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Bepouka B, Mandina M, Mvibudulu D, Matangila J, Okamba A, Muyeke G, Tawaba D, Mayasi N, Odio O, Mangala D, Lukiana T, Mbula M, Situakibanza H, Longokolo M. Clinical Characteristics and Mortality Trends Among COVID-19 Patients During the First Four Waves in Ngaliema Clinic, Democratic Republic of the Congo. Infect Drug Resist 2025; 18:2525-2536. [PMID: 40384799 PMCID: PMC12085894 DOI: 10.2147/idr.s499371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 05/10/2025] [Indexed: 05/20/2025] Open
Abstract
Background COVID-19 disease has been a deadly pandemic in different waves in the Democratic Republic of Congo. However, knowledge of the clinical characteristics of COVID-19 patients and the factors associated with death during different waves is important. Methods We conducted a retrospective cohort of 410 patients hospitalized during 4 waves of COVID-19, from March 20, 2020, to January 2, 2022, at the Ngaliema clinic in DR Congo. We included any patient hospitalized for COVID-19 with biological confirmation by RT-PCR. Factors associated with death were investigated using logistic regression. Results During the 4 waves of the COVID-19 pandemic at Clinique Ngaliema, complaints on admission were most often fever, cough and physical asthenia. Death was most common in the elderly, hypertensive and diabetic patients, those with elevated CRP and hyper leukocytosis. Mortality was highest in the 1st wave (28%), followed by the 3rd wave (27%), then the 2nd (22%) and 4th waves (21%). Factors associated with death were hyper leukocytosis (ORa: 2.76; CI 95%: 1.25-6.1), severe disease stage (ORa 21.24; CI 95%: 1.87-24). Vitamin C 500 mg twice a day use was protective (ORa: 0.24; CI 95%: 0.08-0.72). Conclusion COVID-19 disease poses a real public health problem, with non-negligible mortality. Factors associated with death were degree of disease severity, hyper leukocytosis and non-use of vitamin C. Taking these factors into account will help clinicians and decision-makers to anticipate future waves of the pandemic.
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Affiliation(s)
- Ben Bepouka
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Office of Infectious Diseases and Global Health Research, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Daniel Mvibudulu
- Faculty of Medicine, Kongo University, Kisantu, Democratic Republic of the Congo
- Emergency Service, Ngaliema Clinic, Kinshasa, Democratic Republic of the Congo
| | - Junior Matangila
- Emergency Service, Ngaliema Clinic, Kinshasa, Democratic Republic of the Congo
| | - Armand Okamba
- Cardiology Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Gertrude Muyeke
- Faculty of Medicine, Kongo University, Kisantu, Democratic Republic of the Congo
| | - Dieudonne Tawaba
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Office of Infectious Diseases and Global Health Research, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Nadine Mayasi
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Ossam Odio
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Donat Mangala
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Tuna Lukiana
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
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Yeung ST, Damani-Yokota P, Thannickal SA, Bartnicki E, Bernier ED, Barnett CR, Khairallah C, Duerr R, Noval MG, Segal LN, Stapleford KA, Khanna KM. Nerve- and airway-associated interstitial macrophages mitigate SARS-CoV-2 pathogenesis via type I interferon signaling. Immunity 2025; 58:1327-1342.e5. [PMID: 40286790 DOI: 10.1016/j.immuni.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 12/27/2024] [Accepted: 04/02/2025] [Indexed: 04/29/2025]
Abstract
Despite vaccines, rapidly mutating viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to threaten human health due to an impaired immunoregulatory pathway and a hyperactive immune response. Our understanding of the local immune mechanisms used by tissue-resident macrophages to safeguard the host from excessive inflammation during SARS-CoV-2 infection remains limited. Here, we found that nerve- and airway-associated interstitial macrophages (NAMs) are required to control mouse-adapted SARS-CoV-2 (MA-10) infection. Control mice restricted lung viral distribution and survived infection, whereas NAM depletion enhanced viral spread and inflammation and led to 100% mortality. Mechanistically, type I interferon receptor (IFNAR) signaling by NAMs was critical for limiting inflammation and viral spread, and IFNAR deficiency in CD169+ macrophages mirrored NAM-depleted outcomes and abrogated their expansion. These findings highlight the essential protective role of NAMs in regulating viral spread and inflammation, offering insights into SARS-CoV-2 pathogenesis and underscoring the importance of NAMs in mediating host immunity and disease tolerance.
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Affiliation(s)
- Stephen T Yeung
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Payal Damani-Yokota
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Sara A Thannickal
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Eric Bartnicki
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Eduardo D Bernier
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Clea R Barnett
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Camille Khairallah
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Ralf Duerr
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA; Department of Medicine, Vaccine Center, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Maria G Noval
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Leopoldo N Segal
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kenneth A Stapleford
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Kamal M Khanna
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY 10016, USA; Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA.
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Abera BT, Gebrecherkos T, Weledegebriel MG, Abreha GF. Prevalence of COVID-19 and associated factors among healthcare workers in the war-torn Tigray, Ethiopia. PLoS One 2024; 19:e0310128. [PMID: 39576201 PMCID: PMC11581278 DOI: 10.1371/journal.pone.0310128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 08/23/2024] [Indexed: 11/24/2024] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) has put an enormous encumbrance on the healthcare system and healthcare workers (HCWs) worldwide, particularly in war-torn areas. As the world strives to end the pandemic, knowing the magnitude of the infection and its contributing factors in fragile settings is critical to prevent further waves of the pandemic. METHODS Using rapid diagnostic tests (RDTs), a facility-based cross-sectional study was conducted to assess the prevalence of COVID-19 and its associated factors. The study was conducted among 326 unvaccinated HCWs in two hospitals in Tigray, Ethiopia from. The study period was from June 26 to December 31, 2021. Descriptive statistics were used to analyze the characteristics of study participants and the magnitude of COVID-19 while multivariate logistic regression was applied to assess factors affecting COVID-19 infection among HCWs. RESULTS The seroprevalence of COVID-19 among HCWs in the war-torn region of Tigray was 52.4% and 56.5% using Cellex and INNOVA antibody RDTs, respectively. The point prevalence, using Abbot Antigen test, was 14.2%. The overall infection prevention and control practice (IPC) and facility preparedness was poor with >85% of the HCWs reporting not wearing eye goggle/face shield and respirator in activities that needed transmission-based precautions; none of the participants reporting as having separate waste disposal system for COVID-19 cases; and only 56.8% reporting as having an isolation area during the time of testing. In the multivariate analysis, not having isolation area (AOR = 19.6, 95% CI: 7.57-50.78), re-using of personal protective equipment (PPE) (AOR = 3.23, 95% CI: 1.54-6.77), being symptomatic (AOE = 2.4, 95% CI: 1.02-5.67), and being a medical doctor, doctor of dental surgery, and anesthetist (AOR = 3.64, 95% CI: 1.05-12.66) were significantly associated with having at least one positive result. CONCLUSIONS Shortage of PPE supply, poor IPC practice, suboptimal facility preparedness, and low vaccination coverage in the region contributed to the high rate of COVID-19 infection among HCWs observed in this study.
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Affiliation(s)
- Bisrat Tesfay Abera
- Department of Internal Medicine, School of Medicine, Mekelle University, Tigray, Ethiopia
| | - Teklay Gebrecherkos
- Department of Microbiology and Immunology, School of Biomedical Sciences, Mekelle University, Tigray, Ethiopia
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Abera Dinssa D, Gebremicael G, Mengistu Y, Hull NC, Chalchisa D, Berhanu G, Gebreegziabxier A, Norberg A, Snyder S, Wright S, Gobena W, Abera A, Belay Y, Chala D, Gizaw M, Getachew M, Tesfaye K, Tefera M, Belachew M, Mulu T, Ali S, Kebede A, Melese D, Abdella S, Rinke de Wit TF, Kebede Y, Hailu M, Wolday D, Tessema M, Tollera G. Longitudinal wastewater-based surveillance of SARS-CoV-2 during 2023 in Ethiopia. Front Public Health 2024; 12:1394798. [PMID: 39435409 PMCID: PMC11491403 DOI: 10.3389/fpubh.2024.1394798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 09/16/2024] [Indexed: 10/23/2024] Open
Abstract
Introduction Although wastewater-based epidemiology (WBE) successfully functioned as a tool for monitoring the coronavirus disease 2019 (COVID-19) pandemic globally, relatively little is known about its utility in low-income countries. This study aimed to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater, estimate the number of infected individuals in the catchment areas, and correlate the results with the clinically reported COVID-19 cases in Addis Ababa, Ethiopia. Methods A total of 323 influent and 33 effluent wastewater samples were collected from three Wastewater Treatment Plants (WWTPs) using a 24-h composite Moore swab sampling method from February to November 2023. The virus was captured using Ceres Nanotrap® Enhancement Reagent 2 and Nanotrap® Microbiome A Particles, and then nucleic acids were extracted using the Qiagen QIAamp Viral RNA Mini Kit. The ThermoFisher TaqPath™ COVID-19 kit was applied to perform real-time reverse transcriptase polymerase chain reaction (qRT-PCR) to quantify the SARS-CoV-2 RNA. Wastewater viral concentrations were normalized using flow rate and number of people served. In the sampling period, spearman correlation was used to compare the SARS-CoV-2 target gene concentration to the reported COVID-19 cases. The numbers of infected individuals under each treatment plant were calculated considering the target genes' concentration, the flow rate of treatment plants, a gram of feces per person-day, and RNA copies per gram of feces. Results SARS-CoV-2 was detected in 94% of untreated wastewater samples. All effluent wastewater samples (n = 22) from the upflow anaerobic sludge blanket (UASB) reactor and membrane bioreactor (MBR) technology were SARS-COV-2 RNA negative. In contrast, two out of 11 effluents from Waste Stabilization Pond were found positive. Positive correlations were observed between the weekly average SARS-CoV-2 concentration and the cumulative weekly reported COVID-19 cases in Addis Ababa. The estimated number of infected people in the Kality Treatment catchment area was 330 times the number of COVID-19 cases reported during the study period in Addis Ababa. Discussion This study revealed that SARS-CoV-2 was circulating in the community and confirmed previous reports of more asymptomatic COVID-19 cases in Ethiopia. Additionally, this study provides further evidence of the importance of wastewater-based surveillance in general to monitor infectious diseases in low-income settings. Conclusion Wastewater-based surveillance of SARS-CoV-2 can be a useful method for tracking the increment of COVID-19 cases before it spreads widely throughout the community.
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Affiliation(s)
| | | | - Yohannes Mengistu
- Global Health, The Association of Public Health Laboratories (APHL), Addis Ababa, Ethiopia
| | - Noah C. Hull
- Global Health and Environmental Health, The APHL, Bethesda, MD, United States
| | | | - Girma Berhanu
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | | | - Ashley Norberg
- Global Health and Environmental Health, The APHL, Bethesda, MD, United States
| | - Sarah Snyder
- Global Health and Environmental Health, The APHL, Bethesda, MD, United States
| | - Sarah Wright
- Environmental Health, The APHL, Bethesda, MD, United States
| | - Waktole Gobena
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Adugna Abera
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Yohannes Belay
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Dawit Chala
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Melaku Gizaw
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Mesay Getachew
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Kirubel Tesfaye
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Mesfin Tefera
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Mahlet Belachew
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Tegegne Mulu
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Solomon Ali
- Department of Microbiology, Immunology and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abebaw Kebede
- Africa Centres for Disease Control and Prevention (Africa CDC), Surveillance and Disease Intelligence Division, Addis Ababa, Ethiopia
| | - Daniel Melese
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Saro Abdella
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Tobias F. Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Yenew Kebede
- Africa Centres for Disease Control and Prevention (Africa CDC), Surveillance and Disease Intelligence Division, Addis Ababa, Ethiopia
| | - Mesay Hailu
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Dawit Wolday
- Department of Biochemistry and Biomedical Sciences, Michael G. DeGroote Institute for Infectious Diseases Research and McMaster Immunology Research Center, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Njuguna N, Akolo C, Anzala O, Baeten JM, Heffron R, Mugo NR, Bateganya M. Differentiated Service Delivery Models for Maintaining HIV Treatment and Prevention Services During Crisis and Disease Outbreaks: Lessons from the COVID-19 Pandemic. Curr HIV/AIDS Rep 2024; 21:257-263. [PMID: 39052142 DOI: 10.1007/s11904-024-00703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW This review summarizes differentiated service delivery (DSD) models for HIV treatment and prevention that have been adapted for maintaining continuity of services during the COVID-19 pandemic and proposes strategies for sustaining their benefits now and during future disruptions. RECENT FINDINGS The COVID-19 pandemic resulted in an overburdened and disrupted health system, forcing countries to adopt and/or scale up DSD models for HIV services. While initially implemented as emergency measures, these models evolved and were refined over time to fit recipient needs ensuring continued HIV treatment and prevention services with minimal health system impact. Successful models employed task shifting, community-based delivery models, multimonth scripting and dispensing, and telehealth for remote consultation. DSD models enabled HIV services globally to be maintained during the COVID-19 pandemic. Though these models and adaptations were critical in addressing health gaps and disruptions caused by the pandemic, they were beneficial in improving efficiency and access to client-centered services and should be sustained.
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Affiliation(s)
- Njambi Njuguna
- FHI 360, Nairobi, Kenya.
