Lessons learned during COVID-19: Building critical care/ICU capacity for resource limited countries with complex emergencies in the World Health Organization Eastern Mediterranean Region

Monitoring and evaluation practices and operational research during public health emergencies in southeast Asia region (2012-2022) - a systematic review

This systematic review aimed to explore the monitoring and evaluation (M&E) and operational research (OR) practices during public health emergencies (PHE) in the southeast Asian region (SEAR) over the last decade. We searched electronic databases and grey literature sources for studies published between 2012 and 2022. The studies written in English were included, and a narrative synthesis was undertaken. A total of 29 studies were included in this review. Among these 25 studies documented M&E and four studies documented OR practices. The majority of the studies were from India and Bangladesh, with no evidence found from Sri Lanka, Bhutan, Myanmar, and Timor-Leste. M&E of surveillance programs were identified among which PHE due to COVID-19 was most prevalent. M&E was conducted in response to COVID-19, cholera, Nipah, Ebola, Candida auris, and hepatitis A. OR practice was minimal and reported from India and Indonesia. India conducted OR on COVID-19 and malaria, whereas Indonesia focused on COVID-19 and influenza. While most SEAR countries have mechanisms for conducting M&E, there is a noticeable limitation in OR practices. There is a compelling need to develop a standard framework for M&E. Additionally, enhancing private sector engagement is crucial for strengthening preparedness against PHE. Furthermore, there is a necessity to increase awareness about the importance of conducting M&E and OR during PHE.

Medical Oxygen as a Life-Saving Medicine: A rapid review of the oxygen landscape and innovative efforts in the World Health Organization Eastern Mediterranean Region in Response to COVID-19 and Beyond

Background

Medical oxygen is an essential treatment for life-threatening hypoxemic conditions and is commonly indicated for the clinical management of many leading causes of mortality. Many countries of the World Health Organization (WHO) Eastern Mediterranean Region (EMR) lacked robust medical oxygen systems prior to the COVID-19 (corona virus disease) pandemic and this situation was exacerbated by increased needs, particularly in remote and rural health facilities, resulting in many unfortunate deaths. The aim of this article is to describe the oxygen landscape in the region and the regional initiatives undertaken by countries and WHO.

Methodology

We conducted a rapid review to synthesize the available literature on the needs and availability of oxygen and its related resources and the regional initiatives undertaken. We conducted search in PubMed, relevant WHO and World Bank websites, and in general using google to understand the health of conditions that could benefit from the availability of medical oxygen, oxygen related resources including health workforce available for support and usage of medical oxygen, and the initiatives by WHO, countries and partners to improve the situation. We used a snowballing technique and reviewed all available databases for reports, surveys, assessments, and studies related to medical oxygen, besides WHO internal records, assessments, and consultation reports.

Results

The data on oxygen availability, supply demand gap, infrastructure facilities, and human resources were sparse. The regional initiatives have led to increase in resources, including human resources and oxygen production infrastructure. The Live Oxygen Platform (LOP), contributed to improved availability of quality data needed for supply demand assessments.

Conclusion

A regional enterprise strategy to promote sustainable, decentralized, and contextualized production, supply, and monitoring of oxygen together with human resource support including training and placement by WHO, partners, and governments contributed to improved availability of oxygen in the region. Additionally, with the LOP, governments, WHO, and partners have access to better data availability for policy decision making and timely resource allocation.

Health workforce capacity of intensive care units in the Eastern Mediterranean Region

OBJECTIVE

The onset of COVID-19 pandemic increased the need for functioning and equipped intensive care units (ICUs) with staff trained in operating them. In the Eastern Mediterranean Region, this also triggered the need for assessing the available capacities of ICUs and health workforce so that appropriate strategies can be developed to address emerging challenges of staff shortages in the wake of COVID-19. To address this need, a scoping review on the health workforce capacity of intensive care units in the Eastern Mediterranean Region was conducted.

