Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the Gynaecologic Oncology Unit of a tertiary hospital in South Africa.

OBJECTIVE: The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. MATERIAL AND METHODS: This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. RESULTS: The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers' cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92-11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73-14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. CONCLUSION: The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.

Pre- and intra -COVID-19 trends of contraceptive use among women who had termination of pregnancy at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg South Africa (2010-2020).

BACKGROUND: Contraception is a key prevention strategy for maternal morbidity and mortality and is an important component of postabortion care. The trend of contraceptive uptake can guide interventions among vulnerable individuals. The aim of the study was to determine the trends of immediate post-abortion contraceptive uptake among women who had induced abortion at a dedicated abortion centre in Johannesburg, South Africa. METHOD: This study was a retrospective cross-sectional and trend analysis of the contraceptive uptake among women who had legal termination of unwanted pregnancy at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1 January 2010 to 31 December 2020. We reviewed the nursing records and summaries of the induced abortion cases that were performed for the past eleven years from 1 January 2010 to 31 December 2020. The trends in the annual number of abortion seeking clients, annual contraceptive uptake rate (stratified by types), age of clients and gestational age at presentation were extracted into a spreadsheet for analysis. Join point regression modelling and Pearson's chi square were utilized to assess the trends and association between categorical variables. The trends before and during the Corona Virus disease(COVID-19) era were also compared. RESULTS: In all, 12,006 clients had induced abortion over the study period. Nearly half (n = 5915, 49.26%) of the clients were aged 26-40 years, one tenth (n = 1157, 9.64%) being teenagers and one third (n = 4619, 38.47%) between age 19-25 years. There was a 16.3% annual increase in the number of abortion clients performed at the facility from 2010 to 2014 and a gradual declining trend of about 9.2% per annum from 2014 to 2019. The overall postabortion contraceptive uptake rate was 74.5%. There was an initial 15.1% annual decline in contraceptive uptake per 100 clients from 2010 to 2014 and a subsequent increasing trend of about 11.1% per annum from 53.45 per 100 clients in 2014 to 98 per 100 clients in 2019. About 66.43% of the clients opted for injectable contraceptives. There was a reduction in the number of abortion seeking clients by 32.2% from 985 in 2019 to 668 in 2020 during the COVID-19 era. However, the contraceptive uptake was still high in 2020 (90.72%). There was no statistically significant relationship between the age group and the time periods. Thus, the distribution of the age group accessing the abortion services did not significantly change over the two time periods of 2010-2014 and 2015-2019. (P-value = 0.076). CONCLUSION: There was increased trends in postabortion contraceptive uptake among our clients from 2010 to 2020. Although there was reduced number of performed induced abortion during the COVID -19 era, the contraception uptake rate was still high during the COVID-19 era. About 6 out of every 10 clients accepted injectable contraceptives. More education is needed to improve uptake of other long-acting contraception that may not require frequent contact with the health facility.

Assessment of the utility of a screening tool for COVID-19 diagnosis in an accident and emergency department in Lagos, Nigeria: A pilot study.

The use of reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard laboratory test for diagnosing SARS-CoV-2 infection. However, it has the disadvantage of a long turnaround time and cost. The Nigeria Centre for Disease Control (NCDC) formulated a case definition for COVID-19. We sought to determine the utility of a 14-item, point-weighted clinical screening questionnaire adapted from the NCDC case definition in identifying patients more likely to have the disease. This was to aid prompt clinical decision-making. Methods: We retrospectively reviewed the data of 113 non-surgical patients presenting to the Accident and Emergency Department (A and E) of Lagos University Teaching Hospital, Lagos, Nigeria. Patients were stratified based on screening scores into low (0-2), moderate (3-5) and high (6) pre-test categories. Patients with low and high scores ≥6 were admitted to the A and E and the COVID-19 holding ward, respectively, while the moderate group had chest computed tomography scans to aid further decision-making, pending the outcome of their RT-PCR results. The validity of the triage score as compared to the RT-PCR test result was calculated and the kappa score of agreement was utilised to evaluate the concordance between two triage scores. The optimum cut-off score was also obtained based on the maximal Younden's index. Results: The frequencies of low, moderate and high pre-test scores were 34 (30%), 43 (38.1%) and 36 (31.9%), respectively. Overall, 38.1% (43/113) were RT-PCR positive. RT-PCR was positive in 26.5% (9/34) with low screening scores, 55.8% (24/43) with moderate scores and 27.8% (10/36) with high scores. The sensitivity and specificity of a high score of 6 were 25% and 92.86%, while the lower score of 3 had sensitivity and specificity of 62.5% and 58.6%, respectively. Conclusion: The screening tool showed a high specificity in its initial design, which suggests that anyone with a low score using this tool has a high probability of testing negative. We recommend a cut-off score of 4 (score A) or 6 (score B) of the current screening tool be used to increase the chances of identifying persons with COVID-19 for RT-PCR testing.