- University of Nairobi, Nairobi, Kenya.
| | | | | | | | | | - Nelly R Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- University of Washington, Seattle, WA, USA
| | - Moses Bateganya
- United States Agency for International Development, Dar es Salaam, Tanzania
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Belayneh EK, Workneh Leulseged T, Teklu BS, Tewodros BH, Megiso MZ, Weldesenbet ES, Berhanu MF, Shaweno YS, Hailu KT. Causal Inference of the Effect of Vaccination on COVID-19 Disease Severity and Need for Intensive Care Unit Admission Among Hospitalized Patients in an African Setting. Cureus 2024; 16:e67719. [PMID: 39318914 PMCID: PMC11421194 DOI: 10.7759/cureus.67719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a novel, primarily respiratory, coronavirus that became a pandemic when it spread to over 210 countries and led to the death of over six million people. There is no definitive treatment for COVID-19, but vaccines have been developed that can help prevent severe illness and death. Studies have investigated the effect of vaccination on disease severity and outcome, and the findings indicate that vaccination is linked to a significant reduction in the risk of hospitalization, intensive care unit (ICU) admission, and disease mortality. However, there is a scarcity of evidence in Africa in general, and no similar study has been conducted in Ethiopia yet. Therefore, the study aimed to assess the effect of vaccination on COVID-19 disease severity and the need for ICU admission among hospitalized patients at a private specialty clinic in Ethiopia. Methods A retrospective cohort study was conducted among 126 patients with COVID-19, 41 vaccinated and 85 unvaccinated, who were hospitalized between September 2021 and May 2022. Data were summarized using frequency (percentage) and median (interquartile range (IQR)). To compare the characteristics of the two groups, Chi-square/Fisher's exact and Mann-Whitney U tests at p-values of ≤ 0.05 were used. To identify the effect of vaccination on COVID-19 disease severity, a marginal structural model (MSM) with an inverse probability weighting (IPW) approach using a robust Poisson regression model was fitted. Adjusted relative risk (ARR) and 95% confidence interval (CI) for ARR were used for interpreting the result. Results The cohort included groups that were comparable in terms of their sociodemographic and clinical characteristics. More than half of the participants were older than 60 years (n = 66, 52.4%), were males (n = 71, 56.3%), and had one or more comorbid illnesses (n = 66, 52.4%). At admission, 85 (67.5%) had severe disease, and 11 (8.7%) progressed after hospitalization and required ICU admission, of which three unvaccinated cases died. From the final model, vaccination was found to be associated with a 62% decreased risk of developing severe COVID-19 disease if infected, compared to not getting vaccinated (ARR = 0.38, 95% CI = 0.23-0.65, p < 0.0001). Conclusions The study's findings support previous reports that vaccinated people are less likely to develop severe COVID-19 disease if later infected with the virus, emphasizing the importance of continuing efforts to promote COVID-19 vaccination not only to safeguard individuals but also to confer community-level immunity.
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Affiliation(s)
| | - Tigist Workneh Leulseged
- Public Health, Medical Research Lounge (MRL), Addis Ababa, ETH
- Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, ETH
| | | | | | | | | | | | | | - Kirubel Tesfaye Hailu
- Public Health, Medical Research Lounge (MRL), Addis Ababa, ETH
- Internal Medicine, Life Map Higher Learning Institute, Addis Ababa, ETH
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Gebreyesus A, Gebreslase A. Practice of COVID-19 prevention measures and its factors in long-distance truck drivers of Tigray. Pan Afr Med J 2024; 48:96. [PMID: 39492853 PMCID: PMC11530385 DOI: 10.11604/pamj.2024.48.96.40378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/22/2024] [Indexed: 11/05/2024] Open
Abstract
Introduction long-distance truck drivers are a population group that moves in and out of a country and can meet with different individuals and can easily expose to COVID-19. Therefore, this study aimed to assess the level of practice and associated factors towards COVID-19 prevention measures in long-distance truck drivers of Tigray. Methods this is a cross-sectional study conducted on 350 long-distance truck drivers recruited by systematic random sampling in the Mekelle entry point from July 5th to July 20th 2020. Variables with a p-value ≤0.30 in the bivariate regression analysis were entered into the final model of logistic regression to recognize factors. All associations with the practice of COVID-19 prevention were tested for statistical significance with alpha set at the 0.05 level. Results around 293 (83.7%) with a 95% CI of (79.7-87.6%) of the long-distance truck drivers who participated in this study had good practice towards COVID-19 prevention measures. Having a previous test for COVID-19 is positively significantly associated with good practice towards COVID-19 prevention methods. However, individuals who had a history of COVID-19-like symptoms in the last four months and who have non-communicable diseases are 78% and 84% of the time less likely to practice COVID-19 prevention measures respectively. Conclusion based on this study, the practice of COVID-19 prevention measures among the long-distance truck drivers of Tigray was very good. The results of this study suggest that more emphasis should be placed on drivers who have non-communicable diseases and providing COVID-19-like symptoms to the drivers.
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Affiliation(s)
- Aregawi Gebreyesus
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Asqual Gebreslase
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
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Sseguya W, Bahendeka S, MacLennan S, Mody N, Guntupalli AM. Diabetes mellitus in sub-saharan Africa during the COVID-19 pandemic: A scoping review. PLoS One 2024; 19:e0305112. [PMID: 38976666 PMCID: PMC11230555 DOI: 10.1371/journal.pone.0305112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/24/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic impacted the healthcare and outcomes of individuals with various chronic diseases. However, there is a paucity of data on the impact of the COVID-19 pandemic on diabetes mellitus (DM) in low-resource settings. To address this, we conducted a scoping review to explore the literature published on diabetes-related COVID-19 outcomes and care during the COVID-19 pandemic in countries of sub-Saharan Africa. METHODS We applied our search strategy to PubMed, Web of Science, CINAHL, African Index Medicus, Google Scholar, Cochrane Library, Scopus, Science Direct, ERIC and Embase to obtain relevant articles published from January 2020 to March 2023. Two independent reviewers were involved in screening the retrieved articles. Data from eligible articles were extracted from quantitative, qualitative and mixed-methods studies. Quantitative evidence was summarised using descriptive statistics, while a thematic framework was used to identify and categorise themes from qualitative evidence. RESULTS We found 42 of the retrieved 360 articles eligible, mainly from South Africa, Ethiopia and Ghana (73.4%). The incidence of DM among COVID-19 cases was 13.7/1,000 person-days observation. COVID-19 was associated with increased odds of death (OR 1.30-9.0, 95% CI), hospitalisation (OR 3.30-3.73: 95% CI), and severity (OR: 1.30-4.05, 95% CI) in persons with DM. Challenges in caring for DM during the pandemic were inadequate patient self-management, difficulties in healthcare access, and inadequate healthcare resources. CONCLUSION The COVID-19 pandemic was characterised by a high incidence of DM in persons infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high COVID-19-associated mortality, severity, and hospitalisation among people persons with DM. The pandemic also created difficulties in DM self-management and worsened the quality of DM care services. Policymakers should devise preventive and management strategies for DM during emerging and re-emerging infectious disease epidemics and outbreaks, given that such occurrences are increasingly frequent in the region.
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Affiliation(s)
- Wenceslaus Sseguya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Department of Internal Medicine, St Francis Hospital Nsambya, Kampala, Uganda
| | - Silver Bahendeka
- Department of Internal Medicine, St Francis Hospital Nsambya, Kampala, Uganda
- Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - Sara MacLennan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nimesh Mody
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Alie MS, Negesse Y, Kindie K, Merawi DS. Machine learning algorithms for predicting COVID-19 mortality in Ethiopia. BMC Public Health 2024; 24:1728. [PMID: 38943093 PMCID: PMC11212371 DOI: 10.1186/s12889-024-19196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/19/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), a global public health crisis, continues to pose challenges despite preventive measures. The daily rise in COVID-19 cases is concerning, and the testing process is both time-consuming and costly. While several models have been created to predict mortality in COVID-19 patients, only a few have shown sufficient accuracy. Machine learning algorithms offer a promising approach to data-driven prediction of clinical outcomes, surpassing traditional statistical modeling. Leveraging machine learning (ML) algorithms could potentially provide a solution for predicting mortality in hospitalized COVID-19 patients in Ethiopia. Therefore, the aim of this study is to develop and validate machine-learning models for accurately predicting mortality in COVID-19 hospitalized patients in Ethiopia. METHODS Our study involved analyzing electronic medical records of COVID-19 patients who were admitted to public hospitals in Ethiopia. Specifically, we developed seven different machine learning models to predict COVID-19 patient mortality. These models included J48 decision tree, random forest (RF), k-nearest neighborhood (k-NN), multi-layer perceptron (MLP), Naïve Bayes (NB), eXtreme gradient boosting (XGBoost), and logistic regression (LR). We then compared the performance of these models using data from a cohort of 696 patients through statistical analysis. To evaluate the effectiveness of the models, we utilized metrics derived from the confusion matrix such as sensitivity, specificity, precision, and receiver operating characteristic (ROC). RESULTS The study included a total of 696 patients, with a higher number of females (440 patients, accounting for 63.2%) compared to males. The median age of the participants was 35.0 years old, with an interquartile range of 18-79. After conducting different feature selection procedures, 23 features were examined, and identified as predictors of mortality, and it was determined that gender, Intensive care unit (ICU) admission, and alcohol drinking/addiction were the top three predictors of COVID-19 mortality. On the other hand, loss of smell, loss of taste, and hypertension were identified as the three lowest predictors of COVID-19 mortality. The experimental results revealed that the k-nearest neighbor (k-NN) algorithm outperformed than other machine learning algorithms, achieving an accuracy of 95.25%, sensitivity of 95.30%, precision of 92.7%, specificity of 93.30%, F1 score 93.98% and a receiver operating characteristic (ROC) score of 96.90%. These findings highlight the effectiveness of the k-NN algorithm in predicting COVID-19 outcomes based on the selected features. CONCLUSION Our study has developed an innovative model that utilizes hospital data to accurately predict the mortality risk of COVID-19 patients. The main objective of this model is to prioritize early treatment for high-risk patients and optimize strained healthcare systems during the ongoing pandemic. By integrating machine learning with comprehensive hospital databases, our model effectively classifies patients' mortality risk, enabling targeted medical interventions and improved resource management. Among the various methods tested, the K-nearest neighbors (KNN) algorithm demonstrated the highest accuracy, allowing for early identification of high-risk patients. Through KNN feature identification, we identified 23 predictors that significantly contribute to predicting COVID-19 mortality. The top five predictors are gender (female), intensive care unit (ICU) admission, alcohol drinking, smoking, and symptoms of headache and chills. This advancement holds great promise in enhancing healthcare outcomes and decision-making during the pandemic. By providing services and prioritizing patients based on the identified predictors, healthcare facilities and providers can improve the chances of survival for individuals. This model provides valuable insights that can guide healthcare professionals in allocating resources and delivering appropriate care to those at highest risk.
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Affiliation(s)
- Melsew Setegn Alie
- Department Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia.
| | - Yilkal Negesse
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Gojjam, Ethiopia
| | - Kassa Kindie
- Department Nursing, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Dereje Senay Merawi
- Department of Information Technology, Faculty of Technology, Debre Tabor University, Gonder, Ethiopia
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Gómez-Pérez GP, de Graaff AE, Dekker JT, Agyei BB, Dada I, Milimo E, Ommeh MS, Risha P, Rinke de Wit TF, Spieker N. Preparing healthcare facilities in sub-Saharan Africa for future outbreaks: insights from a multi-country digital self-assessment of COVID-19 preparedness. BMC Health Serv Res 2024; 24:254. [PMID: 38413977 PMCID: PMC10900561 DOI: 10.1186/s12913-024-10761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/20/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, while maintaining essential healthcare services running. METHODS Between May-November 2020, we performed a survey study with SafeCare4Covid - a free digital self-assessment application - to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) availability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities' location, type, and ownership was also collected. RESULTS Four hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0-100 (n=471) was 58.0 (interquartile range 40.0-76.0), and the average supplies score (n=412) was 61.6 (39.0-83.0). Both scores were significantly lower in rural (capability score, mean 53.6 [95%CI:50.3-57.0]/supplies score, 59.1 [55.5-62.8]) versus urban facilities (capability score, 65.2 [61.7-68.7]/supplies score, 70.7 [67.2-74.1]) (P<0.0001 for both comparisons). Likewise, lower scores were found for public versus private clinics, and for primary healthcare centres versus hospitals. Guidelines for triage and isolation, clinical management of COVID-19, staff mental support, and contact tracing forms were largely missing. Handwashing stations were partially equipped in 33% of facilities. The most missing medical supply was COVID-19 specimen collection material (71%), while 43% of facilities did not have N95/FFP2 respirators and 19% lacked medical masks. CONCLUSIONS A large proportion of public and private African facilities providing basic healthcare in rural areas, lacked fundamental COVID-19-related capabilities and life-saving personal protective equipment. Decentralization of epidemic preparedness efforts in these settings is warranted to protect healthcare workers and patients alike in future epidemics. Digital tools are of great value to timely measure and improve epidemic preparedness of healthcare facilities, inform decision-making, create a more stakeholder-broad approach and increase health-system resilience for future disease outbreaks.
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Affiliation(s)
- Gloria P Gómez-Pérez
- PharmAccess Foundation, Amsterdam, The Netherlands.
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | - Peter Risha
- PharmAccess Tanzania, Dar es Salaam, Tanzania
| | - Tobias F Rinke de Wit
- PharmAccess Foundation, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
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Fantaw S, Debeko DD. Time to recovery and determinant factors of COVID-19 patients under treatment in Sidama region, Ethiopia: A retrospective cohort study. Heliyon 2024; 10:e23245. [PMID: 38163231 PMCID: PMC10757004 DOI: 10.1016/j.heliyon.2023.e23245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Evidence from several studies shows that the median recovery time among COVID-19 patients varies in different settings, and why that difference occurs is questionable. The current study was aimed to estimate the time to recovery and to identify determinant factors among COVID-19 patients admitted to treatment centers in the Sidama region, Ethiopia. Methods The secondary data was extracted from the Sidama Public Health Institute (SPHI), data management unit. A total of 1038 COVID-19 patients who were under treatment from 1, June 2020, to 30, June 2022, at different treatment centers in the region were included in the study. The Log-Logistic Accelerated Failure Time (AFT) model was employed to estimate the effects size of different covariates on recovery time of COVID-19 patients under treatment. Results Among the total number of patients in the study, 704 (67.82 %) were recovered, while 334(32.18 %) were censored. The median recovery time was 14 days (IQR: 10-18 days). Patients who were above 65 years old had nearly 1.17 times more prolonged recovery time as compared to patients who were below 25 years old, (OR = 1.168, p-value = 0.032, CI = 0.013,0.298). The log odds of recovery for patients who were in critical severity status at admission was 1.279 times more decelerated as compared to asymptomatic patients (P-value = 0.005, CI = 0.076, 0.417). The log odds of recovery for patients who had no history of headache was 1.107 times more accelerated as compared to patients who had a history of headache (OR = 1.107, p-value = 0.027, CI = 0.011, 0.192). The log odds of recovery for non-diabetic patients was 1.244 times more accelerated as compared to patients who were diabetic (OR = 1,244, p-value = 0.002, CI = 0.077, 0.360), holding other covariates constant in the model. Conclusion Age, critical severity status of infection, having symptoms of infection, having a history of headaches, and being diabetic had statistically significant effects on time to recovery among COVID-19 patients admitted to the treatment centers in the Sidama region.
