Skip to main content
NCBI home page
Antibiotics logoLink to Antibiotics
. 2023 Feb 1;12(2):283. doi: 10.3390/antibiotics12020283

Assessing the Clinical Characteristics and Management of COVID-19 among Pediatric Patients in Ghana: Findings and Implications

Israel Abebrese Sefah 1,*, Seth Adade Sarkodie 2, Giuseppe Pichierri 3, Natalie Schellack 4, Brian Godman 5,6,7,*
Editor: Eleonora Nicolai
PMCID: PMC9952352  PMID: 36830194

Abstract

There is an increasing focus across countries on researching the management of children admitted to hospital with COVID-19. This stems from an increasing prevalence due to new variants, combined with concerns with the overuse of antimicrobials driving up resistance rates. Standard treatment guidelines (STGs) have been produced in Ghana to improve their care. Consequently, there is a need to document the clinical characteristics of children diagnosed and admitted with COVID-19 to our hospital in Ghana, factors influencing compliance to the STG and treatment outcomes. In all, 201 patients were surveyed between March 2020 and December 2021, with males accounting for 51.7% of surveyed children. Those aged between 6 and 10 years were the largest group (44.8%). Nasal congestion and fever were some of the commonest presenting complaints, while pneumonia was the commonest (80.6%) COVID-19 complication. In all, 80.0% of all admissions were discharged with no untreated complications, with a 10.9% mortality rate. A combination of azithromycin and hydroxychloroquine (41.29%) was the most prescribed antimicrobial regimen. Compliance to the STG was variable (68.2% compliance). Increased compliance was associated with a sore throat as a presenting symptom. Mortality increased following transfer to the ICU. However, current recommendations to prescribe antimicrobials without demonstrable bacterial or fungal infections needs changing to reduce future resistance. These are areas to address in the future.

Keywords: antimicrobials, children, COVID-19, Ghana, guidelines, hospitals, outcomes

1. Introduction

The novel coronavirus disease (COVID-19) was first reported in China on the 29 December 2019, and later developed into a pandemic affecting all countries globally [1]. The disease, caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread swiftly from China and Asia across all countries [1]. The first case of COVID-19 in Africa was reported in Egypt in February 2020, with other African countries, including Ghana, following there after [2,3,4]. As of 1 July 2020, there were over 10 million confirmed cases globally with just over 500,000 recorded deaths [5].

The first two confirmed cases of COVID-19 in Ghana were reported on 12 March 2020 [4], and by the end of June 2020 there were 17,741 confirmed cases with 112 deaths [3]. Initially, prevalence and mortality rates were appreciably lower among African countries during the early stages of the pandemic compared with, for instance, Western European countries. This was helped by the earlier introduction of lockdown measures and other initiatives as well as younger populations with lower incidence rates of the infection [3,4], with lockdown and other public health measures proven to be effective in slowing down the spread and the impact of the virus in the absence of effective treatments and vaccines [5,6]. The standard of care in Ghana during the pandemic required that suspected persons are quarantined to reduce transmission, while confirmed cases are transferred to designated treatment centers with effective isolation and disease control capacity. Critically ill patients should subsequently be admitted to an intensive care unit for further management [7].

The greatest concern across countries, including among African countries, with the rapid implementation of lockdown and other measures, has been the unintended consequences on the management of non-communicable diseases as well as vaccination programs for children [8,9]. The lack of routine vaccinations in children in Africa has been an appreciable concern with some authors predicting that for every one excess death from COVID-19 that could occur among parents and others when children visit vaccination clinics, 84 deaths could be prevented by sustaining routine childhood immunization programs [9,10].

Another key concern has been the rapid adoption of re-purposed medicines, including hydroxychloroquine, anti-viral medicines such as remdesivir, as well as anti-parasitic medicines including ivermectin for use in many African countries, despite no robust evidence supporting their use [11,12,13,14,15]. This adoption has been fueled by misinformation on social media and other platforms [11]. The 2020 Ghana Standard Treatment Guidelines (STGs) for COVID-19 treatment, which is yet to be updated, recommends the use of hydroxychloroquine and chloroquine phosphate for the management of all confirmed asymptomatic and symptomatic COVID-19 cases using real time-polymerase chain reaction tests [7]. In addition, azithromycin is empirically indicated for all mild to moderate cases of COVID-19 in addition to hydroxychloroquine [7]. The increased use of these recommended antimicrobials is a concern as this may potentially increase adverse reactions, antimicrobial resistance (AMR), costs and mortality without any additional evidenced-based benefits to patients [13,14,16]. The only exception to the use of re-purposed pharmacological agents in COVID-19 patients has been dexamethasone, which has proven to help hospitalized patients needing ventilatory support [17]. Alongside this, there is growing anxiety with excessive prescribing of antimicrobials in patients with COVID-19, including children, across countries despite limited evidence of bacterial or fungal co-infections [18,19,20,21,22,23]. These high rates of antimicrobial prescriptions may be due to symptoms including coughs and fever which mimic some bacterial infections, as well as concerns with secondary infections especially if this increases mortality [23,24]. However, as mentioned, there are considerable concerns that the overprescribing of antimicrobials will increase AMR [24,25,26,27]. This issue is particularly important in Ghana, with growing resistance rates [28].

Children typically have lower infection rates with COVID-19 as well as milder symptoms compared with adults [29,30,31], with an appreciable number of children being asymptomatic [29,30,31,32]. The typical symptoms of children admitted to hospital with COVID-19 are fever, nausea and respiratory symptoms including coughing, as well as diarrhea, with higher admission rates seen among boys versus girls [20,21,29,30,32]. Between 6% to 10% of children admitted to hospital with COVID-19 experience severe disease, with up to 20% or more admitted to pediatric intensive care units; however, the majority of children may not require ventilatory support [20,21,33]. Since admission rates for children are typically lower than seen in adults, the focus among health authorities for children during the early stages of the pandemic has been on other infectious diseases especially given low vaccination rates following lockdown measures, and the subsequent impact on future morbidity and mortality [9,34].

However, there have been growing concerns with potentially increasing mortality among younger patients with successive waves of the pandemic [35,36,37]. In addition, growing anxiety that children are developing Kawasaki Disease (KD)-like symptoms, now known as Pediatric Inflammatory Multisystem Syndrome (PIMS-TS), alongside experiencing hypoalbuminemia, hyponatremia, leucopenia and respiratory changes with COVID-19 [38,39,40]. These combined symptoms can potentially increase admission to intensive care units (ICUs). This can be an issue in lower- and middle-income countries (LMICs) with limited healthcare resources. It has been reported that whilst a lower percentage of children with severe symptoms are admitted to ICUs in LMICs, deaths among these hospitalized children can be higher [33]. For instance, high mortality rates (40%) were seen at Dr. Cipto Mangunkusumo Hospital, in Indonesia, at the start of the pandemic among children admitted with COVID-19 [41]. However, appreciably lower rates were seen recently among children with COVID-19 admitted to hospitals in Bangladesh (1.4%) and Turkey (0.9%), with nearly all children in hospitals in Bangladesh and India in the early years of the pandemic making a full recovery at 92.5% and 92.2%, respectively, although higher rates were seen in Iran (11% mortality) [20,21,42,43].

