 22-month study period. The incidence of COVID-19 cases and deaths were calculated and classified by sex , gender, as well as the month and year of diagnosis to identify trends in the numbers related to the total number of cases reported in the 0 to 18 years age group. The incidence data was correlated to the time of school closures and other NPI's . Result(s): A total of 6248 COVID-19 confirmed cases were documented in the 0 to 18-year age group, representing 21.7% of all reported cases, and constituting 22.1% of the Barbadian population. During the periods of school reopening the number of childhood cases remained low with small spikes following these periods. The incidence of COVID-19 was similar in the 0 to 4, and 5 to 14 age groups despite the 0 to 4 age group being in nursery school during the time of the second outbreak. Conclusion(s): The surge in childhood cases in Barbados did not reflect opening of schools and day care facilities, but rather seemed to correlate with the general rise in cases in the community in general. NPIs continued to keep similar incidence rates as those in North America, despite low vaccination rates in the childhood and adolescent populations.
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Objective: To identify factors associated with the need for supportive hospitalised care among children admitted for COVID-19. Design and Methods: A multicentre retrospective descriptive cohort of children <17 years , hospitalized with COVID- 19 in nine hospitals in Barbados, The Bahamas, and Jamaica from September 2020 to July 2021. The need for supportive therapy was explored by age, and among children with and without a range of comorbidities. Result(s): Among 238 hospitalized children, 56% were < 5 years of age. Comorbidities were present in 107 (45%), with proportionately more comorbidities among older children (> 5 years of age, p < 0.001). Comorbidities included asthma 21(9%), sickle cell disease 20 (8%), neurological 12 (5%) or cardiac 11 (5%) diseases, and diabetes 11 (5%). Multisystem Inflammatory Syndrome (MISC) was present among 32 (13%) children, and of these the largest proportion 12 (29%) were between 5 and 9 years of age (p = 0.04). All diabetic children had diabetic ketoacidosis (DKA), and 83% of neurology cases had seizures. Oxygen use was common among children with asthma (50%), obesity (75%) and MIS-C (40%). Blood products were required among children with MISC (40%), or with malignancy (50%). Almost three-quarters of children with MISC had additional complications, including liver dysfunction, acute kidney injury, and anaemia, and these children regularly required inotropes (22%), non-invasive ventilatory support (12%), or ICU admission (34%). Conclusion(s): Children with asthma, obesity, malignancy, diabetes and neurological disease require additional support with more ICU support needed in MISC cases. Care of vulnerable groups and early recognition and intervention for severe MISC should be prioritized.
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Objective: The objectives are to determine the incidence of malnutrition and anemia and evaluate the association of nutritional status and COVID-19-related clinical outcomes in children hospitalized for COVID-19. Method(s): This multi-island inpatient survey presents data from nine hospitals in three Caribbean islands in children from birth to 17 years from September 2020 to July 2021. We explore statistical associations with inpatient characteristics and potential differences between malnourished and well-nourished children. Result(s): Among children hospitalized for COVID-19, 6.8% were stunted, 6.6% were underweight, 13.6% were overweight/ obese, and 30% had anemia. Anemia was associated with multi-system inflammatory syndrome (MIS-C) in children but not with malnutrition. The prevalence of underweight children exceeded the 4.4% prevalence in the general pediatric population in islands and there was a greater-than-expected prevalence of overweight children hospitalized with COVID-19. No clear associations were detected between malnutrition and indicator outcomes. There were two deaths in children with severe malnutrition, COVID and septicemia identified after the study window. Conclusion(s): Hospitalizations exceeded baseline population rates of undernutrition but no significant associations were detected possibly due to small numbers. T cell activity is associated with less disease severity in SARS-CoV-2 infection and the diverse repertoire of naive T lymphocytes in children may confer protection to undernourished children. The deaths in two children with severe malnutrition and sepsis may suggest a compound effect on immunity by nutrition severity and COVID-19 disease. Overweight children in this cohort may reflect an increased prevalence of overweight children in the general population that requires further evaluation and intervention.
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Objective: There are few published reports concerning the impact of the COVID-19 pandemic on children in the Caribbean. The specific impacts of COVID-19 on Caribbean children aged 0-19 are examined. Method(s): Using standardized online questionnaire , primary data and published reports the burden of COVID-19 among children is evaluated. Result(s): Most islands have pediatric specialists, but few have designated pediatric hospitals. The higher number of cases among children is notable in islands with large populations such as Cuba, Jamaica, Trinidad, the Dominican Republic, and Haiti. The proportion of children among all cases in these islands range from 0.6%- 16.9% compared with a global case rate of 20.2%. As of August 2021, there were 33 cumulative deaths among children in Haiti, Jamaica, in Trinidad and Barbados. The case fatality rates (CFR) for 0-9-year-old and 10-19-year-old were 2.8 and 0.7 for Haiti, 0.1 and 0.2 for Jamaica, and 0 and 0.14 for Trinidad compared with and globally. Higher CFRs in Haiti may be related to the testing strategy, which may not identify all cases. However, low socioeconomic status and a poor healthcare system may have had an impact. Conclusion(s): Overall COVID-19 prevalence and mortality in children were consistent with global estimates. A standardized regional assessment and the multidimensional impact of the COVID-19 pandemic among children warrants further examination in light of limited resources and the potential lifelong impact of secondary effects.
ABSTRACT
Objective: 1. To identify training gaps in junior clerkship rotations during the COVID-19 pandemic. 2. To develop a Clinical Transition Selective Clerkship (CTSC) during Year 4. 3. To seek student feedback on organization and management of the CTSC. Design and Methods: An online cross-sectional survey of medical students was conducted during June-September 2021 to identify training gaps. In response to identified gaps, the 4-week CTSC was developed to provide further opportunities to develop core competencies. Result(s): Just under half of students reported the opportunity to observe (45.7%) and perform (44.5%) core skills >3 times during the medicine junior clerkship. For the surgical clerkship, 48.3% observed and 44.2% performed core skills 1-3 times. For child health, 39.6% observed and 34.8% performed skills 1-3 times. More than half of respondents (55.3%) expressed concern that they missed the usual clinical clerkship training experiences during online rotations. Three-quarters (74.5%) expressed the need to acquire additional clinical experience. The majority of students rated the following aspects of the CTSC as 'Good' or better: clarity of goals and objectives (58.3%);educational value/amount learned (56.2%);professionalism of faculty (66.7%) and other clinical staff (75%);usefulness of feedback (75%);workload challenge/level of material appropriate (70.8%);overall rating/quality of CTS (60.4%). However, the following aspects were rated as 'Poor' or "Fair": organization and coherency (77.1%);commitment of coordinators (64.6%);CTS achieved stated goals (62.5%). Conclusion(s): Our study identified training gaps in junior clerkship rotations during the COVID-19 pandemic. The CTSC provided opportunities to develop clinical competencies disrupted by the pandemic.