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Affiliation(s)
- Samrawit Fantaw
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Ethiopia
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12
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Socolovsky M, Lu JCY, Zarra F, Wei CK, Chang TNJ, Chuang DCC. Effects of COVID-19 Pandemic in Patients with a Previous Phrenic Nerve Transfer for a Traumatic Brachial Plexus Palsy. J Brachial Plex Peripher Nerve Inj 2024; 19:e20-e26. [PMID: 38868462 PMCID: PMC11168810 DOI: 10.1055/s-0044-1787296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024] Open
Abstract
Background With the advent of the coronavirus disease 2019 (COVID-19) pandemic, some doubts have been raised regarding the potential respiratory problems that patients who previously underwent a phrenic nerve transfer could have. Objectives To analyze the effects of the coronavirus infection on two populations, one from Argentina and another from Taiwan. Specific objectives were: (1) to identify the rate of COVID in patients with a history of phrenic nerve transfer for treatment of palsy; (2) to identify the overall symptom profile; (3) to compare Argentinian versus Taiwanese populations; and (4) to determine if any phrenic nerve transfer patients are at particular risk of more severe COVID. Methods A telephonic survey that included data regarding the number of episodes of acute COVID-19 infection, the symptoms it caused, the presence or absence of potential or life-threatening complications, and the status of COVID-19 vaccination were studied. Intergroup comparisons were conducted using the nonparametric Mann-Whitney U test, with categorical variables conducted using either the Pearson χ2 analysis or the Fisher's exact test, as appropriate. Results A total of 77 patients completed the survey, 40 from Taiwan and 37 from Argentina. Fifty-five (71.4%) developed a diagnosis of COVID. However, among these, only four had any level of dyspnea reported (4/55 = 7.3%), all mild. There were also no admissions to hospital or an intensive care unit, no intubations, and no deaths. All 55 patients isolated themselves at home. Conclusions It can be concluded that an acute COVID-19 infection was very well tolerated in our patients. (Level of evidence 3b, case reports).
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Affiliation(s)
- Mariano Socolovsky
- Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Francisco Zarra
- Department of Neurosurgery, Sanatorio Guemes, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Chen Kuan Wei
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - David Chwei-Chin Chuang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Abraha HE, Tequare MH, Teka H, Gebremedhin MB, Desta KG, Ebrahim MM, Yemane A, Gebremariam SM, Gebresilassie KB, Tekle TH, Atsbaha MT, Berhe E, Berhe B, Berhe DF, Gebregziabher M, Wall LL. Impact of a double catastrophe, war and COVID-19, on health service utilization of a tertiary care hospital in Tigray: an interrupted time-series study. Confl Health 2023; 17:37. [PMID: 37580780 PMCID: PMC10426210 DOI: 10.1186/s13031-023-00537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND In developing nations with fragile healthcare systems, the effect of war is likely to be much worse than it would be in more developed countries. The presence of COVID-19 will also likely exacerbate the war's impact. This study set out to determine the effect of armed conflict and the COVID-19 pandemic on health service utilization at Ayder Comprehensive Specialized Hospital, in the Tigray region of Ethiopia. METHODS An interrupted time-series study design was used to analyze patient visits over forty-eight consecutive months (from July 2017 to June 2021) at inpatient, outpatient, and emergency departments. Data were analyzed using segmented regression analysis with a defined outcome of level and trend changes in the number of patient visits. In addition, negative binomial regression analysis was also used to estimate the impact of both COVID-19 and the war on patient flow. RESULTS There were 59,935 admissions, 876,533 outpatient visits, and 127,872 emergency room visits. The effect of COVID-19 was seen as soon as the Tigray regional government imposed comprehensive restrictions. Immediately after COVID-19 appeared, all the service areas exhibited a significant monthly drop in visits; [-35.6% (95% CI: -48.2%, -23.1%)] for inpatient, [-60.6% (95% CI: -71.6%, -49.5%)] for outpatient, and [-44.1% (95% CI: -59.5%, -28.7%)] for emergency department visits. The impact of the war became apparent after a lag time of one month. Controlling the effects of time and COVID-19, the war led to a significant fall in inpatient visits [-44.3% (95% CI: -67.2%, -21.5%)], outpatients [-52.1% (95% CI: -82.7%, -21.5%)], and emergency-room attendances [-45.0% (95% CI: -74.8%, -15.2%)]. An upward trend in outpatient flow was observed after the war [1,219.4 (95% CI: 326.1, 2,112.8)]. CONCLUSIONS The present study has clearly indicated that the war and COVID-19 have led to a large reduction in admissions, outpatient attendance, and emergency department visits. The evidence from this study suggests that due to this double catastrophe, thousands of patients could not gain access to healthcare, with probable negative consequences. Governments and organizations should implement measures to buttress the healthcare system to maintain pre-war status of service.
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Affiliation(s)
| | | | - Hale Teka
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | | | | | - Awol Yemane
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | | | | | | | - Ephrem Berhe
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Bereket Berhe
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | | | - L Lewis Wall
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
- Washington University in St. Louis, St. Louis, MO, USA
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Gebrecherkos T, Challa F, Tasew G, Gessesse Z, Kiros Y, Gebreegziabxier A, Abdulkader M, Desta AA, Atsbaha AH, Tollera G, Abrahim S, Urban BC, Schallig H, Rinke de Wit T, Wolday D. Prognostic Value of C-Reactive Protein in SARS-CoV-2 Infection: A Simplified Biomarker of COVID-19 Severity in Northern Ethiopia. Infect Drug Resist 2023; 16:3019-3028. [PMID: 37215303 PMCID: PMC10199690 DOI: 10.2147/idr.s410053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To evaluate the role of C-reactive protein (CRP) in predicting severe COVID-19 patients. Methods A prospective observational cohort study was conducted from July 15 to October 28, 2020, at Kuyha COVID-19 isolation and treatment center hospital, Mekelle City, Northern Ethiopia. A total of 670 blood samples were collected serially. SARS-CoV-2 infection was confirmed by RT-PCR from nasopharyngeal swabs and CRP concentration was determined using Cobas Integra 400 Plus (Roche). Data were analyzed using STATA version 14. P-value <0.05 was considered statistically significant. Results Overall, COVID-19 patients had significantly elevated CRP at baseline when compared to PCR-negative controls [median 11.1 (IQR: 2.0-127.8) mg/L vs 0.9 (IQR: 0.5-1.9) mg/L; p=0.0004)]. Those with severe COVID-19 clinical presentation had significantly higher median CRP levels compared to those with non-severe cases [166.1 (IQR: 48.6-332.5) mg/L vs 2.4 (IQR: 1.2-7.6) mg/L; p<0.00001)]. Moreover, COVID-19 patients exhibited higher median CRP levels at baseline [58 (IQR: 2.0-127.8) mg/L] that decreased significantly to 2.4 (IQR: 1.4-3.9) mg/L after 40 days after symptom onset (p<0.0001). Performance of CRP levels determined using ROC analysis distinguished severe from non-severe COVID-19 patients, with an AUC value of 0.83 (95% CI: 0.73-0.91; p=0.001; 77.4% sensitivity and 89.4% specificity). In multivariable analysis, CRP levels above 30 mg/L were significantly associated with an increased risk of developing severe COVID-19 for those who have higher ages and comorbidities (ARR 3.99, 95% CI: 1.35-11.82; p=0.013). Conclusion CRP was found to be an independent determinant factor for severe COVID-19 patients. Therefore, CRP levels in COVID-19 patients in African settings may provide a simple, prompt, and inexpensive assessment of the severity status at baseline and monitoring of treatment outcomes.
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Affiliation(s)
- Teklay Gebrecherkos
- Department of Medical Microbiology and Immunology, College of Health Sciences (CHS), Mekelle University (MU), Mekelle, Tigray, Ethiopia
| | - Feyissa Challa
- National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Department of Bacteriology, Parasitology and Zoonosis, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zekarias Gessesse
- Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Yazezew Kiros
- Department of Internal Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Mahmud Abdulkader
- Department of Medical Microbiology and Immunology, College of Health Sciences (CHS), Mekelle University (MU), Mekelle, Tigray, Ethiopia
| | - Abraham Aregay Desta
- Public Health Research and Emergency Management, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Ataklti Hailu Atsbaha
- Department of Microbiology, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Getachew Tollera
- Research and Technology Transfer Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Saro Abrahim
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Britta C Urban
- Department of Clinical Sciences, Respiratory Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Henk Schallig
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Tobias Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Joep-Lange Institute, Amsterdam, the Netherlands
| | - Dawit Wolday
- Department of Medical Microbiology and Immunology, College of Health Sciences (CHS), Mekelle University (MU), Mekelle, Tigray, Ethiopia
- HIV/TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Tessema AG, Mengiste ZM, Hundie TG, Yosef HG, Huluka DK, Seyoum AB, Abate HK, Howe RC. The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study. BMC Pulm Med 2023; 23:85. [PMID: 36915064 PMCID: PMC10010242 DOI: 10.1186/s12890-023-02375-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Studies have indicated that hospitalized COVID-19 patients benefit from anticoagulation therapy in terms of survival; however, there is an ongoing controversy over the optimum anticoagulant dosage. This study aimed to compare clinical outcomes between patients who received prophylactic anticoagulation and those who received therapeutic anticoagulation. METHODS A multi-center retrospective cohort study was conducted to determine the impact of anticoagulation dosage in hospitalized COVID-19 patients in Ethiopia. The primary outcome measure was in-hospital mortality, and it was assessed using multivariable binary logistic regression and covariate-adjusted Cox Proportional Hazard model. For critical and severe COVID-19 patients, subgroup analyses were performed using multivariable binary logistic regression model and multivariable Cox regression models. RESULT A total of 472 hospitalized COVID-19 patients were included in this study, of whom 235 (49.8%) received therapeutic anticoagulation and 237 (50.2%) received prophylactic dose. The demographic and baseline clinical characteristics were roughly similar between the groups. After adjustment for several confounders, in critical COVID-19 subgroup, therapeutic dose of anticoagulation was significantly associated with a higher inpatient mortality (AOR 2.27, 95% CI, 1.18-4.35, p = 0.013), whereas in severe COVID-19 subgroup, anticoagulation dosage was not associated with inpatient mortality (OR, 1.02, 95% CI, 0.45 - 2.33, p = 0.958). In severe COVID-19 patient group however, the incidence of thrombosis was slightly lower in the therapeutic group as compared with prophylactic group although the difference was not statistically significant (AOR 0.15, 95% CI, 0.02 - 1.20, p = 0.073). Although there were only six major bleeding events in this study, all these were recorded from patients in the therapeutic subgroup, making the difference statistically significant (p = 0.013). CONCLUSION Although this study is limited by its observational design, our results are not consistent with current recommendations on anti-coagulation dose for hospitalized patients with COVID-19, necessitating the need for RCT in resource limited settings.
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Cui SJ, Zhang Y, Gao WJ, Wang XL, Yang P, Wang QY, Pang XH, Zeng XP, Li LM. Symptomatic and Asymptomatic SARS-CoV-2 Infection and Follow-up of Neutralizing Antibody Levels. BIOMEDICAL AND ENVIRONMENTAL SCIENCES : BES 2022; 35:1100-1105. [PMID: 36597289 PMCID: PMC9850449 DOI: 10.3967/bes2022.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate neutralizing antibody levels in symptomatic and asymptomatic patients with coronavirus disease 2019 (COVID-19) at 6 and 10 months after disease onset. METHODS Blood samples were collected at three different time points from 27 asymptomatic individuals and 69 symptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Virus-neutralizing antibody titers against SARS-CoV-2 in both groups were measured and statistically analyzed. RESULTS The symptomatic and asymptomatic groups had higher neutralizing antibodies at 3 months and 1-2 months post polymerase chain reaction confirmation, respectively. However, neutralizing antibodies in both groups dropped significantly to lower levels at 6 months post-PCR confirmation. CONCLUSION Continued monitoring of symptomatic and asymptomatic individuals with COVID-19 is key to controlling the infection.