With the potential for additional cases of COVID-19 in Ghana, including among children, exacerbated by currently high vaccine hesitancy [44], we believed it was important to document current characteristics and management of children with COVID-19 admitted to our hospital in Ghana. There are also concerns with rising AMR rates in Ghana with the appreciable prescribing of antibiotics among patients hospitalized with COVID-19 across countries [18,19,20,21,22,23]. Consequently, the objective of this study was to document the clinical characteristics of children diagnosed and admitted with COVID-19 to the COVID-19 treatment center of the only quaternary medical and research center in Ghana, factors influencing compliance to current Ghanian STG and treatment outcomes. The intention is to provide guidance to improve the future management of children in this hospital and beyond. Compliance to the current STG is important as there have been concerns with adherence to guidelines for the management of infections in our hospital in the past [45,46,47].

2. Results

2.1. Patient Characteristics

The medical records of 201 pediatric patients diagnosed with COVID-19 from March 2020 to December 2021 were extracted, which represented 9.8% (85/869) of pediatric cases admitted from March onwards in 2020, and 10.4% (116/1119) of cases admitted in 2021.

Male patients accounted for 51.7% of admitted patients with COVID-19 (104/201), while those aged between 6 and 10 years accounted for the majority (44.8%, 90/201) of pediatric patients surveyed with a median age of 9 (6–12) years. Nasal congestion (96.0%, 193/201) and fever (95.0%, 191/201) were some of the commonest presenting symptoms, while pneumonia was the commonest (80.6%, 162/210) COVID-19 complication. There was an overall mortality rate of 10.9% (22/201) among our study population (Table 1). Approximately 70% (140/201) of the COVID-19 pediatric cases had no additional diagnosed co-infection on admission, with only 14.9% (30/201) of the cases having a bacterial co-infection diagnosed.

Table 1.

Association between compliance to the COVID-19 Standard Treatment Guidelines (STG) and patients’ characteristics.

Characteristics (n) Total, n (%) Compliance to STG Chi Square
p-Value
Yes, n (%) No, n (%)
Age Category (n = 201) 0.405
Less than 5 41 (20.4%) 32 (78.0%) 9 (22.0%)
6–10 years 90 (44.8%) 59 (65.6%) 31(34.4%)
11–15 years 56 (27.9%) 38 (67.9%) 18 (32.1%)
16–18 years 14 (6.9%) 8 (57.1%) 6 (42.9%)
Year of Admission (n = 201) 0.368
2020 85 (42.3%) 55 (64.7%) 30(35.3%)
2021 116 (57.7) 82 (70.7%) 34(29.3%)
Gender (n = 201) 0.213
Male 104 (51.7%) 75 (72.1%) 29(27.9%)
Female 97 (48.3%) 62 (63.9%) 35(36.1%)
Complications present (n = 201) 0.462
Acute Kidney Injury 19 (9.5%) 15 (78.9%) 4 (21.1%)
Acute Liver Disease 11 (5.5%) 8 (72.7%) 3 (27.3%)
COVID-Pneumonia 162 (80.6%) 109(67.3%) 53(32.7%)
Septic Shock 9 (4.4%) 5 (55.6%) 4 (44.4%)
Presence of co-infection diagnosed
(n = 201)		 0.639
Yes 61 (30.4) 18 (29.5) 46 (32.9)
No 140 (69.6) 43 (70.5) 94 (67.1)
Type of co-infection diagnosed (n = 201) 0.533
None 140 (69.6) 94 (67.1) 36 (25.7)
Bacterial co-infection 30 (14.9) 23 (76.7) 7 (23.3)
Other co-infections 31 (15.5) 20 (64.5) 11 (35.5)
Level of Severity (n = 201) 0.988
Mild/Moderate 77 (38.3%) 52 (67.5%) 25(32.5%)
Severe Pneumonia 64 (31.8%) 44 (68.8%) 20(31.3%)
Severe Pneumonia
with ARDS/Sepsis		 60 (29.9%) 41 (68.3%) 19(31.7%)
Cough as presenting complaint (n = 201) 0.623
Yes 32 (15.9%) 23 (7 1.9%) 9 (28.1%)
No 169 (84.1%) 114(67.5%) 55(32.5%)
Sore Throat as presenting complaint
(n = 201)		 0.026
Yes 23 (11.4%) 11 (47.8%) 12(52.2%)
No 178 (88.6%) 126(70.8%) 52(29.2%)
Fever > 37 °C as a presenting complaint
(n = 201)		 0.898
Yes 191 (95.0%) 130(68.1%) 61(31.9%)
No 10 (5.0%) 7 (70.0%) 3 (30.0%)
Presenting complaint of nasal
congestion (n = 201)		 0.057
Yes 193 (96.0%) 134(69.4%) 59(30.6%)
No 8 (4.0%) 3 (37.5%) 5 (62.5%)
Method of radiological assessment used
in diagnosis (n = 201)		 0.044
Chest CT 27 (13.4%) 22 (81.5%) 5 (18.5%)
Chest X-ray 44 (21.9%) 30 (68.2%) 14(31.8%)
Both 31 (15.4%) 15 (48.4%) 16(51.6%)
None 99 (49.3%) 70 (70.7%) 29 (29.3%)
Treatment Outcome (n = 201) 0.331
Discharge home 179 (89.1%) 120 (67.0%) 59 (33.0%)
Mortality 22 (10.9%) 17 (77.3%) 5 (22.7%)
Transferred to ICU (n = 201) 0.623
Yes 19 (9.5%) 12 (63.2%) 7 (36.8%)
No 182 (90.5%) 125(68.7%) 57 (31.3%)
Duration of Admission (n = 201) 0.243
Less than 7 days 131 (65.2%) 84 (64.1%) 47 (35.9%)
8–14 days 66 (32.8%) 50 (75.8%) 16 (24.2%)
15–21 days 4 (2.0%) 3 (75.0%) 1 (25.0%)
Open in a new tab

NB: Variables with p-values highlighted in bold showed a statistically significant association with compliance to the COVID-19 Standard Treatment Guidelines.

A combination of azithromycin and hydroxychloroquine (41.29%) was the most prescribed antimicrobial regimen followed by a combination of azithromycin, hydroxychloroquine and remdesivir (18.4%). Azithromycin was the most commonly prescribed antibiotic, either alone (14.4%) or in combination (68.2%), with other antimicrobials including chloroquine, hydroxychloroquine, remdesivir, ceftriaxone, doxycycline, meropenem, clindamycin and amoxicillin (Figure 1).

