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Ingabire PM, Nantale R, Sserwanja Q, Nakireka S, Musaba MW, Muyinda A, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Ainembabazi R, Olum R, Munabi I, Kiguli S, Mukunya D. Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study. Trop Med Health 2022; 50:100. [PMID: 36578071 PMCID: PMC9795158 DOI: 10.1186/s41182-022-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Identification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda. METHODS We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration. RESULTS Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1-89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9-16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65-3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01-10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55-0.83) were associated with prolonged hospitalization. CONCLUSION One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19.
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Affiliation(s)
- Prossie M. Ingabire
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ritah Nantale
- grid.448602.c0000 0004 0367 1045Department of Nursing, Busitema University, Tororo, Uganda
| | - Quraish Sserwanja
- Department of Programmes, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan
| | - Susan Nakireka
- grid.461227.40000 0004 0512 5435Department of Medicine, Mengo Hospital, Kampala, Uganda ,grid.442658.90000 0004 4687 3018Department of Medicine and Dentistry, Uganda Christian University, Kampala, Uganda
| | - Milton W. Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda ,grid.448602.c0000 0004 0367 1045Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
| | - Asad Muyinda
- grid.461350.50000 0004 0504 1186Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Criscent Tumuhaise
- grid.461252.60000 0004 0514 4556Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Nkozi, Uganda
| | - Edith Namulema
- grid.461227.40000 0004 0512 5435Covid Task Force Institution, Mengo Hospital, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology, Gulu University, Gulu, Uganda
| | - Agnes Napyo
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
| | | | - Ronald Olum
- grid.461255.10000 0004 1780 2544Department of Medicine, Nsambya Hospital, Kampala, Uganda
| | - Ian Munabi
- grid.11194.3c0000 0004 0620 0548Department of Anatomy, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda
| | - David Mukunya
- grid.448602.c0000 0004 0367 1045Department of Community and Public Health, Busitema Universiy, Tororo, Uganda
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Muyinda A, Ingabire PM, Nakireka S, Tumuhaise C, Namulema E, Bongomin F, Napyo A, Sserwanja Q, Ainembabazi R, Olum R, Nantale R, Akunguru P, Nomujuni D, Olwit W, Musaba MW, Namubiru B, Aol P, Babigumira PA, Munabi I, Kiguli S, Mukunya D. Survival analysis of patients with COVID-19 admitted at six hospitals in Uganda in 2021: a cohort study. Arch Public Health 2022; 80:233. [PMID: 36380388 PMCID: PMC9666944 DOI: 10.1186/s13690-022-00991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Assessing factors associated with mortality among COVID-19 patients could guide in developing context relevant interventions to mitigate the risk. The study aimed to describe mortality and associated factors among COVID-19 patients admitted at six health facilities in Uganda.
Methods
We reviewed medical records of patients admitted with COVID-19 between January 1st 2021 and December 31st 2021 in six hospitals in Uganda. Using Stata version 17.0, Kaplan Meier and Cox regression analyses were performed to describe the time to death and estimate associations between various exposures and time to death. Finally, accelerated failure time (AFT) models with a lognormal distribution were used to estimate corresponding survival time ratios.
Results
Out of the 1040 study participants, 234 (22.5%: 95%CI 12.9 to 36.2%) died. The mortality rate was 30.7 deaths per 1000 person days, 95% CI (26.9 to 35.0). The median survival time was 33 days, IQR (9–82). Factors associated with time to COVID-19 death included; age ≥ 60 years [adjusted hazard ratio (aHR) = 2.4, 95% CI: [1.7, 3.4]], having malaria test at admission [aHR = 2.0, 95% CI:[1.0, 3.9]], a COVID-19 severity score of severe/critical [aHR = 6.7, 95% CI:[1.5, 29.1]] and admission to a public hospital [aHR = 0.4, 95% CI:[0.3, 0.6]]. The survival time of patients aged 60 years or more is estimated to be 63% shorter than that of patients aged less than 60 years [adjusted time ratio (aTR) 0.37, 95% CI 0.24, 0.56]. The survival time of patients admitted in public hospitals was 2.5 times that of patients admitted in private hospitals [aTR 2.5 to 95%CI 1.6, 3.9]. Finally, patients with a severe or critical COVID-19 severity score had 87% shorter survival time than those with a mild score [aTR 0.13, 95% CI 0.03, 0.56].