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Affiliation(s)
- Shu Juan Cui
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Yi Zhang
- General Administration of Customs (Beijing) International Travel Health Care Center, Beijing 100013, China
| | - Wen Jing Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Xiao Li Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Peng Yang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Quan Yi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Xing Huo Pang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Xiao Peng Zeng
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Li Ming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
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Afrash MR, Shanbehzadeh M, Kazemi-Arpanahi H. Predicting Risk of Mortality in COVID-19 Hospitalized Patients using Hybrid Machine Learning Algorithms. J Biomed Phys Eng 2022; 12:611-626. [PMID: 36569564 PMCID: PMC9759642 DOI: 10.31661/jbpe.v0i0.2105-1334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Since hospitalized patients with COVID-19 are considered at high risk of death, the patients with the sever clinical condition should be identified. Despite the potential of machine learning (ML) techniques to predict the mortality of COVID-19 patients, high-dimensional data is considered a challenge, which can be addressed by metaheuristic and nature-inspired algorithms, such as genetic algorithm (GA). OBJECTIVE This paper aimed to compare the efficiency of the GA with several ML techniques to predict COVID-19 in-hospital mortality. MATERIAL AND METHODS In this retrospective study, 1353 COVID-19 in-hospital patients were examined from February 9 to December 20, 2020. The GA technique was applied to select the important features, then using selected features several ML algorithms such as K-nearest-neighbor (K-NN), Decision Tree (DT), Support Vector Machines (SVM), and Artificial Neural Network (ANN) were trained to design predictive models. Finally, some evaluation metrics were used for the comparison of developed models. RESULTS A total of 10 features out of 56 were selected, including length of stay (LOS), age, cough, respiratory intubation, dyspnea, cardiovascular diseases, leukocytosis, blood urea nitrogen (BUN), C-reactive protein, and pleural effusion by 10-independent execution of GA. The GA-SVM had the best performance with the accuracy and specificity of 9.5147e+01 and 9.5112e+01, respectively. CONCLUSION The hybrid ML models, especially the GA-SVM, can improve the treatment of COVID-19 patients, predict severe disease and mortality, and optimize the utilization of health resources based on the improvement of input features and the adaption of the structure of the models.
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Affiliation(s)
- Mohammad Reza Afrash
- PhD, Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Mostafa Shanbehzadeh
- PhD, Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- PhD, Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran
- PhD, Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
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Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JJM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, Langenegger E, for the AFREhealth Research Collaboration on COVID-19 and Pregnancy. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis. Clin Infect Dis 2022; 75:1950-1961. [PMID: 36130257 PMCID: PMC9214158 DOI: 10.1093/cid/ciac294] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
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Affiliation(s)
- Jean B Nachega
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases, and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rhoderick N Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Akwasi Baafuor Opoku
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aminatu Umar Makarfi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chibueze Adirieje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Marc B Tshilanda
- Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo
- Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - John Ditekemena
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Christopher Nsereko
- Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Michael Yaw Yeboah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Denis M Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Etienne Kajibwami Birindwa
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Serge Zigabe Mushamuka
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Edward J Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judith N Wasserheit
- Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark J Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | | | - Eduard Langenegger
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Bepouka B, Mayasi N, Mandina M, Longokolo M, Odio O, Mangala D, Mbula M, Kayembe JM, Situakibanza H. Risk factors for mortality in COVID-19 patients in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0276008. [PMID: 36251715 PMCID: PMC9576083 DOI: 10.1371/journal.pone.0276008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Aim Mortality rates of coronavirus-2019 (COVID-19) disease continue to increase worldwide and in Africa. In this study, we aimed to summarize the available results on the association between sociodemographic, clinical, biological, and comorbidity factors and the risk of mortality due to COVID-19 in sub-Saharan Africa. Methods We followed the PRISMA checklist (S1 Checklist). We searched PubMed, Google Scholar, and European PMC between January 1, 2020, and September 23, 2021. We included observational studies with Subjects had to be laboratory-confirmed COVID-19 patients; had to report risk factors or predictors of mortality in COVID-19 patients, Studies had to be published in English, include multivariate analysis, and be conducted in the sub-Saharan region. Exclusion criteria included case reports, review articles, commentaries, errata, protocols, abstracts, reports, letters to the editor, and repeat studies. The methodological quality of the studies included in this meta-analysis was assessed using the methodological items for nonrandomized studies (MINORS). Pooled hazard ratios (HR) or odds ratios (OR) and 95% confidence intervals (CI) were calculated separately to identify mortality risk. In addition, publication bias and subgroup analysis were assessed. Results and discussion Twelve studies with a total of 43598 patients met the inclusion criteria. The outcomes of interest were mortality. The results of the analysis showed that the pooled prevalence of mortality in COVID-19 patients was 4.8%. Older people showed an increased risk of mortality from SARS-Cov-2. The pooled hazard ratio (pHR) and odds ratio (pOR) were 9.01 (95% CI; 6.30–11.71) and 1.04 (95% CI; 1.02–1.06), respectively. A significant association was found between COVID-19 mortality and men (pOR = 1.52; 95% CI 1.04–2). In addition, the risk of mortality in patients hospitalized with COVID-19 infection was strongly influenced by chronic kidney disease (CKD), hypertension, severe or critical infection on admission, cough, and dyspnea. The major limitations of the present study are that the data in the meta-analysis came mainly from studies that were published, which may lead to publication bias, and that the causal relationship between risk factors and poor outcome in patients with COVID-19 cannot be confirmed because of the inherent limitations of the observational study. Conclusions Advanced age, male sex, CKD, hypertension, severe or critical condition on admission, cough, and dyspnea are clinical risk factors for fatal outcomes associated with coronavirus. These findings could be used for research, control, and prevention of the disease and could help providers take appropriate measures and improve clinical outcomes in these patients.
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Affiliation(s)
- Ben Bepouka
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- * E-mail:
| | - Nadine Mayasi
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ossam Odio
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Donat Mangala
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Marie Kayembe
- Pneumology Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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20
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Abagero A, Ragazzoni L, Hubloue I, Barone-Adesi F, Lamine H, Addissie A, Della Corte F, Valente M. A Review of COVID-19 Response Challenges in Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11070. [PMID: 36078785 PMCID: PMC9518440 DOI: 10.3390/ijerph191711070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has positioned fragile healthcare systems in low-income countries under pressure, leading to critical gaps in service delivery. The pandemic response demands the healthcare system to be resilient and continue provision of healthcare services. This review is aimed at describing the healthcare response challenges during the pandemic in Ethiopia. METHODOLOGY Eligible studies dealing with challenges of the healthcare system in response to the COVID-19 pandemic in Ethiopia were included. The six World Health Organization (WHO) healthcare system building blocks were used to categorize healthcare challenges. PubMed ProQuest, databases were searched, and results were summarized using systematic review synthesis. RESULTS Financial constraints led to a shortage of mechanical ventilators. Furthermore, the pandemic hindered the capacity to avail full packages of personal protective equipment in health facilities and intensive care capacity. The pandemic also affected the delivery of maternal, child and new-born services, prevention, and treatment of childhood illness, including immunization services. CONCLUSIONS The COVID-19 pandemic posed various challenges to the performance of the healthcare system in Ethiopia. It is recommended that policy makers and stakeholders enhance pandemic preparedness and strengthen response capacity by considering the six WHO healthcare system building blocks.
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Affiliation(s)
- Abdulnasir Abagero
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
- ReGEDiM—Research Group on Emergency Disaster Medicine, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa 70710, Ethiopia
| | - Luca Ragazzoni
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
- Department of Sustainable Development and Ecological Transition, University of Eastern Piedmont, 28100 Novara, Italy
| | - Ives Hubloue
- ReGEDiM—Research Group on Emergency Disaster Medicine, Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
| | - Francesco Barone-Adesi
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Hamdi Lamine
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
- Department of Sustainable Development and Ecological Transition, University of Eastern Piedmont, 28100 Novara, Italy
- Faculty of medicine Ibn Aljazzar of Sousse, University of Sousse, Sousse 4002, Tunisia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa 70710, Ethiopia
| | - Francesco Della Corte
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Martina Valente
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy
- Department of Sustainable Development and Ecological Transition, University of Eastern Piedmont, 28100 Novara, Italy
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21
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Cyrille TM, Serge SM, Brice TMJ, Alain TNP, Grace N, Joseph F, Achta H, Gisèle N, Julius N, Marcel T, Melissa S, Lucy N, Ronald P, Claire OAM, Walter PYE, Alain EMG, Richard N, Sara E. Clinical presentation of COVID-19 at the time of testing and factors associated with pre-symptomatic cases in Cameroon. IJID REGIONS 2022; 4:33-41. [PMID: 35720960 PMCID: PMC9148624 DOI: 10.1016/j.ijregi.2022.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 05/29/2023]
Abstract
Objectives To describe the clinical features at time of testing and explore factors associated with SARS-CoV-2 infection and pre-symptomatic cases in Cameroon. Methods Data was collected on people in Cameroon who participated in COVID-19 testing by real-time reverse transcriptase-polymerase chain reaction between 1 March and 5 October 2020. After descriptive analysis, multivariate logistic regression was used to identify factors associated with SARS-CoV-2 infection and pre-symptomatic cases. Results Of 85 206 test participants, 14 863 (17.4%) were infected with SARS-CoV-2. The median age for cases was 38.4 years (interquartile range 29.6-49.4); 6.1% were aged <19 years, and 6.3% were ≥65 years. Of these cases, 46.5% had at least one symptom/sign with a median time from illness onset to testing of 6 days (interquartile range 3-9). Cough (64.2%), headache (46.5%), fatigue/malaise (46.0%), shortness of breath (30.6%) and myalgia/arthralgia (25.6%) were the most commonly observed symptoms/signs. Pre-symptomatic SARS-CoV-2 infection was associated with age <50 years, being male and absence of comorbidities. Conclusion This study provides a comprehensive summary of the early clinical profile of SARS-CoV-2 infection during the first wave of COVID-19 in Cameroon, which was dominated by pre-symptomatic illness. These findings would be helpful for SARS-CoV-2 surveillance and control at a regional level.
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Affiliation(s)
| | | | | | | | - Ngondi Grace
- Virology Laboratory, Laquintinie Hospital, Douala, Cameroon
| | - Fokam Joseph
- Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management, Yaoundé, Cameroon
| | - Hamadou Achta
- Epidemiology and Public Health Service, Pasteur Centre in Cameroon, Yaoundé, Cameroon
| | | | | | - Tongo Marcel
- Emerging and Reemerging Diseases Research Centre, IMPM, Yaoundé, Cameroon
| | - Sander Melissa
- Tuberculosis Reference Laboratory Bamenda, Bamenda, Cameroon
| | - Ndip Lucy
- Laboratory of Emerging Infectious Diseases, University of Buea, Buea, Cameroon
| | - Perraut Ronald
- Pasteur Centre in Cameroon, Annex of Garoua, Garoua, Cameroon
| | | | | | - Etoundi Mballa Georges Alain
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
- Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Njouom Richard
- Virology Service, Pasteur Centre in Cameroon, Yaoundé, Cameroon
| | - Eyangoh Sara
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
- Scientific Department, Pasteur Centre in Cameroon, Yaoundé
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22
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Huluka DK, Etissa EK, Ahmed S, Abule HA, Getachew N, Abera S, Seyoum AB, Araya H, Hundie TG, Tadesse Anteneh B, Gebremedhin GD, Gebregziabher Y, Tefera RY, Tereda AB, Feleke Y, Abebe Y, Gebremariam TH, Ahmed HY, Amogne W, Haisch DA, Sherman CB, Schluger NW. Clinical Characteristics and Treatment Outcomes of COVID-19 Patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. Am J Trop Med Hyg 2022; 107:252-259. [PMID: 35895414 PMCID: PMC9393439 DOI: 10.4269/ajtmh.21-1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
Data from much of Africa are still scarce on the clinical characteristics, outcomes of treatment, and factors associated with disease severity and mortality of COVID-19. A cross-sectional study was conducted at Eka Kotebe General Hospital, Ethiopia's first COVID-19 treatment center. All consecutive symptomatic SARS CoV-2 RT-PCR positive individuals, aged 18 and older, admitted to the hospital between March 13 and September 16, 2020, were included. Of the total 463 cases, 319 (68.9%) were male. The median age was 45 years (interquartile range 32-62). The most common three symptoms were cough (69%), shortness of breath (SOB; 44%), and fatigue (37%). Hypertension was the most prevalent comorbidity, followed by diabetes mellitus. The age groups 40 to 59 and ≥ 60 were more likely to have severe disease compared with those < 40 years of age (adjusted odds ratio [aOR] = 3.45, 95% confidence interval [CI]: 1.88-6.31 and aOR = 3.46, 95% CI: 1.91-6.90, respectively). Other factors associated with disease severity included the presence of any malignancy (aOR = 4.64, 95% CI: 1.32-16.33) and SOB (aOR = 3.83, 95% CI: 2.35-6.25). The age group ≥ 60 was significantly associated with greater in-hospital mortality compared with those < 40 years. In addition, the presence of any malignancy, SOB, and vomiting were associated with higher odds of mortality. In Ethiopia, most COVID-19 patients were male and presented with cough, SOB, and fatigue. Older age, any malignancy, and SOB were associated with disease severity; these factors, in addition to vomiting, also predicted mortality.
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Affiliation(s)
| | | | | | - Hiluf Abate Abule
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nebiyu Getachew
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | | | - Yohannes Feleke
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonathan Abebe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Hanan Yusuf Ahmed
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Charles B. Sherman
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Neil W. Schluger
- Westchester Medical Center, New York Medical College, New York, New York
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Ashamo AY, Bekele A, Petrose A, Gebreyes T, Etissa EK, Bekele A, Haisch D, Schluger NW, Yusuf H, Haile T, Deyessa N, Kebede D. Assessment of hypertension and other factors associated with the severity of disease in COVID-19 pneumonia, Addis Ababa, Ethiopia: A case-control study. PLoS One 2022; 17:e0273012. [PMID: 35969590 PMCID: PMC9377616 DOI: 10.1371/journal.pone.0273012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/29/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Various reports suggested that pre-existing medical illnesses, including hypertension and other demographic, clinical, and laboratory factors, could pose an increased risk of disease severity and mortality among COVID-19 patients. This study aimed to assess the relation of hypertension and other factors to the severity of COVID-19 pneumonia in patients discharged from Eka Kotebe Hospital in June-September, 2020. METHODS This is a single-center case-control study of 265 adult patients discharged alive or dead, 75 with a course of severe COVID-19 for the cases arm and 190 with the non-severe disease for the control arm. Three age and sex-matched controls were selected randomly for each patient on the case arm. Chi-square, multivariable binary logistic regression, and odds ratio (OR) with a 95% confidence interval was used to assess the association between the various factors and the severity of the disease. A p-value of <0.05 is considered statistically significant. RESULTS Of the 265 study participants, 80% were male. The median age was 43 IQR(36-60) years. Both arms had similar demographic characteristics. Hypertension was strongly associated with the severity of COVID-19 pneumonia based on effect outcome adjustment (AOR = 2.93, 95% CI 1.489, 5.783, p-value = 0.002), similarly, having diabetes mellitus (AOR = 3.17, 95% CI 1.374, 7.313, p-value<0.007), chronic cardiac disease (AOR = 4.803, 95% CI 1.238-18.636, p<0.023), and an increase in a pulse rate (AOR = 1.041, 95% CI 1.017, 1.066, p-value = 0.001) were found to have a significant association with the severity of COVID-19 pneumonia. CONCLUSIONS Hypertension was associated with the severity of COVID-19 pneumonia, and so were diabetes mellitus, chronic cardiac disease, and an increase in pulse rate.
