Understanding risk factors for death in Covid-19 is key to providing good quality clinical care. We assessed the presenting characteristics of the 'first wave' of patients with Covid-19 at Royal Oldham Hospital, UK and undertook logistic regression modelling to investigate factors associated with death. Of 470 patients admitted, 169 (36%) died. The median age was 71 years (IQR 57-82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n=218, 46.4%), diabetes (n=143, 30.4%) and chronic neurological disease (n=123, 26.1%). The most frequent complications were acute kidney injury (n=157, 33.4%) and myocardial injury (n=21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received noninvasive ventilation. Independent risk factors for death were increasing age (OR per 10 year

Marked increases in costs have been identified when complications of these chronic diseases occur, underlining the importance of secondary prevention approaches in disease management in South Asia. Higher quality studies, especially those that include longitudinal costs, are required to establish more robust cost estimates.

BackgroundIn Peru, despite decades of concerted control efforts, malaria remains a significant public health burden. Peru has recently exhibited a dramatic rise in malaria incidence, impeding South America’s progress towards malaria elimination. The Amazon basin, in particular the Loreto region of Peru, has been identified as a target for the implementation of intensified control strategies, aiming for elimination. No research has addressed why vector control strategies in Loreto have had limited impact in the past, despite vector control elsewhere being highly effective in reducing malaria transmission. This study employed qualitative methods to explore factors limiting the success of vector control strategies in the region.MethodsTwenty semi-structured interviews were conducted among adults attending a primary care centre in Iquitos, Peru, together with 3 interviews with key informants (health care professionals). The interviews focussed on how local knowledge, together with social and cultural attitudes, determined the use of vector control methods.ResultsFive themes emerged. (a) Participants believed malaria to be embedded within their culture, and commonly blamed this for a lack of regard for prevention. (b) They perceived a shift in mosquito biting times to early evening, rendering night-time use of bed nets less effective. (c) Poor preventive practices were compounded by a consensus that malaria prevention was the government’s responsibility, and that this reduced motivation for personal prevention. (d) Participants confused the purpose of space-spraying. (e) Participants’ responses also exposed persisting misconceptions, mainly concerning the cause of malaria and best practices for its prevention.ConclusionTo eliminate malaria from the Americas, region-specific strategies need to be developed that take into account the local social and cultural contexts. In Loreto, further research is needed to explore the potential shift in biting behaviour of Anopheles darlingi, and how this interacts with the population’s social behaviours and current use of preventive measures. Attitudes concerning personal responsibility for malaria prevention and long-standing misconceptions as to the cause of malaria and best preventive practices also need to be addressed.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2177-9) contains supplementary material, which is available to authorized users.

Background Understanding risk factors for death in Covid 19 is key to providing good quality clinical care. Due to a paucity of robust evidence, we sought to assess the presenting characteristics of patients with Covid 19 and investigate factors associated with death. Methods Retrospective analysis of adults admitted with Covid 19 to Royal Oldham Hospital, UK. Logistic regression modelling was utilised to explore factors predicting death. Results 470 patients were admitted, of whom 169 (36%) died. The median age was 71 years (IQR 57 to 82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n=218, 46.4%), diabetes (n=143, 30.4%) and chronic neurological disease (n=123, 26.1%). The most frequent complications were acute kidney injury (n=157, 33.4%) and myocardial injury (n=21, 4.5%). Forty three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation Independent risk factors for death were increasing age (OR per 10 year increase above 40 years 1.87, 95% CI 1.57 to 2.27), hypertension (OR 1.72, 1.10 to 2.70), cancer (OR 2.20, 1.27 to 3.81), platelets <150x103/microlitre (OR 1.93, 1.13 to 3.30), C-reactive protein >100 micrograms/mL (OR 1.68, 1.05 to 2.68), >50% chest radiograph infiltrates, (OR 2.09, 1.16 to 3.77) and acute kidney injury (OR 2.60, 1.64 to 4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2 (oxygen saturation index), lymphopenia or other comorbidities. Conclusions We characterised the first wave of patients with Covid 19 in one of Englands highest incidence areas, determining which factors predict death. These findings will inform clinical and shared decision making, including the use of respiratory support and therapeutic agents.