Characteristics and outcome profile of hospitalized African patients with COVID-19: The Ethiopian context

Abstract

Background The COVID-19 pandemic seems to have a different picture in Africa; the first case was identified in the continent after it had already caused a significant loss to the rest of the world and the reported number of cases and mortality rate has been low. Understanding the characteristics and outcome of the pandemic in the African setup is therefore crucial. Aim To assess the characteristics and outcome of Patients with COVID-19 and to identify determinants of the disease outcome among patients admitted to Millennium COVID-19 Care Center in Ethiopia. Methods A prospective cohort study was conducted among 1345 consecutively admitted RT-PCR confirmed Patients with COVID-19 from July to September, 2020. Frequency tables, KM plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to clinical recovery and the independent variables, where adjusted hazard ratio, P-value and 95% CI for adjusted hazard ratio were used for testing significance and interpretation of results. Binary logistic regression model was used to assess the presence of a statistically significant association between disease outcome and the independent variables, where adjusted odds ratio, P-value and 95% CI for adjusted odds ratio were used for testing significance and interpretation of results. Results Among the study population, 71 (5.3%) died, 72 (5.4%) were transferred and the rest 1202 (89.4%) were clinically improved. The median time to clinical recovery was 14 days. On the multivariable Cox proportional hazard model; temperature (AHR = 1.135, 95% CI = 1.011, 1.274, p-value = 0.032), COVID-19 severity (AHR = 0.660, 95% CI = 0.501, 0.869, p-value = 0.003), and cough (AHR = 0.705, 95% CI = 0.519, 0.959, p-value = 0.026) were found to be significant determinants of time to clinical recovery. On the binary logistic regression, the following factors were found to be significantly associated with disease outcome; SPO2 (AOR = 0.302, 95% CI = 0.193, 0.474, p-value = 0.0001), shortness of breath (AOR = 0.354, 95% CI = 0.213, 0.590, p-value = 0.0001) and diabetes mellitus (AOR = 0.549, 95% CI = 0.337, 0.894, p-value = 0.016). Conclusions The average duration of time to clinical recovery was 14 days and 89.4% of the patients achieved clinical recovery. The mortality rate of the studied population is lower than reports from other countries including those in Africa. Having severe COVID-19 disease severity and presenting with cough were found to be associated with delayed clinical recovery of the disease. On the other hand, being hyperthermic is associated with shorter disease duration (faster time to clinical recovery). In addition, lower oxygen saturation, subjective complaint of shortness of breath and being diabetic were associated with unfavorable disease outcome. Therefore, patients with these factors should be followed cautiously for a better outcome.

COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

“…Furthermore, patients with comorbidity tend to be older, that in-turn adds to the existing decrease in immunity. This finding is also supported by other studies conducted in Ethiopia, China, England and the US [ 5 , 12 , 26 , 27 , 34 , 35 ].…”

“…This implies that non-respiratory symptoms also might have a predictive value in disease categorization. This is also demonstrated by other studies in Ethiopia [ 4 , 5 , 24 – 26 ].…”

“…Having a history of pre-existing co-morbid illness particularly hypertension, diabetes, severe asthma, cancer, renal disease, cardiovascular, cerebrovascular diseases, and other co-morbidities were also found to be predictors of severe disease [ 6 – 23 ]. This is also reported in studies conducted in Ethiopia [ 4 , 5 , 24 – 26 ].…”

“…According to the Ethiopian Federal Ministry of Health Daily COVID-19 report, as of October 30, 2021, there were a total of 364, 960 infected cases with 425 cases under intensive care [ 3 ]. According to the report and studies conducted in Ethiopia the majority of the reported cases have milder disease presentations with favorable outcomes [ 3 – 5 ].…”

COVID-19 in hospitalized Ethiopian children: characteristics and outcome profile

“…This is in contrast to a study conducted in United Kingdom and North America where mortality rate of 1% and 4% were reported, respectively [ 4 ]. This also shows that the disease might have a different pattern compared to adults as a study conducted at our center among adults reported a mortality rate of 5.3% [ 23 ]. This difference could be attributed to the large proportion of asymptomatic patients in the studied population and also the small sample size in our study.…”