Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

INTRODUCTION: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS: This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION: Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

Predictive factors of mortality in patients with COVID-19 in Guinea: analysis of the first 140 cases admitted to intensive care unit.

INTRODUCTION: the objective was to identify the predictive factors contributing to COVID-related deaths in Intensive Care Unit. METHODS: this was a 4-month (12th March to 12th July 2020) cross sectional study carried out in the intensive care unit of the COVID treatment center of Donka National Hospital, the only hospital with a COVID intensive care unit in Guinea. RESULTS: during our period of study 140 patients were hospitalized in the COVID intensive care unit and 35 patients died (25%). In univariate analysis, the occurrence of death was associated with: confusional syndrome (p<0.001), time to admission (p<0.001), use of an inotropic or vasopressor (p<0.001), Brescia score ≥ 2 (p=0.004), non-invasive ventilation (p=0.011), stroke (p=0.014), Acute Respiratory Distress Syndrome (ARDS) (p=0.015), male (p=0.021), provenance (p=0.021), acute renal failure (p=0.022), pulmonary embolism (p=0.022), invasive ventilation (p=0.022), and age > 60 years (p=0.047). In multivariate analysis, the factors predictive of mortality were: Acute Respiratory Distress Syndrome (ARDS) (OR= 6.33, 95% CI [1.66-29]; p=0.007), a Brescia score ≥ 2 (OR =5.8, 95% CI [1.7-19.2]; p=0.004) and admission delay (OR =5.6, 95% CI [1.8-17.5]; p=0.003). CONCLUSION: our study shows that the acute respiratory distress syndrome, then the Brescia score ≥ 2, and finally the time to admission to intensive care were all associated with an increased risk of death for patients. These results are different from those reported in Asia, Europe and North America.

Clinical presentation, outcomes and factors associated with mortality: A prospective study from three COVID-19 referral care centres in West Africa.

OBJECTIVES: The overall death toll from COVID-19 in Africa is reported to be low but there is little individual-level evidence on the severity of the disease. This study examined the clinical spectrum and outcome of patients monitored in COVID-19 care centres (CCCs) in two West-African countries. METHODS: Burkina Faso and Guinea set up referral CCCs to hospitalise all symptomatic SARS-CoV-2 carriers, regardless of the severity of their symptoms. Data collected from hospitalised patients by November 2020 are presented. RESULT: A total of 1,805 patients (64% men, median age 41 years) were admitted with COVID-19. Symptoms lasted for a median of 7 days (IQR 4-11). During hospitalisation, 443 (25%) had a SpO2 < 94% at least once, 237 (13%) received oxygen and 266 (15%) took corticosteroids. Mortality was 5% overall, and 1%, 5% and 14% in patients aged <40, 40-59 and ≥60 years, respectively. In multivariable analysis, the risk of death was higher in men (aOR 2.0, 95% CI 1.1; 3.6), people aged ≥60 years (aOR 2.9, 95% CI 1.7; 4.8) and those with chronic hypertension (aOR 2.1, 95% CI 1.2; 3.4). CONCLUSION: COVID-19 is as severe in Africa as elsewhere, and there must be more vigilance for common risk factors such as older age and hypertension.