key: cord-0843122-lmyu78e2
authors: Enyama, D.; Chelo, D.; Noukeu Njinkui, D.; Mayouego Kouam, J.; Fokam Djike Puepi, Y.; Mekone Nkwele, I.; Ndenbe, P.; Nguefack, S.; Nguefack, F.; Kedy Koum, D.; Tetanye, E.
title: Impact of the COVID-19 pandemic on pediatricians’ clinical activity in Cameroon
date: 2020-09-23
journal: Arch Pediatr
DOI: 10.1016/j.arcped.2020.09.004
sha: 9ee20b2672b91ec627d5ee49dd40593e8930b059
doc_id: 843122
cord_uid: lmyu78e2

Background: The outbreak of COVID-19 has imposed many challenges on health systems. The purpose of this study was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians. Methods: We conducted a cross-sectional and descriptive online survey among pediatricians practicing in Cameroon. Data were collected through an anonymous pretested Google Form®. Results: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%) of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (p < 0.000). According to the occupancy rate of hospitalization beds, 45.5% of pediatricians reported having 76–100% of pediatric hospitalization beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (p < 0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth “very frequently” before the pandemic to 23.8% using it during the pandemic (p < 0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were “very afraid” or “extremely afraid” of being infected with SARS-Cov-2, respectively, 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). Conclusion: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children’s overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents’ fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.

anonymous pretested Google Form®. Results: Among the 118 pediatricians eligible for the survey, 101 responded (85.6%) of whom 61.2% were women. The pediatric outpatient consultations dropped significantly from 60.4% of pediatricians seeing more than 30 patients per week before the pandemic to 9.9% during the pandemic (p < 0.000). According to the occupancy rate of hospitalization beds, 45.5% of pediatricians reported having 76-100% of pediatric hospitalization beds occupied per week before the pandemic but no pediatrician reported a similar rate during the pandemic (p < 0.000). There was a significant increase in the use of telehealth, ranging from no pediatrician using telehealth "very frequently" before the pandemic to 23.8% using it during the pandemic (p < 0.000). Most of the pediatricians had at their disposal surgical masks (96%), care gloves (80.2%), hydroalcoholic gel (99.0%), and soap and water (86.1%). For the management of children, 90.1% and 71.3% of pediatricians experienced difficulties accessing COVID-19 PCR and chloroquine, respectively, and 74.3% declared difficulties for proper isolation of patients. More than half (65.3%) of the pediatricians interviewed were "very afraid" or "extremely afraid" of being infected with SARS-Cov-2, respectively, 45.5% and 19.8%. The most frequent reasons included fear of infecting their relatives (85.1%) and of developing a severe form of the disease (43.6%). The reluctance to consult health services expressed by the parents was due to: fear of being infected when leaving their home and especially in the health facility (96%), strict compliance with confinement (30.7%), and financial difficulties of families (13.9%). Conclusion: This work highlights the impact of the coronavirus pandemic on the clinical activity of Cameroonian pediatricians. Since the beginning of the pandemic, there has been a significant drop in the use of health facilities, which probably has a negative impact on children's overall level of health. Although the preventive measures explain this drop in attendance at health facilities, the parents' fear of being infected when leaving the house was the predominant reason likely to explain this drop in attendance at health facilities. This could constitute an axis for developing messages to parents to encourage a gradual return to child health services.

In December 2019, an increasing number of cases of pneumonia emerged in Wuhan, a city in central China with a novel coronavirus (2019-nCov) rapidly identified as the causative agent [1] [2] [3] . On February 11, 2020, Although children are less likely to be symptomatic or develop severe symptoms compared with adults, the pandemic has brought other issues such as the missing out on vaccinations due to postponement of campaigns and interruptions in routine immunization [7] [8] [9] .

In Cameroon, a significant drop in the number of visits to health facilities was observed with a decrease in consultations and pediatric hospitalizations among others. The purpose of this survey was to describe the impact of the COVID-19 pandemic on the clinical activity of pediatricians in Cameroon. The questionnaire asked about sociodemographic data of the respondents: gender, age,

year of start of practice as pediatrician, mode and city of practice. A second section was devoted to the description of daily practice before the pandemic and questioned the number of consultations per week, the number of hospital beds available, as well as their occupancy rate on the one hand and the use of telehealth on the other hand. A third section was dedicated to collecting the information cited above, but this time during the pandemic. The fourth section asked the participants about their treatment approach for suspected and confirmed COVID-19 children. A fifth section was dedicated to the evaluation of the availability of personal protective equipment and devices as well as their use before and during the pandemic and the last point evaluated the pediatricians' fear of being infected and the main reasons for this fear as well as the main reasons stated by parents for postponing visits to health facilities during the pandemic.

The data were collected via the Excel sheet automatically generated by GoogleForms and exported for analysis in SPSS version 23 software.

