Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study

Kona Chowdhury,Natalie Schellack,Johanna C Meyer,Mahmuda Hassan,Nasim Jahan,Shaheen Akter,Susmita Biswas,Santosh Kumar,Marshall Gowere,Zia Ul Mustafa,Brian Godman,Sumala Ashraf,Abdul Malek,Afzalunnessa Binte Lutfor,Sifat Uz Zaman,Salequl Islam,Mohammod Didarul Islam,Mohammad Nazmul Hasan,Nihad Adnan,Amanj Kurdi,Nazmus Sihan,Arif Rabbany,Al Mamun Hossain,Enamul Karim,Habibur Rahman,Sylvia Opanga,Nurun Naher,Nadia Nusrat,Mainul Haque,Tanjina Chowdhury,Jebun Nesa,Najnin Akhter,Jesmine Akter,Mohammed Shaheen,Farah Chowdhury,Dilruba Begum ,Prodip Kumar Biswas ,Md Abu Abdullah Hossain Mazumder

doi:10.3390/antibiotics11010105

Abstract

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

Highlights

The principal focus on children in low- and middle-income countries (LMICs) during the COVID-19 pandemic has been to address key issues, including the poor uptake of vaccinations and the envisaged impact as well as behavioural issues as a consequence of lockdowns and social distancing measures [1,2,3,4,5,6]
We will first document the characteristics of patients admitted to hospitals across Bangladesh before documenting prescribed treatments and patient outcomes
One hundred and forty-six children were admitted with COVID-19 to the 24 hospitals taking part in this study, giving an overall prevalence of 3.7% (n = 3902, range = 0.55% to 29.5%) during the study period

Summary

Introduction

The principal focus on children in low- and middle-income countries (LMICs) during the COVID-19 pandemic has been to address key issues, including the poor uptake of vaccinations and the envisaged impact as well as behavioural issues as a consequence of lockdowns and social distancing measures [1,2,3,4,5,6]. This resulted in Bangladesh organising immunisation outreach services for children and increasing the number of home visits to address concerns [3,7]. The focus among children during the current pandemic has been on other infectious diseases and their prevention

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Discussion

Conclusion