Background: Simulation is a crucial component in the training of healthcare professionals, offering a safe environment for practical learning without posing risks to patients. Aim: This study aims to evaluate the effect of simulation with a standardized patient on the acquisition and retention of knowledge, as well as on the self-efficacy of nursing students. Methods: A quasi-experimental study with a pre-test and post-test design was conducted with 120 nursing students, who were randomly assigned to two groups. The experimental group (60) received training through simulation with a standardized patient, supplemented by a lecture-based course. The control group (60) received only the same lecture-based course. A pre-test was conducted to assess students’ baseline knowledge and self-efficacy before any intervention. Student performance was then assessed with a post-test immediately after the training to measure knowledge acquisition and self-efficacy and a post-test three months after the intervention to measure long-term knowledge retention. Results: The results showed a statistically significant difference in mean scores between the intervention and control groups in terms of knowledge acquisition (14.92 vs. 13.32; p < 0.001; d = 0.99), self-efficacy (33.02 vs. 31.05; p < 0.001; d = 1.03) and knowledge retention three months after training (12.4 vs. 10.6; p < 0.001; d = 0.94). Conclusions: The results of this study confirmed the effectiveness of simulation in knowledge acquisition and retention, as well as in the self-efficacy of nursing students. These findings support the integration of this method into training programs to strengthen the skills of future healthcare professionals.

Background: Accurate mortality data associated with infectious diseases such as coronavirus disease 2019 (COVID-19) are often unavailable in countries with fragile health systems such as Somalia. We compared officially reported COVID-19 deaths in Somalia with COVID-19 deaths estimated using verbal autopsy. Methods: We interviewed relatives of deceased persons to collect information on symptoms, cause, and place of death. We compared these data with officially reported data and estimated the positive and negative predictive values of verbal autopsy. Results: We identified 530 deaths during March–October 2020. We classified 176 (33.2%) as probable COVID-19 deaths. Most deaths (78.5%; 416/530) occurred at home and 144 (34.6%) of these were attributed to COVID-19. The positive predictive value of verbal autopsy was lower for home deaths (22.3%; 95% CI: 15.7–30.1%) than for hospital deaths (32.3%; 95% CI: 16.7–51.4%). The negative predictive value was higher: 97.8% (95% CI: 95.0–99.3%) for home deaths and 98.4% (95% CI: 91.5–100%) for hospital deaths. Conclusions Verbal autopsy has acceptable predictive value to estimate COVID-19 deaths where disease prevalence is high and can provide data on the COVID-19 burden in countries with low testing and weak mortality surveillance where home deaths may be missed.

OBJECTIVES: To determine risk factors for death in patients with COVID-19 admitted to the main public sector hospital in Somalia and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. SETTING: Main public sector tertiary hospital in Mogadishu, Somalia. PARTICIPANTS: All 131 laboratory-confirmed COVID-19 patients admitted to the main public tertiary hospital in Somalia between 30 March and 12 June 2020. MAIN OUTCOME MEASURES: We extracted demographic and clinical data from hospital records of all 131 COVID-19 patients admitted to hospital until their death or recovery. We used Kaplan–Meier statistics to estimate survival probabilities and the log-rank test to assess significant differences in survival between groups. We used the Cox proportional hazard model to estimate likelihood of death and assess the effect of risk factors on survival. RESULTS: Of the 131 patients, 52 (40%) died in the hospital and 79 (60%) survived to discharge. The factors independently associated with increased risk of in-hospital death were: age ≥ 60 years – survival probability on day 21 in patients < 60 years was 0.789 (95% confidence interval (CI): 0.658–0.874) compared with 0.339 (95% CI: 0.205–0.478) in patients ≥ 60 years; cardiovascular disease (survival probability 0.478 (95% CI: 0.332–0.610) in patients with cardiovascular disease compared with 0.719 (95% CI: 0.601–0.807) in patients without cardiovascular disease); and non-invasive ventilation on admission – patients who were not ventilated were significantly more likely to survive than those who were ( P < 0.001). CONCLUSION: Our study, which includes the largest cohort of COVID-19 patients admitted to a single hospital in a sub-Saharan African country, confirms that underlying conditions and age are associated with increased risk of in-hospital death in patients with COVID-19. Our results show the advantage of medical oxygen over non-invasive ventilation in the treatment of patients with severe COVID-19 symptoms.