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Affiliation(s)
- Andargew Yohannes Ashamo
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Bekele
- Department of Internal Medicine, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | - Adane Petrose
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegaye Gebreyes
- Department of Internal Medicine, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
| | | | - Amsalu Bekele
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
| | - Deborah Haisch
- Department of Internal Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Neil W. Schluger
- Department of Internal Medicine, Westchester Medical Center, New York Medical College, New York City, New York, United States of America
| | - Hanan Yusuf
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Haile
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dawit Kebede
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Internal Medicine, Eka Kotebe General Hospital, Addis Ababa, Ethiopia
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Bepouka B, Odio O, Mangala D, Mayasi N, Mandina M, Longokolo M, Makulo JR, Mbula M, Kayembe JM, Situakibanza H. Diabetes Mellitus is Associated With Higher COVID-19 Mortality Rates in Sub-Saharan Africa: A Systematic Review and Meta-analysis. Cureus 2022; 14:e26877. [PMID: 35978734 PMCID: PMC9375835 DOI: 10.7759/cureus.26877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/08/2022] Open
Abstract
The rate of COVID-19-related mortality among patients with diabetes mellitus in Sub-Saharan Africa (SSA) is unknown. The current study aimed to determine the mortality rate of COVID-19 among diabetes patients in SSA. We performed a systematic review of research articles until July 1, 2021. A literature review was conducted in accordance with the PRISMA guidelines to gather relevant data. A random effects model was used to calculate odds ratios and 95% confidence intervals (CIs). We used Egger's tests and Begg's funnel plot to examine publication bias. The mortality rate of 7778 COVID-19 patients was analyzed using data from seven studies. The I2 test was used to determine the heterogeneity between studies. The meta-analysis revealed that diabetes mellitus was linked to a 1.39-fold increase in the risk of death among COVID-19 inpatients (95% CI: 1.02-1.76). According to our findings, there was no significant heterogeneity between studies, and there was no publication bias. The present review describes an association between diabetes mellitus and the risk of COVID-19 mortality in SSA.
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Girma D, Dejene H, Adugna L, Tesema M, Awol M. COVID-19 Case Fatality Rate and Factors Contributing to Mortality in Ethiopia: A Systematic Review of Current Evidence. Infect Drug Resist 2022; 15:3491-3501. [PMID: 35813083 PMCID: PMC9270043 DOI: 10.2147/idr.s369266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background The ongoing novel coronavirus disease 2019 (COVID-19) is triggering significant morbidity and mortality due to its contagious nature and absence of definitive management. In Ethiopia, despite a number of primary studies have been conducted to estimate the case fatality rate (CFR) of COVID-19, no review study has attempted to summarize the findings to better understand the nature of pandemics and the virulence of the disease. Objective To summarize the CFR of COVID-19 and factors contributing to mortality in Ethiopia. Methods PRISMA guideline was followed. PubMed, Science Direct, CINAHL, SCOPUS, Hinari, and Google Scholar were systematically searched using pre-specified keywords. Observational studies ie, cohort, cross-sectional, and case-control studies were included. The Newcastle-Ottawa scale adapted for observational studies was used to assess the quality of included studies. CFR was defined as the proportion of COVID-19 cases with the outcome of death within a given period. Factors contributing to COVID-19 mortality at p-value <0.05 were described narratively from the eligible articles. Results A total of 13 observational studies were included in this study. Consequently, this review confirmed the CFR of COVID-19 in Ethiopia ranges between 1–20%. Additionally, comorbid conditions, older age group, male sex, substance use, clinical manifestations (abnormal oxygen saturation level, atypical lymphocyte count, fever, and shortness of breath), disease severity, and history of surgery/trauma increased the likelihood of death from COVID-19 death. Conclusion This study shows that the range of CFR of COVID-19 in Ethiopia is almost equivalent to other countries, despite the country’s low testing capacity and case detection rate in reference to its total population. Comorbid diseases, older age group, male sex, cigarette smoking, alcohol drinking, clinical manifestations and disease severity, and history of surgery/trauma were factors contributing to COVID-19 mortality in Ethiopia. Therefore, given the alarming global situation and rapidly evolving large-scale pandemics, urgent interdisciplinary interventions should be implemented in those vulnerable groups to lessen the risk of mortality. Furthermore, the CFR of COVID-19 should be estimated from all treatment and rehabilitation centers in the country, as underestimation could be linked to a lack of preparedness and mitigation. A large set of prospective studies are also compulsory to better understand the CFR of COVID-19 in Ethiopia.
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Affiliation(s)
- Derara Girma
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
- Correspondence: Derara Girma, Email
| | - Hiwot Dejene
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Leta Adugna
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mengistu Tesema
- Public Health Department, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of Health Sciences, Salale University, Fiche, Ethiopia
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Yemata GA, Tesfaw A, Mihret G, Tiruneh M, Walle Z, Molla E, Sisay E, Admassu FT, Habtie E, Desalagn T, Shimels H, Teshome F. Survival Time to COVID-19 Severity and Its Predictors in South Gondar Zone, North-West Ethiopia: A Prospective Cohort Study. J Multidiscip Healthc 2022; 15:1187-1201. [PMID: 35634568 PMCID: PMC9139343 DOI: 10.2147/jmdh.s361061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coronavirus disease is still a global public health emergency. Due to an inadequate healthcare system in low-income nations like Ethiopia, the pandemic has had a devastating impact. Despite this, information on the severity of COVID-19 and related difficulties in Ethiopia is sparse. Therefore, we aimed to determine the survival time to severity and predictors of COVID-19 in Northwest Ethiopia. Methods A prospective follow-up study was conducted among 202 adult COVID-19 patients in the South Gondar zone treatment centers. Data were entered using EpiData version 3.1 and then exported to Stata 16 for analysis. Kaplan-Meier was used to estimate mean survival time, and Log rank tests were used to compare survival time between explanatory variable groups. A cox-proportional hazards regression model with a 95% confidence interval and a p-value of 0.05 was used to identify covariates associated with the outcome variable. Results The patients' average age was 41.2 years. With an IQR of 4-7 days, the median time to COVID-19 severity was 5 days. The overall COVID-19 severity rate was 6.35 (95% CI: 5.17-7.86) per 100 person-days observed. Senior adult age group (51-59 years) (AHR = 3.59, 95% CI: 1.05, 12.23), elderly age group (≥60 years) (AHR = 2.11, 95% CI: 1.09, 12.67), comorbidity (AHR = 3.26, 95% CI: 1.48, 7.18), high blood pressure at admission (AHR = 4.36, 95% CI: 1.99, 9.54), and high temperature at admission (AHR = 5.60, 95% CI: 2.55, 12.46) were significantly associated with COVID-19 severity time. Conclusion and Recommendation Patients with COVID-19 had a short median severity time, and factors like older age, comorbidity, high temperature, and high blood pressure were all independent predictors of severity time. Patients with high body temperature, blood pressure, comorbidity, and advanced age should be the focus of interventions to reduce progression time and improve clinical outcomes.
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Affiliation(s)
- Getaneh Atikilt Yemata
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Aragaw Tesfaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Gashaw Mihret
- Department of Pediatrics, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Zebader Walle
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Eshetie Molla
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Ermias Sisay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Fitalew Tadele Admassu
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Eyaya Habtie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Tsion Desalagn
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Habtamu Shimels
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Fentaw Teshome
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
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Wang Y, Xie Y, Hu S, Ai W, Tao Y, Tang H, Jing F, Tang W. Systematic Review and Meta-Analyses of The Interaction Between HIV Infection And COVID-19: Two Years' Evidence Summary. Front Immunol 2022; 13:864838. [PMID: 35619709 PMCID: PMC9128408 DOI: 10.3389/fimmu.2022.864838] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/13/2022] [Indexed: 12/20/2022] Open
Abstract
Introduction During the COVID-19 pandemic, people living with HIV (PLWH) were considered to be at risk of worse COVID-19 outcomes once infected. However, the existing evidence is inconsistent. This systematic review and meta-analysis aimed to compare the risk of SARS-CoV-2 infection, severe COVID-19 symptoms, and mortality among PLWH and patients without HIV. Method The articles included studies published in PubMed, Medline, Embase, and Cochrane between December 1, 2019, and December 1, 2021. We included the original studies published in English focusing on observational studies assessing the risk of SARS-CoV-2 infection, severe COVID-19 symptoms, and mortality among PLWH. Four independent reviewers extracted data. STrengthening the Reporting of OBservational studies in Epidemiology-Modified (STROBE-M) checklist was used for quality assessment. For the results with heterogeneity I2 >75%, a random-effects model was employed. Otherwise, a fixed-effects model was used. The risk of SARS-CoV-2 infection, severe COVID-19 symptoms, and mortality were compared with and without HIV. Results We included a total of 32 studies and 71,779,737 study samples, of whom 797,564 (1.11%) were PLWH. Compared with COVID-19 patients without HIV infection, PLWH had comparable risk of SARS-CoV-2 infection (adjusted Risk Ratio=1.07, 95% CI: 0.53-2.16, I2 = 96%, study n=6, n=20,199,805) and risk of developing severe COVID-19 symptoms (aRR=1.06, 95% CI: 0.97-1.16, I2 = 75%, n=10, n=2,243,370). PLWH, if infected with SARS-CoV-2, were found to have an increased risk of mortality compared with people without HIV (aRR=1.30, 95% CI: 1.09-1.56, I2 = 76%, study n=16, n=71,032,659). This finding was consistent across different subgroup analyses. Conclusion PLWH are at increased risk of COVID-19 related mortality once infected. The local health system should, on the one hand, strengthen COVID-19 prevention and clinical management among PLWH to avoid infection and, on the other hand, sustain the HIV care continuum for PLWH for HIV management.
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Affiliation(s)
- Yehua Wang
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Yewei Xie
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Siyue Hu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Wei Ai
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yusha Tao
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Huilin Tang
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Fengshi Jing
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Weiming Tang
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, NC, United States
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28
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Yan LD, Matuja SS, Pain KJ, McNairy ML, Etyang AO, Peck RN. Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review. Hypertension 2022; 79:898-905. [PMID: 35272495 PMCID: PMC9010372 DOI: 10.1161/hypertensionaha.121.17949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA. METHODS In September 2021, we conducted a search in MEDLINE, Embase, and Scopus, limited to English language studies published since 1990, and found a total of 1169 articles. Forty-seven original studies were included, with 32 on COVID-19 and 15 on other emerging viruses. RESULTS Seven articles, including those with the largest sample size and most robust study design, found an association between preexisting hypertension or CVD and COVID-19 severity or death. Ten smaller studies found no association, and 17 did not calculate statistics to compare groups. Two studies assessed the impact of COVID-19 on incident CVD, with one finding an increase in stroke admissions. For other emerging viruses, 3 studies did not find an association between preexisting hypertension or CVD on West Nile and Lassa fever mortality. Twelve studies examined other emerging viral infections and incident CVD, with 4 finding no association and 8 not calculating statistics. CONCLUSIONS Growing evidence from COVID-19 suggests viruses, hypertension, and CVD interact on multiple levels in SSA, but research gaps remain especially for other emerging viral infections. SSA can and must play a leading role in the study and control of emerging viral infections, with expansion of research and public health infrastructure to address these interactions.
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Affiliation(s)
- Lily D Yan
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah S Matuja
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Kevin J Pain
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Margaret L McNairy
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Robert N Peck
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Interventions Trial Unit, Mwanza, Tanzania
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Buitrago-Garcia D, Ipekci AM, Heron L, Imeri H, Araujo-Chaveron L, Arevalo-Rodriguez I, Ciapponi A, Cevik M, Hauser A, Alam MI, Meili K, Meyerowitz EA, Prajapati N, Qiu X, Richterman A, Robles-Rodriguez WG, Thapa S, Zhelyazkov I, Salanti G, Low N. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: Update of a living systematic review and meta-analysis. PLoS Med 2022; 19:e1003987. [PMID: 35617363 PMCID: PMC9135333 DOI: 10.1371/journal.pmed.1003987] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Debate about the level of asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection continues. The amount of evidence is increasing and study designs have changed over time. We updated a living systematic review to address 3 questions: (1) Among people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) What is the infectiousness of asymptomatic and presymptomatic, compared with symptomatic, SARS-CoV-2 infection? (3) What proportion of SARS-CoV-2 transmission in a population is accounted for by people who are asymptomatic or presymptomatic? METHODS AND FINDINGS The protocol was first published on 1 April 2020 and last updated on 18 June 2021. We searched PubMed, Embase, bioRxiv, and medRxiv, aggregated in a database of SARS-CoV-2 literature, most recently on 6 July 2021. Studies of people with PCR-diagnosed SARS-CoV-2, which documented symptom status at the beginning and end of follow-up, or mathematical modelling studies were included. Studies restricted to people already diagnosed, of single individuals or families, or without sufficient follow-up were excluded. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with a bespoke checklist and modelling studies with a published checklist. All data syntheses were done using random effects models. Review question (1): We included 130 studies. Heterogeneity was high so we did not estimate a mean proportion of asymptomatic infections overall (interquartile range (IQR) 14% to 50%, prediction interval 2% to 90%), or in 84 studies based on screening of defined populations (IQR 20% to 65%, prediction interval 4% to 94%). In 46 studies based on contact or outbreak investigations, the summary proportion asymptomatic was 19% (95% confidence interval (CI) 15% to 25%, prediction interval 2% to 70%). (2) The secondary attack rate in contacts of people with asymptomatic infection compared with symptomatic infection was 0.32 (95% CI 0.16 to 0.64, prediction interval 0.11 to 0.95, 8 studies). (3) In 13 modelling studies fit to data, the proportion of all SARS-CoV-2 transmission from presymptomatic individuals was higher than from asymptomatic individuals. Limitations of the evidence include high heterogeneity and high risks of selection and information bias in studies that were not designed to measure persistently asymptomatic infection, and limited information about variants of concern or in people who have been vaccinated. CONCLUSIONS Based on studies published up to July 2021, most SARS-CoV-2 infections were not persistently asymptomatic, and asymptomatic infections were less infectious than symptomatic infections. Summary estimates from meta-analysis may be misleading when variability between studies is extreme and prediction intervals should be presented. Future studies should determine the asymptomatic proportion of SARS-CoV-2 infections caused by variants of concern and in people with immunity following vaccination or previous infection. Without prospective longitudinal studies with methods that minimise selection and measurement biases, further updates with the study types included in this living systematic review are unlikely to be able to provide a reliable summary estimate of the proportion of asymptomatic infections caused by SARS-CoV-2. REVIEW PROTOCOL Open Science Framework (https://osf.io/9ewys/).
