National hospital readiness for COVID-19 in Lesotho: evidence for oxygen ecosystem strengthening

  1. J. E. Sanders
  2. T. Chakare
  3. L. Mapota-Masoabi
  4. M. Ranyali
  5. M. M. Ramokhele
  6. A. M. Rozario
  7. E. D. McCollum

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Abstract

SETTING: Sub-Saharan African country, Lesotho, during the SARS-CoV-2 COVID-19 pandemic. OBJECTIVE: To evaluate COVID-19 hospital capacity in Lesotho. DESIGN: We conducted a pragmatic assessment of all public hospitals in Lesotho using a WHO COVID-19 hospital assessment tool during July 2020 (baseline), with targeted follow-up in December 2020. We adapted the WHO tool into a questionnaire with a focus on hospital services and included oxygen ecosystem elements (pulse oximeters, oxygen, and advanced respiratory care). We converted qualitative questionnaire answers into quantitative ordinal variables and used standard statistics for analysis. RESULTS: At baseline, we found all 12 questionnaire domains demonstrate both hospital preparedness and weakness in infection prevention and control. Key baseline gaps were lack of a dedicated team, and insufficient personal protective equipment and space for donning and doffing. Substantial limitations were noted in hypoxemia diagnosis and treatment; information management and care coordination pathways were also suboptimal. Targeted follow-up after 5 months revealed improvement in the availability of pulse oximetry, oxygen capacity, and heated high-flow nasal cannula devices. CONCLUSION: Our baseline findings may reflect uneven early pandemic care quality; targeted follow-up suggests strengthening of the oxygen ecosystem.

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  1. Version published to 10.5588/pha.21.0067
  2. ScreenIT

    SciScore for 10.1101/2021.04.27.21256199: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Consent was not required as Johns Hopkins University Institutional Review Board and Lesotho National Health Research Ethics Committee classified this activity as non-human subjects research.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are three key limitations to this work. First, this survey was conducted cross-sectionally, and the status of supply chains and stock management are time sensitive. We attempted to account for this through the use of a graded scoring system that recognized partial implementation of interventions and inconsistencies. Second, this survey was based upon self-reporting and given its urgency and our own resource limitations we could not verify all responses. However, our questions were addressed to personnel in the best position to be informed and all respondents were encouraged to consult others. Despite our efforts to optimize reporting accuracy, these results should be interpreted within this context. Lastly, we were unable to follow-up all domains although our baseline assessment identified gaps that would benefit from follow-up. Delivery of health services in sub-Saharan Africa is complex and the COVID-19 pandemic has placed additional, unparalleled demands upon individuals and systems13. Through the use of a user-friendly, pragmatic tool, we conducted a rapid baseline assessment of hospital COVID-19 readiness nationally in Lesotho with targeted follow-up of the oxygen ecosystem. Areas for improvement were noted across all domains. The procurement of pulse oximeters, oxygen concentrators, and advanced respiratory supportive care supplies and equipment, with intensive capacity building of healthcare workers to provide related care is ongoing. Additional support is focuse...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.04.27.21256199v1 on medRxiv