Figure 1.

Figure 1

Open in a new tab

Antimicrobial agents prescribed for the management of COVID-19 infection among pediatric patients at the University of Ghana Medical Centre.

2.2. Bivariate Analysis

The overall compliance to the national COVID-19 STGs based on the choice of antimicrobial prescribed was 68.2%. Compliance to the STG was found to be associated with the reporting of a sore throat, documented in the patient’s medical records as a presenting symptom among the study population (p-value = 0.026), and the method of radiological assessment used in diagnosis (p-value = 0.05) (Table 1).

Treatment outcomes were also found to be associated with age category of the patients (p-value = 0.020), the duration of their admission (p-value = 0.025) and whether they were transferred to ICU (p-value = 0.002) (Table 2).

Table 2.

Association between treatment outcomes and patients’ characteristics.

Characteristics (n) Total, n (%) Treatment Outcome Chi Square
p-Value
Discharge Home, n (%) Death, n (%)
Age Category (n = 201) 0.020
Less than 5 41 (20.4%) 37(90.2%) 4 (9.8%)
6–10 years 90 (44.8%) 81 (90.0%) 9 (10.0%)
11–15 years 56 (27.9%) 52 (92.9%) 4 (7.1%)
16–18 years 14 (6.9%) 9 (64.3%) 5 (35.7%)
Gender (n = 201) 0.780
Male 104 (51.7%) 92 (88.5%) 12 (11.5%)
Female 97 (48.3%) 87 (89.7%) 10 (10.3%)
Year of Admission (n = 201) 0.292
2020 85 (42.3%) 78 (91.8%) 7 (8.2%)
2021 116 (57.7) 101 (87.1%) 15 (12.9%)
Complications present (n = 201) 0.581
Acute Kidney Injury 19 (9.5%) 17 (89.5%) 2 (10.5%)
Acute Liver Disease 11 (5.5%) 8 (72.7%) 3 (27.3%)
COVID-Pneumonia 162 (80.6%) 146 (90.1%) 16 (9.9%)
Septic Shock 9 (4.4%) 8 (88.9%) 1 (11.1%)
Level of Severity (n = 201) 0.523
Mild/Moderate 77 (38.3%) 71 (92.2%) 6 (7.8%)
Severe Pneumonia 64 (31.8%) 56 (87.5%) 8 (12.5%)
Severe Pneumonia
with ARDS/Sepsis		 60 (29.9%) 52 (86.7%) 8 (13.3%)
Method of radiological assessment
used in diagnosis (n = 201)		 0.322
Chest CT 27 (13.4%) 24 (88.9%) 3 (13.7%)
Chest X-ray 44 (21.9%) 37 (84.1%) 7 (15.9%)
Both 31 (15.4%) 26 (83.9%) 5 (16.1%)
None 99 (49.3%) 92 (92.9%) 7 (7.1%)
Presence of co-infection diagnosed
(n = 201)		 0.188
Yes 61 (30.4) 57 (93.4) 4 (6.6)
No 140 (69.6) 122 (87.1) 18 (12.9)
Type of co-infection diagnosed
(n = 201)		 0.421
None 140 (69.6) 122 (87.1) 18 (12.9)
Bacterial coinfection 30 (14.9) 28 (93.3) 2 (6.7)
Other co-infections 31 (15.5) 29 (93.5) 2 (6.5)
Transferred to ICU (n = 201) 0.002
Yes 19 (9.5%) 12(63.2%) 7 (36.8%)
No 182 (90.5%) 167 (91.8%) 15 (8.2%)
Duration of Admission (n = 201) 0.025
Less than 7 days 131 (65.2%) 122 (93.1%) 9 (6.9%)
8–14 days 66 (32.8%) 54 (81.8%) 12 (18.2%)
15–21 days 4 (2%) 3 (75%) 1 (25%)
Compliance to COVID STG (n = 201) 0.468
Yes 137 (68.2%) 120 (87.6%) 17 (12.4%)
No 64 (31.8%) 59 (92.2%) 5 (7.8%)
Open in a new tab

NB: Variables with p-values highlighted in bold showed a statistically significant association with Treatment outcomes.

2.3. Multivariate Analysis

Compliance to the Ghanaian COVID-19 STG was independently predicted by a sore throat as a presenting complaint (aOR = 0.39, CI = 0.16–0.94, p-value = 0.036) (Table 3), while COVID-19 treatment outcomes were independently predicted by the patients’ transfer to the ICU (aOR = 0.22, CI = 0.07–0.66, p-value = 0.007) (Table 4).

Table 3.

Multiple logistic regression between independent variables that showed statistically significant association with STG compliance.

Independent Characteristics Adjusted Odds Ratio 95% CI p-Value
Sore throat as presenting complaint 0.39 0.16–0.94 0.036
Method of radiological assessment used in diagnosis 1.21 0.93–1.57 0.160
Open in a new tab

NB: Variables with p-values highlighted in bold showed a statistically significant association with compliance to the COVID-19 Standard Treatment Guidelines.

Table 4.

Logistic regression between independent variables that showed statistically significant association with treatment outcomes.

Independent Characteristics Adjusted Odds Ratio 95% CI p-Value
Age 0.69 0.41–1.19 0.190
Transferred to ICU 0.22 0.07–0.66 0.007
Duration of Admission 0.44 0.19–1.00 0.052
Open in a new tab

NB: Variables with p-values highlighted in bold showed statistically significant association with treatment outcome.

3. Discussion

To the best of our knowledge, we believe this study is a novelty among pediatric patients admitted to hospitals with COVID-19 in Ghana.

The calculated incidence rates of COVID-19 among pediatric patients managed at the University of Ghana Medical Centre (UGMC) in 2020 and 2021 were 9.8% (85/869) and 10.4% (116/1119), respectively, with an overall mortality rate of 10.9% (22/201). This mortality rate (10.9%) among pediatric patients diagnosed and admitted for COVID-19 was lower than seen in Bangladesh and Indonesia at the start of the pandemic, at 13.3% and 40%, respectively [41,48]. However, it was higher than a recent study in Bangladesh (1.4%), as well as the rate reported by the Child Rights International in Ghana, which showed that the incidence rate of COVID-19 among the pediatric population was 4.43% of the total population, with only four deaths recorded out of 2180 children with the virus (0.13% of total deaths) by the end of 2020 [20,49]. The higher mortality rate seen in UGMC could be accounted for by the surge of the disease following recent waves with new variants, coupled with a relaxation of restrictions surrounding social contact among the pediatric population following the commencement of the vaccination program [50]. In addition, the high COVID-19 vaccine hesitancy rates currently being reported among the population in Ghana may have contributed to these rates [44].