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Affiliation(s)
- Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lucia Araujo-Chaveron
- EHESP French School of Public Health, Paris and Rennes, France
- Institut Pasteur, Paris, France
| | - Ingrid Arevalo-Rodriguez
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal, IRYCIS, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, Fife, Scotland, United Kingdom
| | - Anthony Hauser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Kaspar Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eric A. Meyerowitz
- Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, New York, United States of America
| | | | - Xueting Qiu
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aaron Richterman
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Shabnam Thapa
- Manchester Centre for Health Economics, University of Manchester, Manchester, United Kingdom
| | | | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Mengist B, Animut Z, Tolossa T. Incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia; A retrospective cohort study, 2021. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022; 16:100419. [PMID: 35530744 PMCID: PMC9055687 DOI: 10.1016/j.ijans.2022.100419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background Currently, coronavirus disease 2019 (COVID-19) is the leading cause of death and the rate of mortality is rapidly increasing over time. There is a paucity of information regarding the incidence and predictors of mortality among COVID-19 patients from low-income countries, particularly in Ethiopia. Objective To assess incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia. Methods An institution-based retrospective cohort study was conducted among 552 laboratory-confirmed COVID-19 cases at Debre Markos University and Tibebe Ghion Hospital COVID-19 treatment centers in North West Ethiopia from March 2020 to March 2021. Data were collected from patients' medical records using a structured data extraction tool. Cox-proportional hazards regression models was fitted to identify significant predictors of mortality. Result The overall mortality rate of COVID-19 was 4.7, (95 % CI: 3.3-6.8) per 1000 person day observations. Older age (AHR: 4.9; 95% CI: 1.8, 13.5), rural residence (AHR: 0.18; 95% CI: 0.05, 0.64), presence of hypertension (AHR: 3.04; 95% CI: 1.18, 7.8), presence of diabetes mellitus (AHR: 8.1; 95% CI: 2.9, 22.4) and cardiovascular disease (AHR: 5.2; 95% CI: (1.69, 16.2) were significantly associated with mortality. Conclusions The rate of mortality among hospitalized COVID-19 patients in this study was low. COVID-19 patients from urban residences, older patients, and patients with comorbidity have a high risk of death. These high risk groups should be prioritized for COVID-19 vaccinations, and early screening and appropriate intervention should be established on presentation to health facility.
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Affiliation(s)
- Belayneh Mengist
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Zelalem Animut
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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James A, Dalal J, Kousi T, Vivacqua D, Câmara DCP, Dos Reis IC, Botero Mesa S, Ng'ambi W, Ansobi P, Bianchi LM, Lee TM, Ogundiran O, Stoll B, Chimbetete C, Mboussou F, Impouma B, Hofer CB, Coelho FC, Keiser O, Abbate JL. An in-depth statistical analysis of the COVID-19 pandemic's initial spread in the WHO African region. BMJ Glob Health 2022; 7:bmjgh-2021-007295. [PMID: 35418411 PMCID: PMC9013786 DOI: 10.1136/bmjgh-2021-007295] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.
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Affiliation(s)
- Ananthu James
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, Karnataka, India .,The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland
| | - Jyoti Dalal
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland
| | - Timokleia Kousi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniela Vivacqua
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniel Cardoso Portela Câmara
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Laboratório de Mosquitos Transmissores de Hematozoários (LATHEMA), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Izabel Cristina Dos Reis
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Laboratório de Mosquitos Transmissores de Hematozoários (LATHEMA), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sara Botero Mesa
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Wignston Ng'ambi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Health Economics Policy Unit, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Papy Ansobi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Research and Training Unit in Ecology and Control of Infectious Diseases (URF-ECMI), Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lucas M Bianchi
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,World Health Organization Regional Office for Africa, Brazzaville, Congo.,National School of Public Health Sérgio Arouca, ENSP/Fiocruz, Rio de Janeiro, Brazil
| | - Theresa M Lee
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Opeayo Ogundiran
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Beat Stoll
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Cleophas Chimbetete
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Newlands Clinic, Harare, Zimbabwe
| | - Franck Mboussou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Cristina Barroso Hofer
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávio Codeço Coelho
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,School of Applied Mathematics, Getulio Vargas Foundation, Rio de Janeiro, Brazil
| | - Olivia Keiser
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jessica Lee Abbate
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneva, Switzerland.,World Health Organization Regional Office for Africa, Brazzaville, Congo.,UMI TransVIHMI (Institut de Recherche pour le Développement Institut National de la Santé et de la Recherche Médicale Université de Montpellier), Montpellier, France.,Geomatys, Montpellier, France
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Baguma S, Okot C, Alema NO, Apiyo P, Layet P, Acullu D, Oloya JN, Ochula D, Atim P, Olwedo PO, Okot SG, Oyat FWD, Oola J, Ikoona EN, Aloyo J, Kitara DL. Factors Associated With Mortality Among the COVID-19 Patients Treated at Gulu Regional Referral Hospital: A Retrospective Study. Front Public Health 2022; 10:841906. [PMID: 35480594 PMCID: PMC9035511 DOI: 10.3389/fpubh.2022.841906] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background The advent of the novel coronavirus disease 2019 (COVID-19) has caused millions of deaths worldwide. As of December 2021, there is inadequate data on the outcome of hospitalized patients suffering from COVID-19 in Africa. This study aimed at identifying factors associated with hospital mortality in patients who suffered from COVID-19 at Gulu Regional Referral Hospital in Northern Uganda from March 2020 to October 2021. Methods This was a single-center, retrospective cohort study in patients hospitalized with confirmed SARS-CoV-2 at Gulu Regional Referral Hospital in Northern Uganda. Socio-demographic characteristics, clinical presentations, co-morbidities, duration of hospital stay, and treatments were analyzed, and factors associated with the odds of mortality were determined. Results Of the 664 patients treated, 661 (99.5%) were unvaccinated, 632 (95.2%) recovered and 32 (4.8%) died. Mortality was highest in diabetics 11 (34.4%), cardiovascular diseases 12 (37.5%), hypertensives 10 (31.3%), females 18 (56.3%), ≥50-year-olds 19 (59.4%), no formal education 14 (43.8%), peasant farmers 12 (37.5%) and those who presented with difficulty in breathing/shortness of breath and chest pain 32 (100.0%), oxygen saturation (SpO2) at admission <80 4 (12.5%), general body aches and pains 31 (96.9%), tiredness 30 (93.8%) and loss of speech and movements 11 (34.4%). The independent factors associated with mortality among the COVID-19 patients were females AOR = 0.220, 95%CI: 0.059-0.827; p = 0.030; Diabetes mellitus AOR = 9.014, 95%CI: 1.726-47.067; p = 0.010; Ages of 50 years and above AOR = 2.725, 95%CI: 1.187-6.258; p = 0.018; tiredness AOR = 0.059, 95%CI: 0.009-0.371; p < 0.001; general body aches and pains AOR = 0.066, 95%CI: 0.007-0.605; p = 0.020; loss of speech and movement AOR = 0.134, 95%CI: 0.270-0.660; p = 0.010 and other co-morbidities AOR = 6.860, 95%CI: 1.309-35.957; p = 0.020. Conclusion The overall Gulu Regional Hospital mortality was 32/664 (4.8%). Older age, people with diabetics, females, other comorbidities, severe forms of the disease, and those admitted to HDU were significant risk factors associated with hospital mortality. More efforts should be made to provide "additional social protection" to the most vulnerable population to avoid preventable morbidity and mortality of COVID-19 in Northern Uganda.
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Affiliation(s)
- Steven Baguma
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Gulu Regional Referral Hospital, Gulu, Uganda
| | - Christopher Okot
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Gulu Regional Referral Hospital, Gulu, Uganda
| | - Nelson Onira Alema
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Department of Anatomy, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Paska Apiyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Gulu Regional Referral Hospital, Gulu, Uganda
| | - Paska Layet
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Department of Medicine, St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Denis Acullu
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Aga Kan Hospital, Mombasa, Kenya
| | | | - Denis Ochula
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Lamwo District Local Government, District Health Office, Padibe, Uganda
| | - Pamela Atim
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- St. Joseph's Hospital, Kitgum, Uganda
| | - Patrick Odong Olwedo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Amuru District Local Government, District Health Office, Amuru, Uganda
| | - Smart Godfrey Okot
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Ambrosoli Hospital, Kalongo, Uganda
| | | | - Janet Oola
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Nwoya District Local Government, District Health Office, Anaka, Uganda
| | | | - Judith Aloyo
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Rhites-N, Acholi, Gulu, Uganda
| | - David Lagoro Kitara
- Uganda Medical Association (UMA), UMA-Acholi Branch, Gulu, Uganda
- Department of Surgery, Faculty of Medicine, Gulu University, Gulu, Uganda
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Wolday D, de Wit TFR. Response to Abdelrahman M et al commentary on "Parasites Protect from Severe COVID-19. Myth or Reality?". Int J Infect Dis 2022; 120:46-47. [PMID: 35413465 PMCID: PMC8993697 DOI: 10.1016/j.ijid.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 10/25/2022] Open
Affiliation(s)
- Dawit Wolday
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia; Mekelle University College of Health Sciences, Mekelle, Ethiopia.
| | - Tobias F Rinke de Wit
- Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands; Joep-Lange Institute, Amsterdam, The Netherlands
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Gutata D, Alemu ZA. Factors Associated for COVID19 Severity Among Patients Treated at Selgalu Treatment Center Assosa in Ethiopia: A Case-Control Study. Int J Gen Med 2022; 15:3303-3313. [PMID: 35355795 PMCID: PMC8959867 DOI: 10.2147/ijgm.s351125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Most people infected with the SARS-CoV-2 virus experienced mild to moderate respiratory illness and recovered without requiring special treatment. However, some became seriously ill with conditions that require medical attention and intensive care unit (ICU) admission. Severity varies among individuals; this may be due to age differences and the presence of underlying disease conditions. Objective To identify factors associated with disease severity among COVID19 patients treated at Selgalu treatment center from November 1, 2020, to April 30, 2021. Methods A case–control study was implemented among patients admitted to Selgalu COVID19 treatment center in October 2021. A 210 (70 severe disease and 140 non-severe diseases), cases (disease severity), and controls (non-severe disease). Data entered to Epi data 4.6, exported to SPSS 25. A Chi-square test with a p-value of <0.05 was used as a statistically significant difference between characteristics of disease severity and non-severity of disease. Multivariable binary logistic regression was used to determine variables associated with disease severity based on an adjusted odds ratio with 95% CI and p-value < 0.05. Results 210 (70 cases and 140 controls) selected charts in this study. Patients age category between 40–59 [AOR: 5.30 (2.27–12.34)], aged 60 or older [AOR: 3.85 (1.39–10.64)], patients with fever [AOR: 3.98 (1.59–9.96)], fatigue [AOR: 3.14 (1.50–6.54)], and hypertensive patients [AOR: 3.68 (1.53–8.82)] were significantly predictors for COVID19 disease severity after adjusting for other variables. Conclusion From this study, we conclude that being age 60 or older and 40–59 age groups, having symptoms of fever, fatigue, and underlying comorbid illness hypertension. Were identified a significant predictor of severe COVID-19 disease; despite our limitation of study data highlights the important factors associated with disease severity with covid19 admitted to Selgalu treatment center.