Among the 128 pediatricians registered in the "Information SOCAPED" WhatsApp group, 118 were eligible to respond to the questionnaire, 10 were excluded for the following reasons: one duplicate, one pediatric resident, two general practitioners, four practicing out of Page 5 of 21 J o u r n a l P r e -p r o o f 5 the country, two retired from active practice. Finally, 101 pediatricians responded to the questionnaire giving a response rate of 85.6%. Women were the most represented in the profession 62 (61.2%) compared with men 39 (38.6%), giving a sex ratio of 0.6. The mean age of Cameroonian pediatricians was 46.9 ± 9.5 years, while the mean years of practice experience was 11.9 ± 8.7 years. The majority of participants were primary care pediatricians 60 (59.4%), having a mixed practice both in the hospital and in private practice for 50 (49.5%) of them and located essentially in Yaoundé 49 (48.5%) and in Douala 43 (42.6%).

Regarding the work environment of pediatricians, the majority 50 (49.5%) reported working in health facilities with more than 30 hospitalization beds available. The rest of the respondents reported a number of beds varying from 1 to 10 beds, 11 to 20 beds, and 21 to 30 beds in 15.8%, 9%, and of cases 16.8%, respectively. Nine pediatricians (8.9%) did not have any bed for hospitalization in their health facility (Table 1 ).

Concerning the pediatric outpatient consultations, 61 pediatricians (60.4%) reported seeing more than 30 patients per week before the COVID-19 pandemic as compared with 10 (9.9%) consulting more than 30 children per week during the 4 weeks preceding the survey (p < 0.000). According to the occupancy rate of hospitalization beds, 46 pediatricians (45.5%) reported having 76-100% of pediatric hospitalization beds occupied per week before the COVID-19 pandemic. No pediatrician recorded such a high rate during the 4 weeks preceding

With 118 pediatricians practicing in Cameroon in 2020 for an estimated population of more than 25 million inhabitants, Cameroon has 0.47 pediatricians per 100,000 population. This rate is similar to that of other African countries (0.03-0.8 per 100,000 population) but lower than European figures (11-86 pediatricians per 100,000 population in the UK and Germany) [10] . The female predominance in the profession has been reported in other studies [11] . This survey showed that the majority of pediatricians (91.0%) practice in Douala and Yaoundé, resulting in an uneven distribution of pediatric care offered in the rest of the country. to the best of our knowledge, not yet been described [12] . This decrease in attendance at health immunizations, but also on curative care. Children treated for chronic conditions, for example, could miss follow-up appointments, could experience treatment breaks that may lead to a deterioration in their state of health. Another aspect of this drop in attendance could be delayed consultations and late management of childhood illnesses. Finally, in our sociocultural context, there could be a higher risk that parents of sick children more frequently use alternatives such as advice from pharmacists or, even worse, street drugs, traditional medicine, or prayers to treat their children.

Regarding the use of telehealth, our survey shows a significant increase in the use of telehealth by the pediatricians during the pandemic. In the developing world and particularly in Africa, the use of telehealth is still sporadic [13] . In Cameroon, very little is known about this healthcare modality [14] . Even in the United States, before the COVID-19 outbreak, many health systems and especially pediatricians had low rates of telehealth utilization for routine care [15, 16] . The COVID-19 pandemic has forced all healthcare systems, hospitals, and clinics to rapidly implement telehealth services [17] . In Cameroon, to the best of our knowledge, active telemedicine networks are scarce. Pediatricians consider telehealth to be a real need, which is simply exacerbated by the restrictive measures imposed by the pandemic. While it is true that there are limits to telehealth, it could be very useful in keeping in touch with patients and families and in continuing to follow up and disseminate prevention messages.

Half of the pediatricians surveyed (53.5%) stated that they would administer a treatment for COVID-19-positive children even if they are asymptomatic. Although there is no scientific evidence to reject the decision to treat an asymptomatic child presenting with a positive COVID-19 PCR result, this decision should take into account several conditions [18] . 

This work highlights the impact of the coronavirus pandemic on the activity of Cameroonian pediatricians. Since the beginning of the pandemic, pediatricians have recorded a very significant drop in the use of health facilities, the respecting of preventive measures (especially strict confinement) being one of the reasons to explain this situation, which probably has a negative impact on the overall health of children. Moreover, the parents' fear of being infected when leaving the house to visit a health facility was the main potential reason explaining this drop in attendance at health facilities and could constitute an axis for developing messages to parents to encourage a gradual return to child health services. The survey also evokes the difficulties linked to personal protective equipment, access to diagnostic and treatment means, as well as the pediatricians' fear vis-à-vis the pandemic. Have not faced this issue 4 4.0

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The authors thank all the members of the Cameroonian Pediatric Association for their contribution in collecting data and Dr. Kamgang Willy Steven (Pitoa District Hospital, Cameroon) for the data analysis.