Admission rates among males (104/201, 51.7%) was slightly higher than among females (97/201, 48.3%). This is in line with previous studies conducted in other countries [29,30]; however, this had no association with the two outcomes of interest, i.e., prescribers’ compliance to Ghana COVID-19 STGs concerning the choice of antimicrobials and patient treatment outcomes.

Currently, vaccination against COVID-19 among the pediatric population in Ghana is targeted at those above 15 years. This is a concern since among the pediatric population admitted with COVID-19 at UGMC, those aged from 6 to 10 years formed the majority (44.8%, 90/201) followed by those aged from 11 to 15 years (27.9%, 56/201). This agrees with the Child Rights International report, which showed that majority of the pediatric population who have contracted COVID-19 fell within the age group of 0 to 14 years compared to those aged between 15 and 17 years [49]. It must also be noted that several countries including China, Cuba and the USA, have currently approved COVID-19 vaccination for children below the age of 18 years [51]. In addition, the Pfizer vaccine has now been approved by the US Food and Drug Administration for the vaccination of children between the ages of 5 to 10 years, proving guidance to the authorities in Ghana [51].

The commonly reported symptoms among the admitted pediatric patients included nasal congestion and fever (Table 1). These mirror many reported observational studies; however, a cough was reported less commonly in our study population than reported elsewhere [20,30,33,43,52]. We are not fully sure of the reasons for this, and will be investigating this further.

Encouragingly, most of the pediatric COVID-19 cases that were admitted in our study were mild to moderate, similar to other studies, with only a limited number of children subsequently admitted to ICUs [20,53,54]. These presentations led mostly to a shorter hospital stay of less than seven days (65.2%, 131/201), with pneumonia (80.6%, 162/201) being the most diagnosed complication followed by acute kidney injury (9.5%, 19/201). Overall, few reported cases (9.5%, 19/201) were transferred to the ICU for more aggressive management, which is also similar to other studies [20].

Azithromycin and hydroxychloroquine (41.3%, 83/201) were the most prescribed combination of antimicrobial agents used in the management of COVID-19 among the pediatric patients in our study, followed by the combination of azithromycin, hydroxychloroquine and remdesivir (18.4%, 37/201). A plethora of other antibiotics including meropenem, doxycycline, clindamycin and amoxicillin, were also prescribed, even though just under 15% (Table 1) of the cases had a bacterial coinfection diagnosed, which needs addressing to reduce future resistance rates [27,55]. This is reflected by the fact that compliance to the Ghana COVID-19 STGs concerning the choice of antimicrobials prescribed was sub-optimal, with a reported compliance rate of 68.2% (137/201). However, it must also be emphasized that the recommendations for the use of hydroxychloroquine or chloroquine in both adult and pediatric populations for the management of confirmed COVID-19 asymptomatic cases, and the use of the same antimicrobials in combination with either azithromycin or doxycycline for all forms of symptomatic cases, i.e., from mild to severe symptoms, in the current Ghana STG [7], are at variance with other international guidelines including the WHO COVID-19 guideline, the US National Institute of Health and the UK National Institute of Health and Clinical Excellence (NICE) guidelines. These guidelines recommend against the use of these antimicrobials as there is still no robust evidence for their prescribing, either for SARS-CoV-2 virus treatment or the presumptive treatment of bacteria co-infection [56,57,58]. The increased use of antibiotics either alone, e.g., azithromycin, or in combination with other regimens, without the clinical evidence or suspicion of bacterial co-infection, will, as mentioned, increase AMR and associated morbidity, mortality and healthcare cost without improving patient outcomes [19,26,59]. Consequently, there is an urgent need to review the 2020 Ghana STG for the management of patients with COVID-19 admitted to hospitals, based on the latest evidence. The current situation in Ghana though is similar to a number of other African countries where their STGs routinely recommend the prescribing of an appreciable number of antibiotics when managing patients with COVID-19 in both adults and children [60].

COVID-19 diagnosed patients who presented with a sore throat were less likely (OR = 0.39, C.I 0.16–0.94, p-value = 0.036) to receive empiric treatment with STG recommended antimicrobials in our study compared to those without this symptom. This may be due to the fact the most commonly associated symptoms of COVID-19 in the pediatric population were fever and nasal congestion, and not a sore throat [30,33,36,52]. Whilst the recovery rate in the hospital was high at approximately nine out of 10 admitted cases, pediatric patients who were transferred to the ICU were less likely (OR = 0.22, C.I 0.07–0.60, p-value = 0.007) to be discharged home alive. The higher mortality rate among these critical cases needs to be further investigated to ascertain the availability of essential resources and skills for the effective management of these children to reduce future mortality. We will be following this up in the future.

We are aware of a number of limitations with this study. Firstly, we only conducted the study in one hospital for the reasons stated. Secondly, as this was a retrospective study, some key data sets could not be ascertained and so were not recorded. For instance, we were unable to collect any data on the type of biomarkers used in the screening of potential bacterial co-infections as a way of confirming the presence of suspected co-infections. However, despite these limitations, we believe our findings are robust, providing guidance for the future.

4. Materials and Methods

4.1. Study Design, Study Site and Population

The study design was a retrospective cross-sectional study of medical records of pediatric patients with laboratory confirmed diagnosis of SARS-CoV-2 infection who were admitted to the COVID Treatment Center at the Medical Department of the University of Ghana Medical Centre (UGMC) between March 2020 and December 2021.

The COVID-19 Treatment Center at UGMC is a quaternary medical and research center located on the campus of the University of Ghana in Accra, Ghana. UGMC is an ultra-modern 1000 bed medical center located within the University of Ghana campus in the capital city of Ghana. The Center operates three major service areas namely Quaternary Level Healthcare provision, Medical Training and Scientific/Medical Research.

In addition to the many departments at the center including obstetrics and gynecology, pediatrics, family medicine, laboratory, pharmacy, emergency medicine, it is one of the foremost primary treatment and referral sites offering specialist care for patients with COVID-19 in Ghana. Consequently, this hospital was chosen for this initial study to research the current management and outcomes of children admitted to hospitals in Ghana with COVID-19.

The medical records of pediatric patients between the ages of 0 and 18 years of age admitted for the treatment of laboratory confirmed SARS-CoV-2 infections during the study period were sourced. The medical records of pediatric patients who had missing data concerning laboratory confirmatory tests were excluded.

4.2. Data Collection Method and Analysis

A data collection tool (Supplementary Table S1) was adapted from previous studies and designed to extract the medical records of the study participants [42,43]. We have used this approach before in previous studies involving patients with COVID-19 as well as previous point-prevalence studies [20,37,61,62].