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Affiliation(s)
- Dano Gutata
- Assosa General Hospital, Benishangul Gumuz Regional State Health Bureau, Asosa, Ethiopia
| | - Zewdie Aderaw Alemu
- College of Health Sciences Public Health Department, Debre Markos University, Debre Markos, Ethiopia
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35
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Gebrecherkos T, Kiros YK, Challa F, Abdella S, Gebreegzabher A, Leta D, Desta A, Hailu A, Tasew G, Abdulkader M, Tessema M, Tollera G, Kifle T, Arefaine ZG, Schallig HHDF, Adams ER, Urban BC, de Wit TFR, Wolday D. Longitudinal profile of antibody response to SARS-CoV-2 in patients with COVID-19 in a setting from Sub-Saharan Africa: A prospective longitudinal study. PLoS One 2022; 17:e0263627. [PMID: 35320286 PMCID: PMC8942258 DOI: 10.1371/journal.pone.0263627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/24/2022] [Indexed: 12/14/2022] Open
Abstract
Background Serological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia. Methods In this prospective study, a total of 102 PCR-confirmed COVID-19 patients were enrolled. We obtained 802 plasma samples collected serially. SARS-CoV-2 antibodies were determined using four lateral flow immune-assays (LFIAs), and an electrochemiluminescent immunoassay. We determined longitudinal antibody response to SARS-CoV-2 as well as seroconversion dynamics. Results Serological positivity rate ranged between 12%-91%, depending on timing after symptom onset. There was no difference in positivity rate between severe and non-severe COVID-19 cases. The specificity ranged between 90%-97%. Agreement between different assays ranged between 84%-92%. The estimated positive predictive value (PPV) for IgM or IgG in a scenario with seroprevalence at 5% varies from 33% to 58%. Nonetheless, when the population seroprevalence increases to 25% and 50%, there is a corresponding increases in the estimated PPVs. The estimated negative-predictive value (NPV) in a low seroprevalence scenario (5%) is high (>99%). However, the estimated NPV in a high seroprevalence scenario (50%) for IgM or IgG is reduced significantly to 80% to 85%. Overall, 28/102 (27.5%) seroconverted by one or more assays tested, within a median time of 11 (IQR: 9–15) days post symptom onset. The median seroconversion time among symptomatic cases tended to be shorter when compared to asymptomatic patients [9 (IQR: 6–11) vs. 15 (IQR: 13–21) days; p = 0.002]. Overall, seroconversion reached 100% 5.5 weeks after the onset of symptoms. Notably, of the remaining 74 COVID-19 patients included in the cohort, 64 (62.8%) were positive for antibody at the time of enrollment, and 10 (9.8%) patients failed to mount a detectable antibody response by any of the assays tested during follow-up. Conclusions Longitudinal assessment of antibody response in African COVID-19 patients revealed heterogeneous responses. This underscores the need for a comprehensive evaluation of seroassays before implementation. Factors associated with failure to seroconvert needs further research.
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Affiliation(s)
| | | | - Feyissa Challa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Saro Abdella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Dereje Leta
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Geremew Tasew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Henk HDF Schallig
- Department of Medical Microbiology, and Infection Prevention, Experimental Parasitology Unit, Amsterdam Institute for Infection and Immunity, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
| | - Emily R. Adams
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Britta C. Urban
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tobias F. Rinke de Wit
- Amsterdam Institute Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail: ,
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36
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Churiso G, Diriba K, Girma H, Tafere S. Clinical Features and Time to Recovery of Admitted COVID-19 Cases at Dilla University Referral Hospital Treatment Center, South Ethiopia. Infect Drug Resist 2022; 15:795-806. [PMID: 35281575 PMCID: PMC8904438 DOI: 10.2147/idr.s356606] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background Since coronavirus disease 2019 emergence, millions were infected and many were dying because of the virus. Clinical features and time to recovery of admitted clients vary across settings. Therefore showing clinical features and recovery time from COVID-19 in a different setting is necessary to design appropriate treatment and preventive measures. So, this study attempted to investigate the clinical features and time to recovery of admitted clients to Dilla University Referral Hospital treatment center, Ethiopia. Methods A retrospective study design was conducted in 220 patients confirmed by real time polymerase chain reaction and admitted to Dilla University Referral Hospital treatment center from September 2020 to July 2021. Data were collected from the patients' record. Data entry was done by an Epi-Info version 7.2.1.0 and analyzed by Statistical Package for the Social Sciences version 25 software. Descriptive statistics were used for clinical features, and median time to recovery was computed by using Kaplan-Meier. Results Common clinical features were cough 209 (95%), shortness of breath 153 (69.5%), fever 133 (60.5%), headache 75 (34.1%), easy fatigue 68 (30.9%), joint pain 56 (25.5%), tachypnea 197 (89.5%), hypoxia 95 (43.2%), and tachycardia 83 (37.7%). The overall median recovery time for admitted cases was 5 days. There was significant difference between recovery probability of severe and moderate cases, severe and mild cases (p=0.00), who had normal body temperature and hypothermic (p=0.05), who had normal breathing rate and bradypnea patients (p= 0.014). Conclusion COVID-19 patients frequently show cough, shortness of breath, fever, headache, easy fatigue and joint pain. Median time to recovery was 5 days. Having a normal body temperature, normal breathing rate, and severe disease status had statistically significant association with median recovery time. So, close follow up is required for client admitted with severe disease.
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Affiliation(s)
- Gemechu Churiso
- Department of Medical Laboratory Sciences, Dilla University, Dilla, Ethiopia
| | - Kuma Diriba
- Department of Medical Laboratory Sciences, Dilla University, Dilla, Ethiopia
| | - Henok Girma
- Ohio State University, Global One Health Initiative, Dilla, Ethiopia
| | - Soressa Tafere
- COVID-19 Treatment Center, Dilla University, Dilla, Ethiopia
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37
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Bepouka B, Situakibanza H, Sangare M, Mandina M, Mayasi N, Longokolo M, Odio O, Mangala D, Isekusu F, Kayembe JM, Nachega J, Mbula M. Mortality associated with COVID-19 and hypertension in sub-Saharan Africa. A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2022; 24:99-105. [PMID: 35083847 PMCID: PMC8845466 DOI: 10.1111/jch.14417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 01/08/2023]
Abstract
Hypertension is a common comorbidity in COVID-19 patients. However, little data is available on mortality in COVID-19 patients with hypertension in sub-Saharan Africa (SSA). Herein, the authors conducted a systematic review of research articles published from January 1, 2020 to July 1, 2021. Our aim was to evaluate the magnitude of COVID-19 mortality in patients with hypertension in SSA. Following the PRISMA guidelines, two independent investigators conducted the literature review to collect relevant data. The authors used a random effect model to estimate the odds ratio, or hazard ratio, with a 95% confidence interval (CI). Furthermore, the authors used Egger's tests to check for publication bias. For mortality analysis, the authors included data on 29 945 COVID-19 patients from seven publications. The authors assessed the heterogeneity across studies with the I2 test. Finally, the pooled analysis revealed that hypertension was associated with an increased odds of mortality among COVID-19 inpatients (OR 1.32; 95% CI, 1.13-1.50). Our analysis revealed neither substantial heterogeneity across studies nor a publication bias. Therefore, our prespecified results provided new evidence that hypertension could increase the risk of mortality from COVID-19 in SSA.
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Affiliation(s)
- Ben Bepouka
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Hippolyte Situakibanza
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Modibo Sangare
- Faculty of Medicine and Odontostomatology (FMOS), University of Sciences, Techniques & Technologies of Bamako (USTTB), Bamako, Mali
| | - Madone Mandina
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Nadine Mayasi
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Murielle Longokolo
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Ossam Odio
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Donatien Mangala
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Fiston Isekusu
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
| | - Jean Marie Kayembe
- Pneumology Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, DRC, Kinshasa, USA
| | - Jean Nachega
- Department of Medicine, Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and Department of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marcel Mbula
- Infectious Diseases Unit, Kinshasa University Hospital, Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo, Kinshasa, USA
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38
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Rinke de Wit TF, Janssens W, Antwi M, Milimo E, Mutegi N, Marwa H, Ndili N, Owino W, Waiyaiya E, Garcia Rojas DC, Dolfing M, de Graaff A, Swanepoel R, van der Graaf MH, Mulder D, De Sanctis T, Kratule S, Koyuncu C, Rogo K, Gómez-Pérez GP, Spieker N. Digital health systems strengthening in Africa for rapid response to COVID-19. FRONTIERS IN HEALTH SERVICES 2022; 2:987828. [PMID: 36925782 PMCID: PMC10012758 DOI: 10.3389/frhs.2022.987828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has painfully exposed the constraints of fragile health systems in low- and middle-income countries, where global containment measures largely set by high-income countries resulted in disproportionate collateral damage. In Africa, a shift is urgently needed from emergency response to structural health systems strengthening efforts, which requires coordinated interventions to increase access, efficiency, quality, transparency, equity, and flexibility of health services. We postulate that rapid digitalization of health interventions is a key way forward to increase resilience of African health systems to epidemic challenges. In this paper we describe how PharmAccess' ongoing digital health system interventions in Africa were rapidly customized to respond to COVID-19. We describe how we developed: a COVID-19 App for healthcare providers used by more than 1,000 healthcare facilities in 15 African countries from May-November 2020; digital loans to support private healthcare providers with USD 20 million disbursed to healthcare facilities impacted by COVID-19 in Kenya; a customized Dutch mobile COVID-19 triage App with 4,500 users in Ghana; digital diaries to track COVID-19 impacts on household expenditures and healthcare utilization; a public-private partnership for real-time assessment of COVID-19 diagnostics in West-Kenya; and an expanded mobile phone-based maternal and child-care bundle to include COVID-19 adapted services. We also discuss the challenges we faced, the lessons learned, the impact of these interventions on the local healthcare system, and the implications of our findings for policy-making. Digital interventions bring efficiency due to their flexibility and timeliness, allowing co-creation, targeting, and rapid policy decisions through bottom-up approaches. COVID-19 digital innovations allowed for cross-pollinating the interests of patients, providers, payers, and policy-makers in challenging times, showing how such approaches can pave the way to universal health coverage and resilient healthcare systems in Africa.
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Affiliation(s)
- Tobias F Rinke de Wit
- PharmAccess Foundation, Amsterdam, Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
| | - Wendy Janssens
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands.,School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Heri Marwa
- PharmAccess Foundation, Dar es Salaam, Tanzania
| | | | | | | | - Diana C Garcia Rojas
- School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | - Cem Koyuncu
- PharmAccess Foundation, Amsterdam, Netherlands
| | - Khama Rogo
- African Institute for Health Transformation, Luanda, Kenya
| | - Gloria P Gómez-Pérez
- PharmAccess Foundation, Amsterdam, Netherlands.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands
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Ayana GM, Merga BT, Birhanu A, Alemu A, Negash B, Dessie Y. Predictors of Mortality Among Hospitalized COVID-19 Patients at a Tertiary Care Hospital in Ethiopia. Infect Drug Resist 2021; 14:5363-5373. [PMID: 34938084 PMCID: PMC8685765 DOI: 10.2147/idr.s337699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The very unprecedented virus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued causing catastrophes in economy and loss of human lives. Despite countries' urgent and resilient public health actions against the COVID-19 pandemic, the disease is causing a large number of deaths. However, predictors of mortality among hospitalized COVID-19 patients have not been well investigated in Ethiopia. Therefore, this study aimed to identify the predictors of mortality among hospitalized COVID-19 patients at a tertiary care hospital in Ethiopia. METHODS A hospital-based retrospective cohort design study was implemented among hospitalized COVID-19 patients at a tertiary care hospital in Harar, Ethiopia from March 20 to August 20, 2021. Data of 531 admitted patients were entered using Epi-data 3.1 and exported to STATA 14.2 for analysis. Binary logistic regression was used to identify significant predictors of outcome variables with an adjusted odds ratio (AOR) with a 95% confidence interval. RESULTS Of the total 531 study participants, 101 deaths occurred. The mortality rate was 16.2 per 1000 person-days of observation with median survival time of 44 days with IQR [28, 74]. Smoking history [AOR=2.55, 95% CI (1.15, 5.65)], alcohol history [AOR=2.3, 95% CI (1.06, 4.97)], comorbidities [AOR=2.95, 95% CI (1.26, 6.91)], and increasing oxygen saturation [AOR=0.92, 95% CI (0.89, 0.95)], and lymphocyte count [AOR=0.90, 95% CI (0.88, 0.97)] were independent significant predictors of death from Covid-19. CONCLUSION The incidence of mortality among hospitalized COVID-19 patients was found to be high. Devising individual, tailored management for patients with "risk" behaviors, comorbid conditions, and poor prognostic markers such as lymphopenia and low oxygen saturation, may reduce the incidence of death among hospitalized COVID-19 patients.
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Affiliation(s)
- Galana Mamo Ayana
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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40
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Dakroub F, Fakhredine S, Yassine M, Dayekh A, Jaber R, Fadel A, Akl H, Maatouk A. A retrospective analysis of 902 hospitalized COVID‐19 patients in Lebanon: clinical epidemiology and risk factors. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100048. [PMID: 35262028 PMCID: PMC8532499 DOI: 10.1016/j.jcvp.2021.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The clinical epidemiology of hospitalized COVID-19 patients has never been described before in Lebanon. Moreover, the hospital admission and PCR positivity rates have not been assessed and compared yet. Objectives: To describe the characteristics and outcomes of hospitalized patients with coronavirus induced disease 2019 (COVID-19) in Lebanon and identify risk factors for severe disease or death. Study design: This is a retrospective mono-center cohort study in which we used patients’ files to extract and analyse data on demographic and clinical characteristics, as well as mortality. Moreover, we tracked the pandemic by recording the daily total and ICU inpatient census and the PCR positivity rate for admitted and outpatients. Results: Although the total admission rate increased from September to April, the ICU census switched this trend in December to stabilize at an average of around 10 patients/day until April. The case fatality rate was 19% for the 902 hospitalized patients, of which the majority (80%) had severe COVID-19. The severity odds ratio is significantly decreased in immunosuppressed cases (OR, 0.18; CI, 0.05-0.67; p=0.011). Additionally, the odds of COVID-19 related death are significantly greater if consolidations are found in the chest computed tomography (CT) scan (OR, 12; CI, 2.63-55.08; p=0.0013). Conclusion: Consolidations in the lungs significantly increase the COVID-19 death risk. Risk factors identification is important to improve patients’ management and vaccination strategies. In addition, hospital statistics are good indicators of a pandemic's track.
