Characteristics and outcome profile of Hospitalized African COVID-19 patients: The Ethiopian Context

Abstract

BackgroundThe COVID-19 pandemic seems to have a different picture in Africa; the first case was identified in the continent after it has 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 pandemicin the African setup is therefore crucial.AimTo assess the characteristics and outcome of COVID-19 patients and to identify determinants of the disease outcome among patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA prospective cohort study was conducted among 1345 consecutively admitted RT-PCR confirmed COVID-19 patients 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 improvement 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 resultsResultsAmong 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 improvement 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 improvement. 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).ConclusionsThe average duration of time to clinical improvement was 14 days and 89.4 % of the patients achieved clinical improvement. 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 improvement of the disease. On the other hand, being hyperthermic is associated with shorter disease duration (faster time to clinical improvement). In addition, lower oxygen saturation and 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 in Hospitalized Ethiopian Children: Characteristics and Outcome Profile

“…Otherwise, the time to clinical improvement didn’t show significant difference among the groups classified by age group, symptoms and disease severity. This is an opposing pattern compared to adult findings in the center where survival distribution showed a significant difference between groups classified by age, symptom and disease severity but didn’t show a difference between the two sexes 18 .…”

“…Similarly, a study conducted in China among pediatric patients showed that the median time to cure was 16 days 6 . The median time to recovery among adults was also the same in the study area 18 .…”

“…Almost two third (63.3%) of the participants were females unlike the pediatric studies conducted in other countries where the majority of infected children are males 3,4 . In addition, researches conducted among adults in our center also showed a contrasting pattern where the majority of infected are males 18-23 .…”

Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa: descriptive observational study

“…Mortality rates reported from a field hospital in Ethiopia were much lower (5.3%) despite a similar profile of COVID-19 severity in those seen. 25 This may be explained by much lower levels of comorbidity. For example, no HIV or TB was reported and diabetes was found in 14% as opposed to 25% of patients.…”

Asthma in Adult Patients with COVID-19. Prevalence and Risk of Severe Disease

“…In nine studies conducted in South Korea (n = 37,938) (70,(118)(119)(120)(121)(122)(123)(124)(125), the pooled prevalence was 5.4% (95 % CI, 2.3-9.6%). Data regarding asthma prevalence in people with COVID-19 in Canada ( 126), Brazil (127-129), India (130,131), Bangladesh (132,133), the Philippines (134), Japan (135,136), Africa (137)(138)(139)(140), Iran (141,142), Kuwait (143), Turkey (144)(145)(146), Israel (147)(148)(149), and Saudi Arabia (150) were relatively sparse, making them difficult to characterize by country, but they were generally within the range of the prevalences reported above.…”