COVID-19 advanced respiratory care educational training programme for healthcare workers in Lesotho: an observational study

OBJECTIVE

To develop and implement a 'low-dose, high-frequency' (LDHF) advanced respiratory care training programme for COVID-19 care in Lesotho.

DESIGN

Prospective pretraining-post-training evaluation.

SETTING

Lesotho has limited capacity in advanced respiratory care.

PARTICIPANTS

Physicians and nurses.

INTERVENTIONS

Due to limited participation in May-September 2020, the LDHF approach was modified into a traditional 1-day offsite training in November 2020 that reviewed respiratory anatomy and physiology, clinical principles for conventional oxygen, heated high-flow nasal cannula and non-invasive ventilation management. Basic mechanical ventilation principles were introduced.

OUTCOME MEASURES

Participants completed a 20-question multiple choice examination immediately before and after the 1-day training. Paired t-tests were used to evaluate the difference in average participant pretraining and post-training examination scores.

RESULTS

Pretraining and post-training examinations were completed by 46/53 (86.7%) participants, of whom 93.4% (n=43) were nurses. The overall mean pretraining score was 44.8% (SD 12.4%). Mean scores improved by an average of 23.7 percentage points (95% CI 19.7 to 27.6, p<0.001) on the post-training examination to a mean score of 68.5% (SD 13.6%). Performance on basic and advanced respiratory categories also improved by 17.7 (95% CI 11.6 to 23.8) and 25.6 percentage points (95% CI 20.4 to 30.8) (p<0.001). Likewise, mean examination scores increased on the post-training test, compared with pretraining, for questions related to respiratory management (29.6 percentage points, 95% CI 24.1 to 35.0) and physiology (17.4 percentage points, 95% CI 12.0 to 22.8).

CONCLUSIONS

An LDHF training approach was not feasible during this early emergency period of the COVID-19 pandemic in Lesotho. Despite clear knowledge gains, the modest post-training examination scores coupled with limited physician engagement suggest healthcare workers require alternative educational strategies before higher advanced care like mechanical ventilation is implementable. Conventional and high-flow oxygen is better aligned with post-training healthcare worker knowledge levels and rapid implementation.

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

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.