METHODS

A scoping review methodology as outlined by Cochrane was followed. Available literature and different data sources were reviewed. Database includes Pubmed (medline,Plos included), IMEMR, Google Scholar for peer-reviewed literature, and Google for grey literature such as relevant website of ministries, national and international organization. The search was performed for publications on intensive care unit health workers for each of the EMR countries in the past 10 years (2011-2021). Data from included studies was charted, analysed and reported in a narrative format. A brief country survey was also conducted to supplement the findings of the review. It included quantitative and qualitative questions about number of ICU beds, physicians and nurses, training programs as well as challenges faced by ICU health workforce.

RESULTS

Despite limited data availability, this scoping review was able to capture information important for the Eastern Mediterranean Region. Following major themes appeared in findings and results were synthesized for each category: facility and staffing, training and qualification, working conditions/environment and performance appraisal. Shortage of intensive care specialist physicians and nurses were in majority of countries. Some countries offer training programmes, mostly for physicians, at post-graduate level and through short courses. High level of workload, emotional and physical burnout and stress were a consistent finding across all countries. Gaps in knowledge were found regarding procedures common for managing critically ill patients as well as lack of compliance with guidelines and recommendations.

CONCLUSION

The literature on ICU capacities in EMR is limited, however, our study identified valuable information on health workforce capacity of ICUs in the region. While well-structured, up-to-date, comprehensive and national representative data is still lacking in literature and in countries, there is a clearly emerging need for scaling up the health workforce capacities of ICUs in EMR. Further research is necessary to understand the situation of ICU capacity in EMR. Plans and efforts should be made to build current and future health workforce.

COVID-19 Vaccine Coverage in India: A District-Level Analysis

India implemented the largest COVID-19 vaccination drive in the world, through which it vaccinated the majority of its population. Lessons from the Indian COVID-19 vaccination experience can be invaluable for other LMICs as well as for preparedness for future outbreaks. Our study is designed to explore the factors associated with COVID-19 vaccination coverage in India at the district level. We used data from COVID-19 vaccination in India combined with several other administrative data to create a unique data set that facilitated a spatio-temporal exploratory analysis by uncovering the factors associated with vaccination rates across different vaccination phases and districts. We found evidence that past reported infection rates were positively correlated with COVID-19 vaccination outcomes. Past cumulative COVID-19 deaths as a proportion of district populations were associated with lower COVID-19 vaccination, but the percentage of past reported infection was positively correlated with first-dose COVID-19 vaccination, which might indicate a positive role of higher awareness created by a higher reported infection rate. Districts that on average had a higher population burden per health centre were likely to have lower COVID-19 vaccination rates. Vaccination rates were lower in rural areas relative to urban areas, whereas the association with literacy rate was positive. Districts with a higher percentage of children with complete immunisation were associated with higher COVID-19 vaccination, whereas low vaccination was observed in districts that had higher percentages of wasted children. COVID-19 vaccination was lower among pregnant and lactating women. Higher vaccination was observed among populations with higher blood pressure and hypertension (which were a few of the co-morbidities associated with COVID-19 infection).

Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience

Background

Response to the outbreak of poliomyelitis in mid-1950 led to recognition and consequent development of critical care. Seventy years later the humankind was struck by COVID-19, another major challenge for critical care medicine which was especially big in Low-Resources-Settings where more than two thirds of the world population live, including the population of the Republic of Srpska (RS).

Design and methods

The main aim was to show an overview of all interventions in order to boost hospitals' capacities to the level which is sufficient to manage high amount of critically ill COVID-19 patients in the RS. A before-after cohort study design was conducted to evaluate the effects of interventions for increase in preparedness and capacity of ICUs for admission and treatment of COVID-19 critically ill patients in nine hospitals in the RS. Results: Following interventions, the biggest and university affiliated hospital in the RS has increased ICU capacities: total number of ICU beds increased by 38% and number of ventilators by 114%. Availability of machines for veno-venous extracorporeal membrane oxygenation (vvECMO) increased by 100%. Number of doctors who were involved in treatment of critically ill patients increased by 47% and nurse/patient's ratio reached 1:2.5. Similarly, all other hospitals experienced boosting of ICU beds by 189% and ventilators by 373% while number of doctors increased by 108% and nurse/patient's ratio reached 1:4.