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Affiliation(s)
- Fatima Dakroub
- Research unit, Saint George Hospital, Lebanon
- Biology Department, Faculty of Sciences-I, Lebanese University, Lebanon
| | - Suha Fakhredine
- Research unit, Saint George Hospital, Lebanon
- Infectious diseases division, Saint George Hospital, Lebanon
| | - Mohammad Yassine
- Research unit, Saint George Hospital, Lebanon
- Pharmacy Department, Saint George Hospital, Lebanon
| | - Alaa Dayekh
- Research unit, Saint George Hospital, Lebanon
- Quality Improvement Department, Saint George Hospital, Lebanon
| | - Rachid Jaber
- Faculty of Medicine, Lebanese University, Lebanon
| | - Abbass Fadel
- Infectious diseases division, Saint George Hospital, Lebanon
| | - Haidar Akl
- Biology Department, Faculty of Sciences-I, Lebanese University, Lebanon
| | - Ali Maatouk
- The pulmonary department, Saint George Hospital, Lebanon
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Pang KW, Tham SL, Ng LS. Exploring the Clinical Utility of Gustatory Dysfunction (GD) as a Triage Symptom Prior to Reverse Transcription Polymerase Chain Reaction (RT-PCR) in the Diagnosis of COVID-19: A Meta-Analysis and Systematic Review. Life (Basel) 2021; 11:1315. [PMID: 34947846 PMCID: PMC8706269 DOI: 10.3390/life11121315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The diagnosis of COVID-19 is made using reverse transcription polymerase chain reaction (RT-PCR) but its sensitivity varies from 20 to 100%. The presence of gustatory dysfunction (GD) in a patient with upper respiratory tract symptoms might increase the clinical suspicion of COVID-19. AIMS To perform a systematic review and meta-analysis to determine the pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) of using GD as a triage symptom prior to RT-PCR. METHODS PubMed and Embase were searched up to 20 June 2021. Studies published in English were included if they compared the frequency of GD in COVID-19 adult patients (proven by RT-PCR) to COVID-19 negative controls in case control or cross-sectional studies. The Newcastle-Ottawa scale was used to assess the methodological quality of the included studies. RESULTS 21,272 COVID-19 patients and 52,298 COVID-19 negative patients were included across 44 studies from 21 countries. All studies were of moderate to high risk of bias. Patients with GD were more likely to test positive for COVID-19: DOR 6.39 (4.86-8.40), LR+ 3.84 (3.04-4.84), LR- 0.67 (0.64-0.70), pooled sensitivity 0.37 (0.29-0.47) and pooled specificity 0.92 (0.89-0.94). While history/questionnaire-based assessments were predictive of RT-PCR positivity (DOR 6.62 (4.95-8.85)), gustatory testing was not (DOR 3.53 (0.98-12.7)). There was significant heterogeneity among the 44 studies (I2 = 92%, p < 0.01). CONCLUSIONS GD is useful as a symptom to determine if a patient should undergo further testing, especially in resource-poor regions where COVID-19 testing is scarce. Patients with GD may be advised to quarantine while repeated testing is performed if the initial RT-PCR is negative. FUNDING None.
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Affiliation(s)
- Khang Wen Pang
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore 119228, Singapore; (S.-L.T.); (L.S.N.)
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Assefa N, Regassa LD, Teklemariam Z, Oundo J, Madrid L, Dessie Y, Scott J. Seroprevalence of anti-SARS-CoV-2 antibodies in women attending antenatal care in eastern Ethiopia: a facility-based surveillance. BMJ Open 2021; 11:e055834. [PMID: 34819290 PMCID: PMC8613670 DOI: 10.1136/bmjopen-2021-055834] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We conducted serosurveillance of anti-SARS-CoV-2 antibodies among pregnant women attending their first antenatal care. SETTING The surveillance was set in one referral hospital in Harar, one district hospital and one health centre located in Haramaya district in rural eastern Ethiopia. PARTICIPANTS We collected questionnaire data and a blood sample from 3312 pregnant women between 1 April 2020 and 31 March 2021. We selected 1447 blood samples at random and assayed these for anti-SARS-CoV-2 antibodies at Hararghe Health Research laboratory using WANTAI SARS-CoV-2 Rapid Test for total immunoglobulin. OUTCOME We assayed for anti-SARS-CoV-2 antibodies and temporal trends in seroprevalence were analysed with a χ2 test for trend and multivariable binomial regression. RESULTS Among 1447 sera tested, 83 were positive for anti-SARS-CoV-2 antibodies giving a crude seroprevalence of 5.7% (95% CI 4.6% to 7.0%). Of 160 samples tested in April-May 2020, none was seropositive; the first seropositive sample was identified in June and seroprevalence rose steadily thereafter (χ2 test for trend, p=0.003) reaching a peak of 11.8% in February 2021. In the multivariable model, seroprevalence was approximately 3% higher in first-trimester mothers compared with later presentations, and rose by 0.75% (95% CI 0.31% to 1.20%) per month of calendar time. CONCLUSIONS This clinical convenience sample illustrates the dynamic of the SARS-CoV-2 epidemic in pregnant women in eastern Ethiopia; infection was rare before June 2020 but it spread in a linear fashion thereafter, rather than following intermittent waves, and reached 10% by the beginning of 2021. After 1 year of surveillance, most pregnant mothers remained susceptible.
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Affiliation(s)
- Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Zelalem Teklemariam
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph Oundo
- London School of Hygiene & Tropical Medicine, London, UK
| | - Lola Madrid
- London School of Hygiene & Tropical Medicine, London, UK
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jag Scott
- London School of Hygiene & Tropical Medicine, London, UK
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Wang Y, Xu J, Wang Y, Hou H, Shi L, Yang H. Prevalence of comorbid tuberculosis amongst COVID-19 patients: A rapid review and meta-analysis. Int J Clin Pract 2021; 75:e14867. [PMID: 34670351 PMCID: PMC8646527 DOI: 10.1111/ijcp.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yadong Wang
- Department of ToxicologyHenan Center for Disease Control and PreventionZhengzhouChina
| | - Jie Xu
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Ying Wang
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Hongjie Hou
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Li Shi
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
| | - Haiyan Yang
- Department of EpidemiologySchool of Public HealthZhengzhou UniversityZhengzhouChina
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44
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Active pulmonary tuberculosis and coronavirus disease 2019: A systematic review and meta-analysis. PLoS One 2021; 16:e0259006. [PMID: 34673822 PMCID: PMC8530351 DOI: 10.1371/journal.pone.0259006] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The proportion of COVID-19 patients having active pulmonary tuberculosis, and its impact on COVID-19 related patient outcomes, is not clear. We conducted this systematic review to evaluate the proportion of patients with active pulmonary tuberculosis among COVID-19 patients, and to assess if comorbid pulmonary tuberculosis worsens clinical outcomes in these patients. METHODS We queried the PubMed and Embase databases for studies providing data on (a) proportion of COVID-19 patients with active pulmonary tuberculosis or (b) severe disease, hospitalization, or mortality among COVID-19 patients with and without active pulmonary tuberculosis. We calculated the proportion of tuberculosis patients, and the relative risk (RR) for each reported outcome of interest. We used random-effects models to summarize our data. RESULTS We retrieved 3,375 citations, and included 43 studies, in our review. The pooled estimate for proportion of active pulmonary tuberculosis was 1.07% (95% CI 0.81%-1.36%). COVID-19 patients with tuberculosis had a higher risk of mortality (summary RR 1.93, 95% CI 1.56-2.39, from 17 studies) and for severe COVID-19 disease (summary RR 1.46, 95% CI 1.05-2.02, from 20 studies), but not for hospitalization (summary RR 1.86, 95% CI 0.91-3.81, from four studies), as compared to COVID-19 patients without tuberculosis. CONCLUSION Active pulmonary tuberculosis is relatively common among COVID-19 patients and increases the risk of severe COVID-19 and COVID-19-related mortality.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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45
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Kassam N, Aghan E, Aziz O, Mbithe H, Hameed K, Shah R, Surani S, Orwa J, Somji S. Factors Associated with Mortality Among Hospitalized Adults with COVID-19 Pneumonia at a Private Tertiary Hospital in Tanzania: A Retrospective Cohort Study. Int J Gen Med 2021; 14:5431-5440. [PMID: 34526810 PMCID: PMC8436253 DOI: 10.2147/ijgm.s330580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Nadeem Kassam
- Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania
| | - Eric Aghan
- Family Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, East Africa, Dar-es-Salaam, Tanzania
| | - Omar Aziz
- Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania
| | - Hanifa Mbithe
- Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania
| | - Kamran Hameed
- Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania
| | - Reena Shah
- Infectious Disease & Internal Medicine, The Aga Khan University, Medical College, Nairobi, Kenya
| | - Salim Surani
- Pulmonology & Internal Medicine, Texas a&m University, Texas A&M College Station, TX, USA
| | - James Orwa
- Population Health, Aga Khan University, Medical College, East Africa, Nairobi, Kenya
| | - Samina Somji
- Internal Medicine, The Aga Khan Hospital, Dar es Salaam, Tanzania & Aga Khan University, Medical College, Dar-es- Salaam, Tanzania
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46
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Wolday D, Gebrecherkos T, Arefaine ZG, Kiros YK, Gebreegzabher A, Tasew G, Abdulkader M, Abraha HE, Desta AA, Hailu A, Tollera G, Abdella S, Tesema M, Abate E, Endarge KL, Hundie TG, Miteku FK, Urban BC, Schallig HHDF, Harris VC, de Wit TFR. Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study. EClinicalMedicine 2021; 39:101054. [PMID: 34368662 DOI: 10.1101/2021.02.02.21250995] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 05/28/2023] Open
Abstract
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., Hymenolepis 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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Affiliation(s)
- Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Saro Abdella
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | - Britta C Urban
- Department of Clinical Sciences, Respiratory Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Henk H D F Schallig
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa C Harris
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Joep Lange Institute, Amsterdam, the Netherlands
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47
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Wolday D, Gebrecherkos T, Arefaine ZG, Kiros YK, Gebreegzabher A, Tasew G, Abdulkader M, Abraha HE, Desta AA, Hailu A, Tollera G, Abdella S, Tesema M, Abate E, Endarge KL, Hundie TG, Miteku FK, Urban BC, Schallig HH, Harris VC, de Wit TFR. Effect of co-infection with intestinal parasites on COVID-19 severity: A prospective observational cohort study. EClinicalMedicine 2021; 39:101054. [PMID: 34368662 PMCID: PMC8324426 DOI: 10.1016/j.eclinm.2021.101054] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/08/2023] Open
Abstract
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., Hymenolepis 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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Affiliation(s)
- Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | | | | | | | - Geremew Tasew
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Saro Abdella
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | - Ebba Abate
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
| | | | | | | | - Britta C. Urban
- Department of Clinical Sciences, Respiratory Clinical Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Henk H.D.F. Schallig
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa C. Harris
- Department of Medical Microbiology and Infection Prevention, Experimental Parasitology Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Tobias F. Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Joep Lange Institute, Amsterdam, the Netherlands
- Corresponding author: at Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University Medical Center, Amsterdam, the Netherlands
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48
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Sah P, Fitzpatrick MC, Zimmer CF, Abdollahi E, Juden-Kelly L, Moghadas SM, Singer BH, Galvani AP. Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis. Proc Natl Acad Sci U S A 2021; 118:e2109229118. [PMID: 34376550 PMCID: PMC8403749 DOI: 10.1073/pnas.2109229118] [Citation(s) in RCA: 304] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Pratha Sah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Meagan C Fitzpatrick
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Charlotte F Zimmer
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
| | - Elaheh Abdollahi
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Lyndon Juden-Kelly
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06520
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Wolday D, Ndungu FM, Gómez-Pérez GP, de Wit TFR. Chronic Immune Activation and CD4 + T Cell Lymphopenia in Healthy African Individuals: Perspectives for SARS-CoV-2 Vaccine Efficacy. Front Immunol 2021; 12:693269. [PMID: 34220854 PMCID: PMC8249933 DOI: 10.3389/fimmu.2021.693269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic immune activation has been considered as the driving force for CD4+ T cell depletion in people infected with HIV-1. Interestingly, the normal immune profile of adult HIV-negative individuals living in Africa also exhibit chronic immune activation, reminiscent of that observed in HIV-1 infected individuals. It is characterized by increased levels of soluble immune activation markers, such as the cytokines interleukin (IL)-4, IL-10, TNF-α, and cellular activation markers including HLA-DR, CD-38, CCR5, coupled with reduced naïve and increased memory cells in CD4+ and CD8+ subsets. In addition, it is accompanied by low CD4+ T cell counts when compared to Europeans. There is also evidence that mononuclear cells from African infants secrete less innate cytokines than South and North Americans and Europeans in vitro. Chronic immune activation in Africans is linked to environmental factors such as parasitic infections and could be responsible for previously observed immune hypo-responsiveness to infections and vaccines. It is unclear whether the immunogenicity and effectiveness of anti-SARS-CoV-2 vaccines will also be reduced by similar mechanisms. A review of studies investigating this phenomenon is urgently required as they should inform the design and delivery for vaccines to be used in African populations.
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Affiliation(s)
- Dawit Wolday
- Department of Medicine, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Francis M. Ndungu
- Department of Global Health, Kenyan Medical Research Institute (KEMRI) – Wellcome Research Programme, Nairobi, Kenya
| | - Gloria P. Gómez-Pérez
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University, Amsterdam, Netherlands
| | - Tobias F. Rinke de Wit
- Amsterdam Institute of Global Health and Development, Department of Global Health, Amsterdam University, Amsterdam, Netherlands
- Joep-Lange Institute, Amsterdam, Netherlands
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50
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Leulseged TW, Hassen IS, Maru EH, Zewsde WC, Chamiso NW, Bayisa AB, Abebe DS, Ayele BT, Yegle KT, Edo MG, Gurara EK, Damete DD, Tolera YA. Characteristics and outcome profile of hospitalized African patients with COVID-19: The Ethiopian context. PLoS One 2021; 16:e0259454. [PMID: 34752481 PMCID: PMC8577729 DOI: 10.1371/journal.pone.0259454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Tigist W. Leulseged
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Ishmael S. Hassen
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Endalkachew H. Maru
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wuletaw C. Zewsde
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Negat W. Chamiso
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abdi B. Bayisa
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Daniel S. Abebe
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Birhanu T. Ayele
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kalkidan T. Yegle
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mesay G. Edo
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eyosyas K. Gurara
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dereje D. Damete
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yared A. Tolera
- Millennium COVID-19 Care Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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