Patients’ age, gender, year of admission, the presence of complications, the level of the severity of their COVID-19 spanning from mild to severe symptoms including acute respiratory distress syndrome based on the criteria contained within the current Ghana STG [7], their presenting symptoms, (i.e., fever, cough, sore throat and nasal congestion, treatment outcomes, categorized as discharged home and mortality, their duration of hospital admission, whether the children were transferred to the ICU for subsequent management or not, any antimicrobials prescribed, and compliance of the choice of antimicrobials prescribed based on the level of severity of COVID-19 according to the 2020 edition of the Ghana COVID-19 STG [7]. Adherence to guidelines is increasingly seen as a marker of the quality of care as part of antimicrobial stewardship programs in hospitals [46,61,63,64,65,66].

All data collected were entered on Microsoft Excel version 2013 and imported into STATA version 14 (StataCorp, TX, USA) for analysis. The analysis comprised of descriptive statistics, bivariate analysis (Chi-square test of independence) to determine any association between the study outcomes (guideline compliance and treatment outcome) and the independent variables at a significance level of 95%, and a multiple logistic regression to determine the predictors of the study outcomes, i.e., compliance to guidelines and treatment outcomes.

4.3. Ethical Consideration

Ethical clearance has been obtained for the work from the UHAS research and Ethics committee (Protocol Identification Number: UHAS-REC 4.7 l7l2t-22) and from the University of Ghana Medical and Research Centre (Protocol Identification Number: UGMC-IRB/MSRC/011/2022).

5. Conclusions

From our study, the incidence rates of COVID-19 among the pediatric population admitted at the COVID-19 treatment center of the UGMC in Ghana were reported to be higher in 2021 than in 2020. They were also observed to be higher among the age group of 6 to 10 years and the male gender population.

The commonly reported symptoms among these patients included nasal congestion, fever and cough and were usually mild to moderate in severity. However, the mortality rate was higher among those children subsequently transferred to the ICU.

Azithromycin and hydroxychloroquine were the most prescribed combination of antimicrobial agents used in the management of COVID-19 among the pediatric patients in our study. This reflected the recommendations in the current Ghanian STG; however, overall compliance with the current STG was sub-optimal. Knowledge of the clinical presentation as well as management and the impact of COVID-19 on pediatric patients is important to ensure that appropriate resources and skillful personnel are allocated for their care. In addition, there is an urgent need to revise the Ghana STG given concerns with over-promoting the prescribing of antimicrobials. We will be following this up in the future.

Acknowledgments

We acknowledge the management and staff of UGMC especially Josephine Mensah (the head of the pharmacy department).

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/antibiotics12020283/s1, Table S1: Study Questionnaire.

Click here for additional data file. (185.2KB, zip)

Author Contributions

Conceptualization, I.A.S., S.A.S. and B.G.; methodology, I.A.S., S.A.S., G.P. and N.S.; validation, I.A.S. and S.A.S.; formal analysis, I.A.S., S.A.S. and B.G.; investigation, I.A.S. and S.A.S.; resources, I.A.S. and S.A.S.; data curation, I.A.S., S.A.S., G.P. and N.S.; writing—original draft preparation, I.A.S. and B.G.; writing—review and editing, I.A.S., S.A.S., G.P., N.S. and B.G.; visualization, I.A.S.; supervision, I.A.S.; project administration, I.A.S. and B.G. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Ethical clearance has been obtained for the work from the UHAS research and Ethics committee (Protocol Identification Number: UHAS-REC 4.7 l7l2t-22) and from the University of Ghana Medical and Research Centre (Protocol Identification Number: UGMC-IRB/MSRC/011/2022).

Informed Consent Statement

No informed consent was sought as there was no direct contact with patients or their guardians. The data collected was obtained directly from patients’ medical records. This is in line with other similar studies undertaken by the co-authors [20,67,68,69,70,71,72,73].

Data Availability Statement

Additional data are available from the corresponding authors on reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

Funding Statement

This research received no external funding.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

