Clinical features and risk factors associated with morbidity and mortality among patients with COVID-19 in northern Ethiopia

Abraha, Hiluf Ebuy; Gessesse, Zekarias; Gebrecherkos, Teklay; Kebede, Yazezew; Weldegiargis, Aregawi Weldegebreal; Tequare, Mengistu Hagazi; Welderufael, Abadi Luel; Zenebe, Dawit; Gebremariam, Asqual Gebreslassie; Dawit, Tsega Cherkos; Gebremedhin, Daniel Woldu; Wit, Tobias Rinke de; Wolday, Dawit

doi:10.1016/j.ijid.2021.03.037

Cited by 57 publications

(83 citation statements)

References 39 publications

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“…Fourth, it is difficult to ascertain whether the cases included in our study can be considered representative of the wider population, given the fact that there is lack of data from the country. Finally, the inclusion of a smaller proportion of critical cases (which are rare in our settings) [33] , as compared to other categories within the clinical spectrum of COVID-19 in our cohort may potentially bias the results. Confounding through other treatments the patients may have received on their COVID-19 severity in our cohorts is negligible, as very few patients ( n = 5) took remdesivir.…”

Section: Discussionmentioning

confidence: 99%

Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study

Wolday¹,

Gebrecherkos²,

Arefaine³

et al. 2021

EClinicalMedicine

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive ( p <0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17–0.30; p <0.0001) for all parasites, aOR 0.37 ([95% CI 0.26–0.51]; p <0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19–0.35]; p <0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolopis nana, Schistosoma mansoni , and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites ( p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) – European Union, and Joep Lange Institute (JLI), The Netherlands. Trial registration: Clinicaltrials.gov: NCT04473365

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Section: Discussionmentioning

confidence: 99%

Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study

Wolday¹,

Gebrecherkos²,

Arefaine³

et al. 2021

EClinicalMedicine

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“… 4 , 24 , 25 Our study findings are consistent with reports published globally and comparable to other studies done in Africa. 8 , 26 Elderly and males have been found to be at an increased risk of mortality, this has been associated with the higher levels of angiotensin-converting enzyme 2 (ACE2), which is a cell surface receptor for SARS-CoV-2. 27 Nevertheless, our study did not find any association between gender and increased odds of mortality.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study

Kassam¹,

Aghan²,

Aziz³

et al. 2021

IJGM

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Background:The emergence of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. There has been paucity of data for hospitalized African patients suffering from COVID-19. This study aimed to identify factors associated with in-hospital mortality in patients suffering from COVID-19 in Tanzania. Methods: This was a single center, retrospective, observational cohort study in adult patients hospitalized with confirmed COVID-19 infection. Demographics, clinical pattern, laboratory and radiological investigations associated with increased odds of mortality were analyzed. Results: Of the 157 patients, 107 (68.1%) patients survived and 50 (31.8%) died. Mortality was highest in patients suffering with severe (26%) and critical (68%) forms of the disease. The median age of the cohort was 52 years (IQR 42-61), majority of patients were male (86%) and of African origin (46%), who presented with fever (69%), cough (62%) and difficulty in breathing (43%). Factors that were associated with mortality among our cohort were advanced age (OR 1.07, 95% CI 1.03-1.11), being overweight and obese (OR 9.44, 95% CI 2.71-41.0), suffering with severe form of the disease (OR 4.77, 95% CI 1.18-25.0) and being admitted to the HDU and ICU (OR 6.68, 95% CI 2.06-24.6). Conclusion:The overall in-hospital mortality was 31.8%. Older age, obesity, the severe form of the disease and admission to the ICU and HDU were major risk factors associated with in-hospital mortality.

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“…Out of the 25 studies selected, 7 studies performed screening of all close household contacts ( 64 , 80 , 83 , 103 , 117 , 131 ), 3 screened all flight passengers ( 28 , 84 , 91 ), and 2 screened all members of a tourist/pilgrim group ( 94 , 129 ). Others were based on screening of healthcare workers ( 25 , 110 ), inpatients admitted for non−COVID-19 reasons ( 19 , 50 , 59 , 72 , 108 , 113 ), rigorously community screening ( 82 , 166 ), travelers ( 18 , 180 ), and those associated with a detention facility ( 92 ).…”

Section: Methodsmentioning

confidence: 99%

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Sah

Fitzpatrick

Zimmer

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

406

351

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Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.

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Clinical features and risk factors associated with morbidity and mortality among patients with COVID-19 in northern Ethiopia

Cited by 57 publications

References 39 publications

Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study

Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study

Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

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