RESUMO
Affordable novel strategies are needed to treat COVID-19 cases complicated by respiratory compromise in resource limited settings. We report a mixed-methods pre-post assessment of 1) the useability of CPAP/O2 helmet non-invasive ventilation (NIV) to treat COVID-19, at [~] 1% the cost of mechanical ventilation; 2) the effectiveness of a train-the-trainer practice facilitation intervention; and 3) whether use of CPAP/O2 helmet NIV was associated with increased COVID-19 infection among healthcare workers. At baseline, eight COVID-19 treatment centers in Nigeria (CircumVent network) received CPAP/O2 helmet systems, and were instructed on its use. After five months, clinicians within the CircumVent netwok participated in a 2-day train-the-trainers educational intervention. The physicians completed i) standardized forms on patient demographics, clinical course, and outcomes for patients seen in the treatment centers; ii) standardized surveys of feasibility and acceptability of use of CPAP/O2 helmet systems; and iii) in-depth-interviews to explore facilitators and barriers to implementation of CPAP/O2 helmet NIV. Physicians described the CPAP/O2 helmet ventilator as easy to use and they felt comfortable training their staff on its use. They rated CPAP/O2 helmet NIV as feasible, acceptable, and appropriate (mean score of 4.0, 3.8, and 3.9 out of 5, respectively, on standardized scales). Case report forms for 546 patients with suspected and/or confirmed COVID-19 infection were obtained between May 2020 and November 2021. Of these, 69% (n=376) were treated before the training; and 29.7% (n=162) were treated with CPAP/O2 helmet ventilation. CPAP/O2 helmet NIV was well-tolerated by patients, with 12% reporting claustrophobia, and 2% reporting loose- or tight-fitting helmets. Although patient outcomes improved among CPAP/O2 helmet users overall, this was not associated with training (P=0.2). This finding persisted after adjustment for disease severity at presentation. Serosurvey of 282 health workers across treatment centers revealed that 40% (n=112) were seropositive for SARS-CoV-2. Seropositivity was significantly associated with direct contact with COVID-19 patients and limited access to PPE and hand hygiene during aerosol generating procedures (P = 0.02), but not use of CPAP/O2 helmet (Ps [≥] 0.2). In conclusion, physicians effectively used CPAP/O2 helmet NIV systems to treat COVID-19 patients in Nigeria without need for practice facilliation of their training and without increased risk of infection among healthcare workers. The use of CPAP/O2 helmet NIV could be an important strategy for treating individuals with COVID-19 infection and other disease conditions complicated by respiratory distress, particularly in settings were resources such mechanical ventilation are limited.
RESUMO
Introduction: Infant feeding choices made by mothers in the context of HIV infection depend on a number of factors. In our environment, the relative contribution of some of these factors is not known. Methods: The infant feeding practices of HIV positive mothers seen over a decade (July 2004 and December 2015) at a large HIV treatment centre in Lagos, South-western Nigeria were reviewed. Information on maternal socio-economic characteristics, obstetric, HIV treatment history and infant feeding choices were extracted from the program data base for analysis with SPSS version 20. Results: Exclusive formula feeding (EFF) was the most common feeding practice of the mothers ( 86.4%). However, it decreased from 95.3 % before 2010 to 79.5% after 2010. Exclusive breastfeeding (EBF) was practised by only 9.0% of the mothers. Mixed breastfeeding practice increased from 1.1% pre-2010 to 4.1% post-2010. The provision of free infant formula was found not to influence significantly the EFF or EBF rates but the MBF rate. MBF rate decreased from 3.0% pre-free formula to 1.7% after the introduction of free infant formula. Conclusion: Exclusive formula feeding was the most practised infant feeding method in this study (86.4%). Change in infant feeding guidelines was found to influence the infant feeding choice of HIV positive mothers. Health workers implementing PMTCT programs in our setting should be made aware of the risk of mixed breastfeeding with the new guidelines and educate mothers on its dangers at every contact with the health system.