  • 1.Khan M., Adil S.F., Alkhathlan H.Z., Tahir M.N., Saif S., Khan M., Khan S.T. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules. 2020;26:39. doi: 10.3390/molecules26010039. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Aljazeera Egypt Confirms Coronavirus Case, the First in Africa. [(accessed on 21 June 2021)]. Available online: https://www.aljazeera.com/news/2020/2/14/egypt-confirms-coronavirus-case-the-first-in-africa.
  • 3.Ogunleye O.O., Basu D., Mueller D., Sneddon J., Seaton R.A., Yinka-Ogunleye A.F., Wamboga J., Miljković N., Mwita J.C., Rwegerera G.M., et al. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front. Pharmacol. 2020;11:1205. doi: 10.3389/fphar.2020.01205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Afriyie D.K., Asare G.A., Amponsah S.K., Godman B. COVID-19 pandemic in resource-poor countries: Challenges, experiences and opportunities in Ghana. J. Infect. Dev. Ctries. 2020;14:838–843. doi: 10.3855/jidc.12909. [DOI] [PubMed] [Google Scholar]
  • 5.Ayouni I., Maatoug J., Dhouib W., Zammit N., Ben Fredj S., Ghammam R., Ghannem H. Effective public health measures to mitigate the spread of COVID-19: A systematic review. BMC Public Health. 2021;21:1015. doi: 10.1186/s12889-021-11111-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Nejadghaderi S.A., Saghazadeh A., Rezaei N. Health Care Policies and COVID-19 Prevalence: Is There Any Association? Int. J. Health Serv. 2022;52:9–22. doi: 10.1177/0020731421993940. [DOI] [PubMed] [Google Scholar]
  • 7.Republic of Ghana Ministry of Health Provisional Standard Treatment Guidelines for Novel Coronavirus Infection: COVID-19 Guidelines for Ghana. [(accessed on 21 June 2021)]; Available online: https://www.moh.gov.gh/wp-content/uploads/2016/02/COVID-19-STG-JUNE-2020-1.pdf.
  • 8.Kluge H.H.P., Wickramasinghe K., Rippin H.L., Mendes R., Peters D.H., Kontsevaya A., Breda J. Prevention and control of non-communicable diseases in the COVID-19 response. Lancet. 2020;395:1678–1680. doi: 10.1016/S0140-6736(20)31067-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Abbas K., Procter S.R., van Zandvoort K., Clark A., Funk S., Mengistu T., Hogan D., Dansereau E., Jit M., Flasche S. Routine childhood immunisation during the COVID-19 pandemic in Africa: A benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Glob. Health. 2020;8:e1264–e1272. doi: 10.1016/S2214-109X(20)30308-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Causey K., Fullman N., Sorensen R.J.D., Galles N.C., Zheng P., Aravkin A., Danovaro-Holliday M.C., Martinez-Piedra R., Sodha S.V., Velandia-González M.P., et al. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: A modelling study. Lancet. 2021;398:522–534. doi: 10.1016/S0140-6736(21)01337-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Schellack N., Strydom M., Pepper M.S., Herd C.L., Hendricks C.L., Bronkhorst E., Meyer J.C., Padayachee N., Bangalee V., Truter I. Social Media and COVID-19; Perceptions and Public Deceptions of Ivermectin, Colchicine and Hydroxychloroquine: Lessons for Future Pandemics. Antibiotics. 2022;11:445. doi: 10.3390/antibiotics11040445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Sefah I.A., Ogunleye O.O., Essah D.O., Opanga S.A., Butt N., Wamaitha A., Guantai A.N., Chikowe I., Khuluza F., Kibuule D., et al. Rapid Assessment of the Potential Paucity and Price Increases for Suggested Medicines and Protection Equipment for COVID-19 Across Developing Countries with a Particular Focus on Africa and the Implications. Front. Pharmacol. 2021;11:588106. doi: 10.3389/fphar.2020.588106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Abena P.M., Decloedt E.H., Bottieau E., Suleman F., Adejumo P., Sam-Agudu N.A., Muyembe TamFum J.-J., Seydi M., Eholie S.P., Mills E.J., et al. Chloroquine and Hydroxychloroquine for the Prevention or Treatment of novel coronavirus disease (COVID-19) in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings. Am. J. Trop. Med. Hyg. 2020;102:1184–1188. doi: 10.4269/ajtmh.20-0290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.RECOVERY Collaborative Group. Horby P., Mafham M., Linsell L., Bell J.L., Staplin N., Emberson J.R., Wiselka M., Ustianowski A., Elmahi E., et al. Effect of Hydroxychloroquine in Hospitalized Patients with COVID-19. N. Engl. J. Med. 2020;383:2030–2040. doi: 10.1056/NEJMoa2022926. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Dyer O. COVID-19: Remdesivir has little or no impact on survival, WHO trial shows. BMJ. 2020;371:m4057. doi: 10.1136/bmj.m4057. [DOI] [PubMed] [Google Scholar]
  • 16.Ferner R.E., Aronson J.K. Chloroquine and hydroxychloroquine in COVID-19. BMJ. 2020;369:m1432. doi: 10.1136/bmj.m1432. [DOI] [PubMed] [Google Scholar]
  • 17.RECOVERY Collaborative Group. Horby P., Lim W.S., Emberson J.R., Mafham M., Bell J.L., Linsell L., Staplin N., Brightling C., Ustianowski A., et al. Dexamethasone in Hospitalized Patients with COVID-19. N. Engl. J. Med. 2021;384:693–704. doi: 10.1056/NEJMoa2021436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Langford B.J., So M., Raybardhan S., Leung V., Soucy J.-P.R., Westwood D., Daneman N., MacFadden D.R. Antibiotic prescribing in patients with COVID-19: Rapid review and meta-analysis. Clin. Microbiol. Infect. 2021;27:520–531. doi: 10.1016/j.cmi.2020.12.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Alshaikh F.S., Godman B., Sindi O.N., Seaton R.A., Kurdi A. Prevalence of bacterial coinfection and patterns of antibiotics pre-scribing in patients with COVID-19: A systematic review and meta-analysis. PLoS ONE. 2022;17:e0272375. doi: 10.1371/journal.pone.0272375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Chowdhury K., Haque M., Nusrat N., Adnan N., Islam S., Lutfor A.B., Begum D., Rabbany A., Karim E., Malek A., et al. Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study. Antibiotics. 2022;11:105. doi: 10.3390/antibiotics11010105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Kumar S., Haque M., Shetty A., Choudhary S., Bhatt R., Sinha V., Manohar B., Chowdhury K., Nusrat N., Jahan N., et al. Characteristics and Management of Children with Suspected COVID-19 Admitted to Hospitals in India: Implications for Future Care. Cureus. 2022;14:e27230. doi: 10.7759/cureus.27230. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Ramzan K., Shafiq S., Raees I., Mustafa Z.U., Salman M., Khan A.H., Meyer J.C., Godman B. Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications. Antibiotics. 2022;11:789. doi: 10.3390/antibiotics11060789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Rawson T.M., Moore L.S.P., Zhu N., Ranganathan N., Skolimowska K., Gilchrist M., Satta G., Cooke G., Holmes A.H. Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescribing. Clin. Infect. Dis. 2020;71:2459–2468. doi: 10.1093/cid/ciaa530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Lai C.-C., Chen S.-Y., Ko W.-C., Hsueh P.-R. Increased antimicrobial resistance during the COVID-19 pandemic. Int. J. Antimicrob. Agents. 2021;57:106324. doi: 10.1016/j.ijantimicag.2021.106324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Lucien M.A.B., Canarie M.F., Kilgore P.E., Jean-Denis G., Fénélon N., Pierre M., Cerpa M., Joseph G.A., Maki G., Zervos M.J., et al. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. Int. J. Infect. Dis. 2021;104:250–254. doi: 10.1016/j.ijid.2020.12.087. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Ghosh S., Bornman C., Zafer M.M. Antimicrobial Resistance Threats in the emerging COVID-19 pandemic: Where do we stand? J. Infect. Public Health. 2021;14:555–560. doi: 10.1016/j.jiph.2021.02.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Hsu J. How COVID-19 is accelerating the threat of antimicrobial resistance. BMJ. 2020;369:m1983. doi: 10.1136/bmj.m1983. [DOI] [PubMed] [Google Scholar]
