Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications

Nadia Nusrat,Salequl Islam,Mahmuda Hassan,Afzalunnessa Binte Lutfor,Mainul Haque,Sifat Uz Zaman,Nihad Adnan,Dilara Begum,Natalie Schellack,Amanj Kurdi,Marshall Gowere,Mohammad Nazmul Hasan,Kona Chowdhury,Nazmus Sihan,Arif Rabbany,Enamul Karim,Brian Godman

doi:10.3329/bjms.v20i5.55615

Abstract

Objective: The focus on COVID-19 in children in low- and middle-income countries including Bangladesh has been on addressing key issues including poor vaccination rates as well as mental health issues, domestic violence and child labour. However, the focus on optimally managing children in hospitals is changing with new variants and concerns with the development of hyperinflammatory syndromes. There are also concerns with the overuse of antimicrobials to treat patients with COVID-19 in hospitals enhancing resistance rates. The Bangladesh Paediatric Association have developed guidelines to improve patient care building on national guidance. Consequently, there is a need to document the current management of children with COVID-19 in Bangladesh and use the findings for future guidance. Methods: Rapid analysis of the management of children with COVID-19 among eight private and public hospitals in Bangladesh with varying numbers of in-patient beds using purposely developed case report forms (CRFs). The CRFs were piloted before full roll-out. Results: Overall low numbers of children in hospital with COVID-19 (4.3% of in-patient beds). The majority were male (59.6%) and aged 5 years or under (63.5%). Reasons for admission included respiratory distress/ breathing difficulties with 94.2% of COVID-19 cases confirmed. All children were prescribed antibiotics empirically, typically those on the Watch list of antibiotics and administered parenterally, with only a small minority switched to oral therapy before discharge. There was appreciable prescribing of Vitamins (C and D) and zinc and encouragingly limited prescribing of other antimicrobials (antivirals, antimalarials and antiparasitic medicines). Length of stay was typically 5 to 10 days. Conclusion: Encouraging to see low hospitalisation rates and limited use of antimicrobials apart from antibiotics. Concerns with high empiric use of antibiotics and limited switching to oral formulations can be addressed by instigating antimicrobial stewardship programmes. We will be monitoring this. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.188-198

Highlights

COVID-19 was first identified in Wuhan, China, in December 20191,2, and towards the end of August 2021, there were already 213.7 million recorded cases worldwide with just under 4.5 million recorded deaths giving a case fatality ratio (CFR) of 2.09%3
Concerns generally with the level of misinformation regarding potential approaches to prevention and treatment resulted in respected bodies including the British Medical Journal, European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation (WHO) providing guidance from March 2020 onwards[22,23,24,25,26]
% of these patients admitted to paediatric intensive care units (PICUs) and the reasons – taken from severe respiratory distress/ low O2 saturation; shock; coagulation disorders/ thromboembolic manifestations; and extensive lung involvement in high-resolution CT scan (HRCT)

Summary

Introduction

COVID-19 was first identified in Wuhan, China, in December 20191,2, and towards the end of August 2021, there were already 213.7 million recorded cases worldwide with just under 4.5 million recorded deaths giving a case fatality ratio (CFR) of 2.09%3. Various re-purposed medicines were suggested to reduce morbidity and mortality in patients with COVID-19 including hydroxychloroquine, lopinavir/ ritonavir and remdesivir These three had little impact on patient outcomes when objectively trialled in an appreciable number of patients, with potential issues with hydroxychloroquine increasing morbidity, mortality and costs[4,12,13,14,15,16,17]. As a result, encouraging the implementation of evidence-based approaches[1,27] This was helped in Bangladesh by the Ministry of Health and Family Welfare making national guidelines available from Spring 2020 onwards[28]. Guidance on how to run a COVID-19 Hospital in Bangladesh[29]

Methods

Results

Discussion

Conclusion