COVID-19 preparedness\u2014a survey among neonatal care providers in low- and middle-income countries

Claus Klingenberg,Anna Lavizzari,Sithembiso Velaphi,Khawaja Ahmad Irfan Waheed,Eleanor J Molloy,Danielle Ehret ,Nisreen Alkafi ,Néstor E Vain ,Sahil Tembulkar ,Alexander Stevenson ,John A.f Zupancic ,Gonzalo Mariani ,Ömer Erdeve ,Jean‐Michel Roué ,Charles C Roehr ,Víctor J Díaz ,Surender Singh Bisht,Hon Kin Cheong,Alejandra Barrero-Castillero,Jochen Profit

doi:10.1038/s41372-021-01019-4

Abstract

ObjectiveTo evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents.Study designCross-sectional, web-based survey administered between May and June, 2020.ResultsOf 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making.ConclusionsMany LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.

Highlights

The COVID-19 pandemic has hit the global community with disastrous consequences for health, economic, and social structures, not seen for the last century [1, 2]
This study follows on our prior survey describing neonatal COVID-19 guidelines in 20 predominantly high-income countries (HICs) in March 2020 [15]
We identified and contacted leading neonatologists from low- and middle-income countries (LMICs) on all continents through peer networking and pediatric societies’ member lists

Summary

Introduction

The COVID-19 pandemic has hit the global community with disastrous consequences for health, economic, and social structures, not seen for the last century [1, 2]. The pandemic has strained health care capacities in high-income countries (HICs) [3, 4]. These authors contributed : John A.F. Zupancic, Jochen Profit. Extended author information available on the last page of the article (LMICs) face even greater challenges with overwhelmed health care systems and substantial excess deaths [5,6,7]. The political environment, health system capacity, and ethnic and social inequality are among the factors potentially explaining differences in outcomes within and between countries and regions [8]

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Results

Conclusion