Conclusion

All interventions implemented during COVID-19 pandemic outbreak in the RS resulted in increasing capacity for treatment of critically ill patients, but the education of health care professionals was identified as the most important conducted intervention.

Building Critical Care Capacity in a Low-Income Country

Critical illness is common throughout the world and is associated with high costs of care and resource intensity. The Corona virus disease 2019 (COVID-19) pandemic created a sudden surge of critically ill patients, which in turn led to devastating effects on health care systems worldwide and more so in Africa. This narrative report describes how an attempt was made at bridging the existing gaps in quality of care for critically ill patients at national and regional levels for COVID and the postpandemic era in a low income country.

Lessons from the frontline: Documenting the pandemic emergency care experience from the Pacific region - Infrastructure and equipment

Background

The COVID-19 pandemic highlighted challenges for all health systems worldwide. This research aimed to explore the impact of COVID-19 across the Pacific especially with regards to emergency care (EC) and clinicians' preparations and responses.

Methods

A collaboration of Australia and Pacific researchers conducted prospective qualitative research over 18 months of the pandemic. In this three phase study data were gathered from Emergency Clinicians and stakeholders through online support forums, in-depth interviews and focus groups. A phenomenological methodological approach was employed to explore the lived experience of participants. This paper discusses the findings of the study regarding the EC building block of 'Infrastructure and Equipment.'

Findings

Pre-existing infrastructure and equipment were not sufficient to help control the pandemic. Adequate space and correct equipment were essential needs for Pacific Island emergency clinicians, with donations, procurement and local ingenuity required for suitable, sustainable supplies and facilities. Adequate personal protective equipment (PPE) conferred a sense of security and increased Health Care Workers willingness to attend to patients.

Interpretation

Investing in adequate infrastructure and appropriate equipment is crucial for an effective response to the COVID-19 pandemic. The sustainability of such investments in the Pacific context is paramount for ongoing EC and preparation for future surge responses and disasters.

Funding

Phases 1 and 2A of this study were part of an Epidemic Ethics/World Health Organization (WHO) initiative, supported by Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding for this research was received from the Australasian College for Emergency Medicine Foundation via an International Development Fund Grant.

A new COVID-19 intubation prediction strategy using an intelligent feature selection and K-NN method

Background

Predicting severe respiratory failure due to COVID-19 can help triage patients to higher levels of care, resource allocation and decrease morbidity and mortality. The need for this research derives from the increasing demand for innovative technologies to overcome complex data analysis and decision-making tasks in critical care units. Hence the aim of our paper is to present a new algorithm for selecting the best features from the dataset and developing Machine Learning(ML) based models to predict the intubation risk of hospitalized COVID-19 patients.

Methods

In this retrospective single-center study, the data of 1225 COVID-19 patients from February 9, 2020, to July 20, 2021, were analyzed by several ML algorithms which included, Decision Tree(DT), Support Vector Machine (SVM), Multilayer perceptron (MLP), and K-Nearest Neighbors(K-NN). First, the most important predictors were identified using the Horse herd Optimization Algorithm (HOA). Then, by comparing the ML algorithms' performance using some evaluation criteria, the best performing one was identified.

Results

Predictive models were trained using 12 validated features. Also, it found that proposed DT-based predictive model enables a reasonable level of accuracy (=93%) in predicting the risk of intubation among hospitalized COVID-19 patients.

Conclusions

The experimental results demonstrate the effectiveness of the proposed meta-heuristic feature selection technique in combining with DT model in predicting intubation risk for hospitalized patients with COVID-19. The proposed model have the potential to inform frontline clinicians with quantitative and non-invasive tool to assess illness severity and to identify high risk patients.