# Pediatric COVID-19 in Lesotho and Post-pandemic Implications on Lower Respiratory Infections in Children

## TL;DR

This study examines the low rate of severe pediatric COVID-19 in Lesotho and highlights gaps in healthcare worker training that could affect post-pandemic care for children with respiratory infections.

## Contribution

The study provides insights into pediatric COVID-19 in Lesotho and evaluates the impact of training on healthcare workers' knowledge.

## Key findings

- Only 1.2% of hospitalizations at Lesotho's treatment centers were for children under 15.
- Healthcare workers showed a 32.2% average improvement in post-training examination scores.
- Four out of 18 children hospitalized with COVID-19 died.

## Abstract

Background

The United States Agency for International Development (USAID) Reaching Impact, Saturation, and Epidemic Control (RISE) program funded Jhpiego to support the Government of Lesotho’s COVID-19 response, including two national COVID-19 treatment centers. To evaluate the status of post-pandemic pediatric respiratory care in Lesotho, we analyzed pediatric treatment center data and healthcare worker (HCW) performance on pediatric COVID-19 training offered to HCWs at COVID-19 treatment centers.

Methods

We conducted a retrospective cohort study of patients 15 years of age or less hospitalized at two COVID-19 treatment centers in Lesotho from May 1, 2020, to April 30, 2022. Patient data were extracted from hospital files. We used the independent sample t-test, Mann-Whitney U test, or Fisher's exact test to evaluate associations between exposure variables and death. We also assessed differences between pre- and post-training examination scores of three one-day HCW training on pediatric COVID-19 using paired t-tests.

Results

Overall, <15-year-olds comprised 18/1,448 (1.2%) hospitalizations. Twenty-two percent (4/18) of children were hypoxemic (oxyhemoglobin saturation <94%) within the first 24 hours and 44% (8/18) at any point in the hospitalization. Oxygen utilization increased over the two-year period (p=0.004) and all eight children with hypoxemia received oxygen (p<0.001). Four of 18 (22%) patients died. For HCW training, pre- and post-training examinations were completed by 76/82 (92.7%) participants. The overall mean pretraining score was 44.6% (standard deviation (SD) 15.7%). Mean scores improved by an average of 32.2% (95% confidence interval (CI) 27.7%, 36.6%, p<0.001) on the same day post-training examination.

Conclusions

National COVID-19 treatment center data indicate a low burden of severe pediatric COVID-19 disease in Lesotho. However, recognized HCW knowledge gaps suggest deficiencies in identifying and referring severely ill children, which may detrimentally impact the ongoing post-pandemic care of children with severe lower respiratory infections.