COVID-19 in Malawi: lessons in pandemic preparedness from a tertiary children's hospital.
COVID-19 in Malawi: lessons in pandemic preparedness from a tertiary children's hospital.
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DOI：
10.1136/archdischild-2020-319980
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发表时间：
2021-03
影响因子：
5.2
通讯作者：
Department of Paediatrics, Queen Elizabeth Central Hospital
中科院分区：
文献类型：
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作者：
Chaziya J;Freyne B;Lissauer S;Nielsen M;Langton J;O'Hare B;Molyneux L;Moxon C;Iroh Tam PY;Hoskyns L;Masanjala H;Ilepere S;Ngwira M;Kawaza K;Mumba D;Chimalizeni Y;Dube Q;Department of Paediatrics, Queen Elizabeth Central Hospital
非洲的COVID-19疫情曲线落后于欧洲。马拉维的第一例SARS-CoV-2病例于4月2日得到确认。1马拉维关闭了学校和机场，但没有实施“封锁”，因为认识到经济和卫生服务中断对人口造成的风险。2虽然总体确诊率较低，但到7月，全国范围内的病例检测证实了社区传播。尽管如此，到医院就诊的急性病例数量仍然低于预期。目前全国确诊的COVID-19病例总数刚刚超过6000 1，其中布兰太尔地区占全国总数的三分之一。3位于布兰太尔的伊丽莎白女王中央医院是马拉维南部地区的三级转诊医院。这一流行病加剧了与有限的人力和物力资源有关的现有挑战。公众恐惧和卫生保健工作者（HCW）静坐与个人防护设备（PPE）不足的担忧有关，扰乱了服务，并导致患者就诊延迟。我们成立了一个多学科COVID-19工作组，与医院、地区和国家领导人合作，协调旨在减轻COVID-19大流行对员工和儿科患者的直接和间接风险的活动。我们现在反思并分享我们在QECH儿科部门的流行病准备方面的初步经验教训。在大流行的最初几个月，有越来越多的证据表明，医院传播和职业暴露的风险很高。4 5作为回应，马拉维卫生部建立了独立于中央医院的COVID-19治疗中心。这一政策对儿科具有挑战性，因为世卫组织用于隔离的临床病例定义与大多数住院儿科诊断重叠。有限的诊断导致了不适当的隔离风险，高风险儿童和监护人不必要地暴露于COVID-19，并降低了对急性不适儿童的专科护理水平。我们从两个方面处理这个问题。首先，我们与地区卫生团队合作，在当地隔离设施提供儿科培训和咨询。其次，我们在急诊科（艾德）设立了新冠肺炎确诊区，在确诊为新冠肺炎之前，疑似病例可在此稳定病情，并接受气泡持续气道正压通气等专科服务。最终，这一方法优先考虑儿童个人的权利，同时与更广泛的公共卫生战略保持一致。个人防护设备短缺是一个世界性问题，在低收入国家更为突出。低收入和中等收入国家卫生部的采购工作因供应链中断、定价失控以及捐助和协调机构大幅削减而受到阻碍。提供个人防护设备对保持工作人员士气和服务至关重要。2月份，我们面临着PPE短缺的真实的威胁。我们获得了两个有效的资源：强大的、权力下放的领导和社区团结。QECH的部门和医院领导层有权进行变革和创新。我们推出了“COVID-19应对”活动，团队成员可以自由利用他们的合作伙伴关系。我们收到了来自学术合作伙伴、当地慈善机构和宗教团体的现金捐款，用于开发可重复使用的礼服洗衣服务、个人防护装备、布口罩、水卫生和个人卫生用品以及洗手液。虽然我们的医院受益于许多先前存在的合作伙伴关系，但在此过程中建立了许多新的关系。
The COVID-19 pandemic curve in Africa has lagged behind that of Europe. The first case of SARS-CoV-2 in Malawi was confirmed on 2 April. 1 Malawi closed schools and airports, but no ‘lockdown’was enforced in recognition of the risk to a population vulnerable to economic and health service disruption. 2 Although overall ascertainment was low, detection of cases nationwide confirmed community transmission by July. Nonetheless, the number of acute cases presenting to hospital remained less than expected. The current total number of confirmed COVID-19 cases nationwide is just over 6000 1 with Blantyre district contributing one-third of the nationwide total. 3 Queen Elizabeth Central Hospital (QECH) in Blantyre is the tertiary referral hospital for the Southern Region of Malawi. The pandemic heightened existing challenges related to limited human and material resources. Public fear and healthcare worker (HCW) sit-ins associated with concerns around inadequate personal protective equipment (PPE) disrupted services and contributed to delayed patient presentation. We established a multidisciplinary COVID-19 task force to work with hospital, district and national leaders in the coordination of activities aimed at mitigating the direct and indirect risks of the COVID-19 pandemic on staff and paediatric patients. We now reflect and share