Retrospective mortality and prevalence of SARS-CoV-2 antibodies in greater Omdurman, Sudan: a population-based cross-sectional survey

BackgroundEven after adjusting for the expected lower severity due to the younger age of the population, relatively low SARS-CoV-2 incidence and mortality rates have been reported throughout Africa. For investigating whether this is truly the case, we conducted a survey to estimate the COVID-19 related mortality and cumulative incidence of SARS-CoV-2 infections in Omdurman the most populated city of the tripartite metropolis Khartoum in Sudan. MethodsA retrospective, cross-sectional, mortality and seroprevalence survey was conducted in Omdurman, Sudan, from March 1, until April 10 2021. A two-stage cluster sampling method was used to investigate the death rate for the pre-pandemic (January 1, 2019-February 29, 2020) and pandemic (March 1, 2020 - day of the survey) period using questionnaires. The seroprevalence survey was performed in a subset of households and all consenting members were tested with a rapid serological test (SD-Biosensor) and a subgroup additionally with ELISA (EUROIMMUN). Fishers exact test was used to assess differences between the pre-and pandemic periods and a random effect and Bayesian latent class model to adjust for test performance. FindingsData from 27315 people (3716 households) for the entire recall period showed a 67% (95% CI 32-110) increase in death rate between the pre-pandemic (0.12 deaths/10000 people/day [95% CI 0.10-0.14]) and pandemic (0.20 [0.16-0.23]) periods. Notably, a 74% (30-133) increase in death was observed among people aged [≥]50 years. The adjusted seroprevalence of SARS-CoV-2 was 54.6% (95% CI 51.4-57.8). The seroprevalence was significantly associated with age, increasing up to 80.7% (71.7-89.7) for the oldest age group ([≥]50 years). InterpretationOur results showed a significant elevated mortality for the pandemic period with a considerable excess mortality in Omdurman, Sudan. The overall high seroprevalence indicated a different age pattern compared to other countries, with a significant increase by age. FundingMedecins Sans Frontieres

The National Early Warning Score (NEWS2) systematically underestimates the risk of in-hospital mortality in unplanned COVID-19 admissions to hospital.

BackgroundAlthough the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring for deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We analysed the performance of National Early Warning Score (NEWS2) during the first phase of the COVID-19 pandemic. MethodsAdult non-elective admissions discharged between 11-March-2020 to 13-June-2020 with an index NEWS2 electronically recorded within {+/-}24 hours of admission are used to predict mortality at four time points (in-hospital, 24hours, 48hours, and 72hours) in COVID-19 versus non-COVID-19 admissions. ResultsOut of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7yrs), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (e.g.NEWS2=5: 36% vs 9%). InterpretationNEWS2 is a valid predictor of the mortality risk but substantially underestimates the absolute mortality risk in COVID-19 patients. Clinical staff and escalation protocols based on NEWS2 need to make note of this finding.

Association between the nationality of nurses and safety culture in maternity units of Oman

Background: Patient safety culture/climate in maternity units has been linked to better safety outcomes. Nurses have a crucial role in patient safety and represent the majority of staff in maternity units. In many countries, nurses are recruited from abroad, bringing their own perceptions of patient safety culture. Nonetheless, little is known about the relationship between perceptions of patient safety culture and nurses’ nationality. Understanding this relationship will assist stake-holders in designing a responsive programme to improve patient safety culture. Aims: To investigate the association between nurses’ nationality and their perceptions about patient safety culture in maternity units in Ministry of Health hospitals in Oman.Methods: In 2017, the Safety Attitude Questionnaire (SAQ) was distributed to all staff (892 distributed, 735 returned) in 10 maternity units.Results: About three-quarters (74%, 541/735) of the returned SAQs were completed by nurses, of whom 34% were non-Om-ani, 21.8% were Omani and 44.7% did not report their nationality (missing). Overall, the mean safety score for non-Omani nurses was significantly higher than for the Omani nurses: 3.9 (SD 1.3) vs 3.6 (SD 1.2) (P < 0.001). The mean safety score for stress recognition was significantly lower for non-Omani nurses: 2.8 (SD 1.5) vs 3.2 (SD 1.3) (P < 0.001). Conclusion: Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses except in respect of stress recognition. Decision-makers, directors, and clinicians should consider these differences when designing interventions to improve patient safety culture.

Contexte : Un lien a été établi entre la culture/le climat de sécurité des patients dans les services de maternité et de meilleurs résultats sur le plan de la sécurité. Les infirmiers(ères) jouent un rôle crucial dans la sécurité des patients et représentent la majorité du personnel des services de maternité. Dans de nombreux pays, les personnels infirmiers sont recrutés à l’étranger et apportent leurs propres perceptions de la culture de la sécurité des patients. Néanmoins, le lien entre les perceptions de la culture de la sécurité des patients et la nationalité des personnels infirmiers est mal connu. Comprendre ce lien aidera les parties prenantes à concevoir un programme pertinent pour améliorer la culture de sécurité des patients. Objectifs : La présente étude visait à examiner le lien entre la nationalité des personnels infirmiers et leurs perceptions de la culture de la sécurité des patients dans les services de maternité des hôpitaux du ministère de la Santé à Oman. Méthodes : En 2017, le « Safety attitudes Questionnaire » (SAQ) a été distribué à l’ensemble du personnel de dix services de maternité (892 questionnaires distribués, 735 questionnaires retournés). Résultats : Près des trois quarts (74 %, 541/735) des questionnaires SAQ retournés ont été remplis par des infirmiers(ères), parmi lesquel(le)s 34 % n’étaient pas omanais(es), 21,8 % étaient omanais(es) et 44,7 % n’avaient pas indiqué leur nationalité (manquante). Globalement, le score de sécurité moyen pour les personnels infirmiers non omanais était beaucoup plus élevé que pour ceux qui étaient omanais : 3,9 (E.T. 1,3) contre 3,6 (E.T. 1,2) (p < 0,001). Le score de sécurité moyen concernant la reconnaissance du stress était beaucoup moins élevé pour les personnels infirmiers non omanais : 2,8 (E.T. 1,5) contre 3,2 (E.T. 1,3) (p < 0,001). Conclusion : Les personnels infirmiers non omanais ont une perception plus positive de la culture de la sécurité des patients que les ceux qui sont de nationalité omanaise, excepté pour la reconnaissance du stress. Les décideurs, les directeurs et les cliniciens devraient prendre en compte ces différences pour concevoir des interventions visant à améliorer la culture de la sécurité des patients.