  • 28.Godman B., Egwuenu A., Wesangula E., Schellack N., Kalungia A.C., Tiroyakgosi C., Kgatlwane J., Mwita J.C., Patrick O., Niba L.L., et al. Tackling antimicrobial resistance across sub-Saharan Africa: Current challenges and implications for the future. Expert Opin. Drug Saf. 2022;21:1089–1111. doi: 10.1080/14740338.2022.2106368. [DOI] [PubMed] [Google Scholar]
  • 29.Cui X., Zhao Z., Zhang T., Guo W., Guo W., Zheng J., Zhang J., Dong C., Na R., Zheng L., et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19) J. Med. Virol. 2020;93:1057–1069. doi: 10.1002/jmv.26398. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Ma X., Liu S., Chen L., Zhuang L., Zhang J., Xin Y. The clinical characteristics of pediatric inpatients with SARS-CoV-2 infection: A meta-analysis and systematic review. J. Med. Virol. 2021;93:234–240. doi: 10.1002/jmv.26208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Howard-Jones A.R., Bowen A.C., Danchin M., Koirala A., Sharma K., Yeoh D.K., Burgner D.P., Crawford N.W., Goeman E., Gray P.E., et al. COVID-19 in children: I. Epidemiology, prevention and indirect impacts. J. Paediatr. Child Health. 2021;58:39–45. doi: 10.1111/jpc.15791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Mansourian M., Ghandi Y., Habibi D., Mehrabi S. COVID-19 infection in children: A systematic review and meta-analysis of clinical features and laboratory findings. Arch. De Pédiatrie. 2021;28:242–248. doi: 10.1016/j.arcped.2020.12.008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Irfan O., Muttalib F., Tang K., Jiang L., Lassi Z.S., Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: A systematic review and meta-analysis. Arch. Dis. Child. 2021;106:440–448. doi: 10.1136/archdischild-2020-321385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Olorunsaiye C.Z., Yusuf K.K., Reinhart K., Salihu H.M. COVID-19 and Child Vaccination: A Systematic Approach to Closing the Immunization Gap. Int. J. Matern. Child Health AIDS (IJMA) 2020;9:381–385. doi: 10.21106/ijma.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Kumar G., Mukherjee A., Sharma R.K., Menon G.R., Sahu D., Wig N., Panda S., Rao V.V., Singh S., Guleria R., et al. Clinical profile of hospitalized COVID-19 patients in first & second wave of the pandemic: Insights from an Indian registry based observational study. Indian J. Med. Res. 2021;153:619–628. doi: 10.4103/ijmr.ijmr_1628_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Zeiser F.A., Donida B., da Costa C.A., Ramos G.D.O., Scherer J.N., Barcellos N.T., Alegretti A.P., Ikeda M.L.R., Müller A.P.W.C., Bohn H.C., et al. First and second COVID-19 waves in Brazil: A cross-sectional study of patients’ characteristics related to hospitalization and in-hospital mortality. Lancet Reg. Health Am. 2021;6:100107. doi: 10.2139/ssrn.3894389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Kumar S., Haque M., Shetty A., Acharya J., Kumar M., Sinha V.K., Manohar B., Gowere M., Godman B. Current management of children with COVID-19 in hospitals in India; Pilot study and findings. Adv. Hum. Biol. 2022;12:16–21. [Google Scholar]
  • 38.Mantovani A., Rinaldi E., Zusi C., Beatrice G., Saccomani M.D., Dalbeni A. Coronavirus disease 2019 (COVID-19) in children and/or adolescents: A meta-analysis. Pediatr. Res. 2020;89:733–737. doi: 10.1038/s41390-020-1015-2. [DOI] [PubMed] [Google Scholar]
  • 39.Mardi P., Esmaeili M., Iravani P., Abdar M.E., Pourrostami K., Qorbani M. Characteristics of Children with Kawasaki Disease-Like Signs in COVID-19 Pandemic: A Systematic Review. Front. Pediatr. 2021;9:625377. doi: 10.3389/fped.2021.625377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Yasuhara J., Watanabe K., Takagi H., Sumitomo N., Kuno T. COVID-19 and multisystem inflammatory syndrome in children: A systematic review and meta-analysis. Pediatr. Pulmonol. 2021;56:837–848. doi: 10.1002/ppul.25245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Dewi R., Kaswandani N., Karyanti M.R., Setyanto D.B., Pudjiadi A.H., Hendarto A., Djer M.M., Prayitno A., Yuniar I., Indawati W., et al. Mortality in children with positive SARS-CoV-2 polymerase chain reaction test: Lessons learned from a tertiary referral hospital in Indonesia. Int. J. Infect. Dis. 2021;107:78–85. doi: 10.1016/j.ijid.2021.04.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Cura Yayla B.C., Özsürekçi Y., Aykaç K., Derin Oygar P., Laçinel Gürlevik S., İlbay S., Kukul M.G., Karahan S., Cengiz A.B., Ceyhan M. Characteristics and Management of Children with COVID-19 in Turkey. Balk. Med. J. 2020;37:341–347. doi: 10.4274/balkanmedj.galenos.2020.2020.7.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Mahmoudi S., Mehdizadeh M., Badv R.S., Navaeian A., Pourakbari B., Rostamyan M., Ekbatani M.S., Eshaghi H., Abdolsalehi M.R., Alimadadi H., et al. The Coronavirus Disease 2019 (COVID-19) in Children: A Study in an Iranian Children’s Referral Hospital. Infect. Drug Resist. 2020;13:2649–2655. doi: 10.2147/IDR.S259064. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Ogunleye O.O., Godman B., Fadare J.O., Mudenda S., Adeoti A.O., Yinka-Ogunleye A.F., Ogundele S.O., Oyawole M.R., Schönfeldt M., Rashed W.M., et al. Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future. Vaccines. 2022;10:1553. doi: 10.3390/vaccines10091553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Sefah I.A., Denoo E.Y., Bangalee V., Kurdi A., Sneddon J., Godman B. Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: Findings and implications. JAC Antimicrob. Resist. 2022;4:dlac102. doi: 10.1093/jacamr/dlac102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Sefah I.A., Essah D.O., Kurdi A., Sneddon J., Alalbila T.M., Kordorwu H., Godman B. Assessment of adherence to pneumonia guidelines and its determinants in an ambulatory care clinic in Ghana: Findings and implications for the future. JAC Antimicrob. Resist. 2021;3:dlab080. doi: 10.1093/jacamr/dlab080. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Campbell S.M., Meyer J., Godman B. Why Compliance to National Prescribing Guidelines is Important Especially across Sub-Saharan Africa and Suggestions for the Future. J. Biomed. Pharm. Sci. 2021;4:1–7. [Google Scholar]
  • 48.Hussain M., Al Mamun M.A. COVID-19 in children in Bangladesh: Situation analysis. Asia Pac. J. Paediatr. Child Health. 2020;3:59–65. [Google Scholar]
