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The Mental health care: Adverse Sequelae of COVID-19 study aimed to (1) compare the consequences of the COVID-19 pandemic for mental health services and people with pre-existing mental health conditions (MHCs) in six low- and middle-income countries and (2) identify good practice to mitigate these impacts.
An observational study, using a mixed-methods convergent design triangulating data from (1) semistructured interviews or focus groups and/or a self-completed survey, (2) routine service utilisation data, (3) local grey literature and (4) expert consultation.
The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka.
121 key informants.
We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared with the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. In sites where primary care-based mental healthcare was more developed or prioritised, systems seemed more resilient and adaptive.
Our findings have the following implications. First, these mental health service reductions are clear examples of ‘structural stigma’, namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental healthcare into all general healthcare settings is key to ensuring accessibility and parity of physical and mental healthcare. Third, digital innovations should be designed to strengthen and not fragment health systems. We discuss these findings in terms of anticipating such challenges for future pandemics and preparing layers of resilience.
by Abebaw Misganaw, Alaye Debas Ayenew, Netsanet Temesgen Ayenew, Enyew Fenta Mengistu, Baye Ashenef, Samrawit Nega Shiferaw, Getamesay Demelash Simegn
BackgroundSurgery and anesthesia can disrupt normal physiological function through surgical stress and residual anesthetic effects, increasing the risk of post-anesthetic complications, known as critical incidents. This study aimed to determine the incidence of critical events in the post-anesthesia care unit at Debre Markos Comprehensive Specialized Hospital, Ethiopia.
MethodsAn institution-based prospective cross-sectional study was conducted from June 1, 2024, to September 30, 2024. The sample size was determined by a single proportion formula using a prevalence of 50% and a 5% margin of error at the 95% confidence interval. The data was analyzed using SPSS version 22 for windows. Analysis was conducted using bivariable and multivariable logistic regression as needed.
ResultOf the 422 patients, 160 (37.9%) experienced one or more critical events, with a total of 214 complications recorded. The most common critical events that occurred in the PACU were cardiovascular-related events (42%) and respiratory & airway related incidents (20%). BMI, duration of anesthesia, intraoperative complications, patient handover, PACU staff training, and ASA physical status were significantly associated with the occurrence of critical events. The odds of critical events were higher among underweight (AOR = 3.71; 95% CI: 1.27–10.79) and overweight patients (AOR = 3.05; 95% CI: 1.28–7.24). Anesthesia duration of 1–2 hours (AOR = 2.01; 95% CI: 1.06–3.81) and >2 hours (AOR = 4.11; 95% CI: 1.59–10.66) also increased the risk. Patients with intraoperative complications had higher odds of critical events (AOR = 3.52; 95% CI: 1.88–6.58), as did those without proper handover (AOR = 3.92; 95% CI: 2.11–7.25). Increasing ASA class was associated with higher risk ASA II (AOR = 2.59; 95% CI: 1.11–6.07), ASA III (AOR = 2.86; 95% CI: 1.20–6.86), and ASA IV (AOR = 11.75; 95% CI: 2.76–50.03). Additionally, patients cared for by PACU nurses without prior PACU training were more likely to develop complications (AOR = 3.15; 95% CI: 1.73–5.72).
ConclusionApproximately 38% of patients experienced ≥1 critical event, mainly cardiovascular and respiratory complications. Patients who had intraoperative complications, ASA 2 to ASA 4 status, under/overweight, and those who received anesthesia for a prolonged duration were relatively at higher risk of developing critical events. There was a long time to stay in the PACU for those patients who experienced critical events.
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