our initial lessons in pandemic preparedness in the Department of Paediatrics at QECH. In the early months of the pandemic, there was mounting evidence that the risk of nosocomial transmission and occupational exposure was high. 4 5 In response, the Ministry of Health of Malawi developed COVID-19 treatment centres separate from central hospitals. This policy was challenging for paediatrics as the WHO clinical case definition used for isolation overlaps with the majority of in-patient paediatric diagnoses. Limited diagnostics led to a risk of inappropriate isolation, unnecessary exposure of high-risk children and guardians to COVID-19 and a reduced level of specialty care for acutely unwell children. We addressed this issue on two fronts. First, we collaborated with the district health team to provide paediatric training and consultation at the local isolation facility. Second, we developed a respiratoryCOVID zone in the emergency department (ED) where suspected cases could be stabilised and receive specialist services such as bubble continuous positive airway pressure ventilation prior to assigning a diagnosis of COVID-19. Ultimately, this approach prioritises the rights of the individual child while aligning with the broader public health strategy. Shortages of PPE has been a worldwide issue, more prominent in low-income countries. The procurement efforts of Ministries of Health in low-income and middle-income countries (LMICs) have been hampered by disruption to supply chains, uncontrolled pricing and drastic cuts to donor and coordinating agencies. The provision of PPE is essential to maintaining staff morale and services. In February, we faced the real threat of PPE shortage. We accessed two effective resources; strong, devolved leadership and community solidarity. Departmental and hospital level leadership at QECH is empowered to progress change and innovate. We launched a ‘COVID-19 response’campaign, and team members were free to leverage their partnerships. We received cash donations to develop a reusable gown laundry service, PPE items, cloth masks, water sanitation and hygiene items and hand sanitiser from academic partners, local charities and religious groups. Although our hospital benefitted from many pre-existing partnerships, many new relationships were forged in this process …
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DOI：
10.1093/cid/ciaa1605
发表时间：
2021-10-05
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Geretti AM;Stockdale AJ;Kelly SH;Cevik M;Collins S;Waters L;Villa G;Docherty A;Harrison EM;Turtle L;Openshaw PJM;Baillie JK;Sabin CA;Semple MG
通讯作者：
Semple MG
影响因子：
2.4
作者：
Nosek CA;Buck WC;Caviness AC;Foust A;Nyondo Y;Bottomani M;Kazembe PN
通讯作者：
Kazembe PN
影响因子：
3.3
作者：
Ben-Farhat, Jihane;Schramm, Birgit;Pujades-Rodriguez, Mar
通讯作者：
Pujades-Rodriguez, Mar
影响因子：
1.8
作者：
Harris, Caroline;Mills, Rowena;Kennedy, Neil
通讯作者：
Kennedy, Neil
DOI：
10.23749/mdl.v111i3.9767
发表时间：
2020-06-26
期刊：
La Medicina del lavoro
影响因子：
--
作者：
Garzaro G;Clari M;Ciocan C;Grillo E;Mansour I;Godono A;Borgna LG;Sciannameo V;Costa G;Raciti IM;Bert F;Berchialla P;Coggiola M;Pira E
通讯作者：
Pira E