ABSTRACT
BackgroundThe impact of COVID-19 sanitary measures on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown. MethodsWe conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification ( infectious, chronic, and other). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation. FindingsData on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37.0 {+/-} 25.2 and 30.3 {+/-} 21.7 in 2016-2019 and 45.5 {+/-} 24.7 and 39{middle dot}5 {+/-} 23.3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366.5 and 358.25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394.75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2.39, 2017= 2.74, 2018= 2.39, 2019= 2.01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment. InterpretationDuring the implementation of COVID-19 sanitary measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations. Key PointsO_ST_ABSQuestionC_ST_ABSHow has the application of COVID-19 sanitary measures affected emergency medical consultations from March to July 2020 compared to previous years? FindingThe rates of infectious diseases decreased as rates of chronic diseases stayed stagnant with the application of sanitary measures. Among the infectious and chronic disease consultations, no racial/ethnic disparities were observed. MeaningUnderstanding the effects of the sanitary measures against COVID-19 in Sub-Saharan Africa has helped emphasize the possibility of limiting the spread of other infectious diseases in this part of the world where they are still highly prevalent and the efficiency of controlling the spread of the virus while avoiding racial/ethnic disparities.
ABSTRACT
ObjectiveTo evaluate the impact of the COVID-19 pandemic on the delivery of cardiology services in Africa. DesignCross-sectional e-survey study. SettingAfrican countries ParticipantsCardiologists Primary and Secondary outcomes measuresThe primary outcome was the change in service delivery in African cardiology units during the on-going COVID-19 pandemic. The secondary outcomes were the satisfaction of cardiologists with regards to the workload and factors associated with this satisfaction. ResultsThere was a significant reduction in working time and the number of patients consulted by week during this pandemic (p<0.001). In general, there was a decrease in the overall activities in cardiovascular care delivery. The majority of cardiology services (76.5%) and consulting programs (85%) were adjusted to the pandemic. Only half of the participants were satisfied with their workload. Reconfiguration of the consultation schedule was associated with a reduced satisfaction of participants (p=0.02). ConclusionsCOVID-19 is associated with an overall reduction in cardiology services rendered in Africa. Since the cardiovascular burdens continue to increase in this part of the World and the risk of cardiovascular complications linked to SARS COV2 remains unchanged cardiology, departments in Africa should anticipate a significant surge of cardiology services demanded by patients after the COVID-19 pandemic. Strengths and limitations of this studyO_LIThe study is one of the first African studies to report the impact of the COVID-19 pandemic on the delivery of cardiology services which are very important for Africans given the high prevalence of cardiovascular diseases in this continent. C_LIO_LIThe multinational design of the study leading to the inclusion of 14 African countries makes the results generalizable to the entire African. C_LIO_LIThe cross-sectional design of the study represents a major limitation as it remains impossible to either infer causality or untangle bi-directional relationships between the reduction of the delivery in cardiology services and the pandemic or participants satisfaction. C_LIO_LIAlso, the e-survey was drawn in English and this might have restricted the participation by some non-English African respondents due to the language barrier. Hence, perhaps contributing to the relatively small sample size of the study. C_LI
ABSTRACT
ObjectiveTo determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychloroquine and Azithromycin. DesignProspective study. SettingTreatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. ParticipantsWe enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200mg twice daily during seven days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main outcomes measuresThe primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. ResultsThe population (29 men and 22 women) was aged 39 {+/-} 11 years (range 17 to 61 years). Mean Tisdale score was 3.35{+/-}0.48. No significant change from baseline (D0) of QTc was observed at D7 (429{+/-}27 ms at D0 versus 396{+/-}26 ms at D7; p=0.27). A reduction of heart rate was observed between the D0 and D7 (75{+/-}13 bpm versus 70{+/-}13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95{+/-}10 ms versus 102{+/-}17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. ConclusionsNo life-threatening modifications of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.