  • 49.Child Rights International COVID-19: State of Children in Ghana. [(accessed on 21 June 2021)]. Available online: https://crighana.org/wp-content/uploads/2020/11/COVID19-STATE-OF-CHILDREN-IN-GHANA_EDIT.pdf.
  • 50.Karim S.S.A., Karim Q.A. Omicron SARS-CoV-2 variant: A new chapter in the COVID-19 pandemic. Lancet. 2021;398:2126–2128. doi: 10.1016/S0140-6736(21)02758-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Mishra M., Erman M.U.S. FDA Authorizes First COVID-19 Shot for Young Kids. [(accessed on 21 June 2021)]. Available online: https://www.reuters.com/world/us/us-fda-expected-authorize-first-covid-19-vaccine-young-children-friday-nyt-2021-10-29/
  • 52.Yasuhara J., Kuno T., Takagi H., Sumitomo N. Clinical characteristics of COVID-19 in children: A systematic review. Pediatr. Pulmonol. 2020;55:2565–2575. doi: 10.1002/ppul.24991. [DOI] [PubMed] [Google Scholar]
  • 53.Castagnoli R., Votto M., Licari A., Brambilla I., Bruno R., Perlini S., Rovida F., Baldanti F., Marseglia G.L. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020;174:882–889. doi: 10.1001/jamapediatrics.2020.1467. [DOI] [PubMed] [Google Scholar]
  • 54.Forrest C.B., Burrows M.E.K., Mejias A., Razzaghi M.H., Christakis D., Jhaveri R., Lee G.M., Pajor N.M., Rao S., Thacker D., et al. Severity of Acute COVID-19 in Children <18 Years Old March 2020 to December 2021. Pediatrics. 2022;149:e2021055765. doi: 10.1542/peds.2021-055765. [DOI] [PubMed] [Google Scholar]
  • 55.Jampani M., Chandy S.J. Increased antimicrobial use during COVID-19: The risk of advancing the threat of antimicrobial resistance. Health Sci. Rep. 2021;4:e459. doi: 10.1002/hsr2.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.NICE COVID-19 Rapid Guideline: Managing COVID-19. [(accessed on 21 June 2021)]. Available online: https://www.nice.org.uk/guidance/ng191/resources/covid19-rapid-guideline-managing-covid19-pdf-51035553326.
  • 57.National Institutes of Health COVID-19 Treatment Guidelines; Anti-SARS-CoV-2 Antibody Products. [(accessed on 17 January 2022)]; Available online: https://www.covid19treatmentguidelines.nih.gov/
  • 58.WHO Clinical Management of COVID-19: Living Guideline. [(accessed on 21 June 2021)]. Available online: https://www.who.int/publications/i/item/WHO-2019-nCoV-Clinical-2022.2.
  • 59.Murray C.J., Ikuta K.S., Sharara F., Swetschinski L., Aguilar G.R., Gray A., Han C., Bisignano C., Rao P., Wool E., et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet. 2022;399:629–655. doi: 10.1016/S0140-6736(21)02724-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Adebisi Y.A., Jimoh N.D., Ogunkola I.O., Uwizeyimana T., Olayemi A.H., Ukor N.A., Lucero-Prisno D.E. The use of antibiotics in COVID-19 management: A rapid review of national treatment guidelines in 10 African countries. Trop. Med. Health. 2021;49:51. doi: 10.1186/s41182-021-00344-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61.Anand Paramadhas B.D., Tiroyakgosi C., Mpinda-Joseph P., Morokotso M., Matome M., Sinkala F., Gaolebe M., Malone B., Molosiwa E., Shanmugam M.G., et al. Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications. Expert Rev. Anti Infect. Ther. 2019;17:535–546. doi: 10.1080/14787210.2019.1629288. [DOI] [PubMed] [Google Scholar]
  • 62.Nusrat N., Haque M., Chowdhury K., Adnan N., Lutfor A.B., Karim E., Hassan M., Rabbany A., Begum D., Hasan M.N., et al. Pilot Study on the Current Management of Children with COVID-19 In Hospitals in Bangladesh; Findings and Implications. Bangladesh J. Med. Sci. 2021;20:188–198. doi: 10.3329/bjms.v20i5.55615. [DOI] [Google Scholar]
  • 63.Versporten A., Zarb P., Caniaux I., Gros M.-F., Drapier N., Miller M., Jarlier V., Nathwani D., Goossens H., Koraqi A., et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: Results of an internet-based global point prevalence survey. Lancet Glob. 2018;6:e619–e629. doi: 10.1016/S2214-109X(18)30186-4. [DOI] [PubMed] [Google Scholar]
  • 64.Brink A.J., Messina A.P., Feldman C., Richards G.A., van den Bergh D. From guidelines to practice: A pharmacist-driven prospective audit and feedback improvement model for peri-operative antibiotic prophylaxis in 34 South African hospitals. J. Antimicrob. Chemother. 2017;72:1227–1234. doi: 10.1093/jac/dkw523. [DOI] [PubMed] [Google Scholar]
  • 65.Niaz Q., Godman B., Campbell S., Kibuule D. Compliance to prescribing guidelines among public health care facilities in Na-mibia; findings and implications. Int. J. Clin. Pharm. 2020;42:1227–1236. doi: 10.1007/s11096-020-01056-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66.Saleem Z., Godman B., Cook A., Khan M.A., Campbell S.M., Seaton R.A., Siachalinga L., Haseeb A., Amir A., Kurdi A., et al. Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future. Antibiotics. 2022;11:1824. doi: 10.3390/antibiotics11121824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Godman B., Momanyi L., Opanga S., Nyamu D., Oluka M., Kurdi A. Antibiotic prescribing patterns at a leading referral hospital in Kenya: A point prevalence survey. J. Res. Pharm. Pract. 2019;8:149–154. doi: 10.4103/jrpp.JRPP_18_68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 68.Okoth C., Opanga S., Okalebo F., Oluka M., Kurdi A., Godman B. Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: Findings and implications. Hosp. Pract. 2018;46:128–136. doi: 10.1080/21548331.2018.1464872. [DOI] [PubMed] [Google Scholar]
  • 69.Mustafa Z.U., Salman M., Yasir M., Godman B., Majeed H.A., Kanwal M., Iqbal M., Riaz M.B., Hayat K., Hasan S.S. Antibiotic consumption among hospitalized neonates and children in Punjab province, Pakistan. Expert Rev. Anti Infect. Ther. 2021;20:931–939. doi: 10.1080/14787210.2021.1986388. [DOI] [PubMed] [Google Scholar]
  • 70.Dlamini N.N., Meyer J.C., Kruger D., Kurdi A., Godman B., Schellack N. Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: A pilot study and implications. Hosp. Pract. 2019;47:88–95. doi: 10.1080/21548331.2019.1592880. [DOI] [PubMed] [Google Scholar]
  • 71.Skosana P., Schellack N., Godman B., Kurdi A., Bennie M., Kruger D., Meyer J. A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications. Expert Rev. Anti Infect. Ther. 2021;19:1353–1366. doi: 10.1080/14787210.2021.1898946. [DOI] [PubMed] [Google Scholar]
  • 72.Saleem Z., Hassali M.A., Versporten A., Godman B., Hashmi F.K., Goossens H., Saleem F. A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: Findings and implications. Expert Rev. Anti Infect. Ther. 2019;17:285–293. doi: 10.1080/14787210.2019.1581063. [DOI] [PubMed] [Google Scholar]
  • 73.Kurdi A., Hasan A.J., Baker K.I., Seaton R.A., Ramzi Z.S., Sneddon J., Godman B. A multicentre point prevalence survey of hospital antibiotic prescribing and quality indices in the Kurdistan regional government of Northern Iraq: The need for urgent action. Expert Rev. Anti Infect. Ther. 2021;19:805–814. doi: 10.1080/14787210.2021.1834852. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Click here for additional data file. (185.2KB, zip)

Data Availability Statement

Additional data are available from the corresponding authors on reasonable request.

Articles from Antibiotics are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

RESOURCES