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

Abstract

Background The COVID-19 pandemic started a little later in Ethiopia than the rest of the world and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting. Objective The study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity. Methods A cross-sectional study was conducted from June to August 2020 among 686 randomly selected patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify factors associated with COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing. Results Having moderate as compared with mild disease was significantly associated with having hypertension (AOR = 2.30, 95%CI = 1.27,4.18), diabetes mellitus (AOR = 2.61, 95%CI = 1.31,5.19for diabetes mellitus), fever (AOR = 6.12, 95%CI = 2.94,12.72) and headache (AOR = 2.69, 95%CI = 1.39,5.22). Similarly, having severe disease as compared with mild disease was associated with age group (AOR = 4.43, 95%CI = 2.49,7.85 for 40–59 years and AOR = 18.07, 95%CI = 9.29,35.14for ≥ 60 years), sex (AOR = 1.84, 95%CI = 1.12,3.03), hypertension (AOR = 1.97, 95%CI = 1.08,3.59), diabetes mellitus (AOR = 3.93, 95%CI = 1.96,7.85), fever (AOR = 13.22, 95%CI = 6.11, 28.60) and headache (AOR = 4.82, 95%CI = 2.32, 9.98). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR = 4.87, 95%CI = 2.85, 8.32 for 40–59 years and AOR = 18.91, 95%CI = 9.84,36.331 for ≥ 60 years), fever (AOR = 2.16, 95%CI = 1.29,3.63) and headache (AOR = 1.79, 95%CI = 1.03, 3.11). Conclusions Significant factors associated with severe COVID-19 in Ethiopia are being older than 60 years old, male, a diagnosis of hypertension, diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in the country were the relatively younger with fewer health problems.

Factors Associated for COVID19 Severity Among Patients Treated at Selgalu Treatment Center Assosa in Ethiopia: A Case–Control Study

“… 15 , 16 This study showed that COVID-19 severity was higher among patients with 40–59 age groups and being aged 60 or older than the other age groups category respectively. It is consistent with case-control studies conducted in our country 17 and other country. Though nearly half of patients in this study were aged less than 40, a very small number of the case were observed among mentioned age category, This might be because immune systems grow weaker as we age and it is one of many adverse consequences of body ability to defend itself from disease, and being aged therefore often suspected to contribute to disease severity, which makes it more challenging for older adults to fight off disease severity.…”

Determinants of mortality among COVID-19 patients with diabetes mellitus in Addis Ababa, Ethiopia, 2022: An unmatched case-control study

“…Previous studies showed the association of COVID-19 patients with advanced age (>65 years). This finding is evidenced in the general population (diabetic and non-diabetic patients) (22, 23). Conversely, the current study reported that patients younger than 65 years are also at a higher risk of death than those without DM.…”

“…The study finding also revealed that diabetic patients who were admitted with mild and moderate COVID-19 disease had five times [(AOR=4.95; 95% CI: 2.20, 11.30), p=<0.001] increased chance of mortality compared with non-diabetic patients with the same disease severity. Even though not specific to patients with DM, existing evidence documented high mortality among patients who presented with severe COVID-19 illness (23). Equally, the current study notified that having DM would raise the risk of mortality even among those admitted with mild and moderate COVID-19 illness.…”

Survival Time to COVID-19 Severity and Its Predictors in South Gondar Zone, North-West Ethiopia: A Prospective Cohort Study

“…33 This could be due to high blood pressure altering ACE2 expression, increasing the risk of cardiovascular and renal failure, and may cause organ damage; thus, the detrimental effect of high blood pressure on COVID-19 outcomes. 36 In other studies, [37][38][39][40] factors such as sex, clinical symptoms like headache or cough, co-infection, lymphocytopenia, leukopenia, and low platelet count were related to COVID-19 severity and mortality. However, in our study, these variables were not statistically associated with COVID-19 severity.…”