Conclusion
In-hospital mortality among COVID-19 patients was high. Factors associated with shorter survival; age ≥ 60 years, a COVID-19 severity score of severe or critical, and having malaria at admission. We therefore recommend close monitoring of COVID-19 patients that are elderly and also screening for malaria in COVID-19 admitted patients.
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Ojji DB, Shedul GL, Sani M, Ogah OS, Dzudie A, Barasa F, Mondo C, Ingabire PM, Jones ESW, Rayner B, Albertino D, Ogola E, Smythe W, Hickman N, Francis V, Shahiemah P, Shedul G, Aje A, Sliwa K, Stewart S. A Differential Response to Antihypertensive Therapy in African Men and Women: Insights From the CREOLE Trial. Am J Hypertens 2022; 35:551-560. [PMID: 35134817 DOI: 10.1093/ajh/hpac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We sought to address the paucity of data to support the evidence-based management of hypertension to achieve optimal blood pressure (BP) control on a sex-specific basis in Africa. METHODS We undertook a post hoc analysis of the multicenter, randomized CREOLE (Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans) Trial to test the hypothesis that there would be clinically important differences in office BP control between African men and women. We compared the BP levels of 397 and 238 hypertensive women (63%, 50.9 ± 10.5 years) and men (51.2 ± 11.3 years) from 10 sites across sub-Saharan Africa who completed baseline and 6-month profiling according to their randomly allocated antihypertensive treatment. RESULTS Overall, 442/635 (69.6%) participants achieved an office BP target of <140/90 mm Hg at 6 months; comprising more women (286/72.0%) than men (156/65.5%) (adjusted odds ratio [OR] 1.59, 95% confidence interval [CI] 1.07-2.39; P = 0.023). Women randomized to amlodipine-hydrochlorothiazide (HCTZ) (adjusted OR 3.03, 95% CI 1.71-5.35; P < 0.001) or amlodipine-perindopril (adjusted OR 2.62, 95% CI 1.49-4.58; P = 0.01) were more likely to achieve this target compared with perindopril-HCTZ. Among men, there were no equivalent treatment differences-amlodipine-HCTZ (OR 1.54, 95% CI 0.76-3.12; P = 0.23) or amlodipine-perindopril (OR 1.32, 95% CI 0.65-2.67; P = 0.44) vs. perindopril-HCTZ. Among the 613 participants (97%) with 24-hour ambulatory BP monitoring, women had significantly lower systolic (124.1 ± 18.1 vs. 127.3 ± 16.9; P = 0.028) and diastolic (72.7 ± 10.4 vs. 75.1 ± 10.5; P = 0.007) BP levels at 6 months compared with men. CONCLUSIONS These data suggest clinically important differences in the therapeutic response to antihypertensive combination therapy among African women compared with African men.
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Affiliation(s)
- Dike B Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja & University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.,Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria
| | - Gabriel L Shedul
- Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria.,Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mahmoud Sani
- Department of Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Okechukwu S Ogah
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Anastase Dzudie
- Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Felix Barasa
- Department of Medicine, MOI University Hospital, Eldoret, Kenya
| | - Charles Mondo
- Department of Medicine, St Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Brian Rayner
- Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Damasceno Albertino
- Department of Medicine, Eduardo Mondlane University Hospital, Maputo, Mozambique
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Wynand Smythe
- Department of Pharmacy, Life St. Vincent Pallotti Hospital in Cape Town, Cape Town, South Africa
| | - Nicky Hickman
- Clinical Research Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Veronica Francis
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Pandie Shahiemah
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, Department of Internal Medicine, University of Abuja, Abuja, Nigeria.,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Akinyemi Aje
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Institute for Health Research, University of Notre Dame, Australia, Fremantle, Australia
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Ingabire PM, Ojji DB, Rayner B, Ogola E, Damasceno A, Erika J, Dzudie A, Ogah O, Poulter N, Sani MU, Barasa F, Shedul G, Mukisa J, Mukunya D, Mondo CK. High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction.
Objectives
To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients.
Methods
This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures.
Results
The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium >140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40).
Conclusion
There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1
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Affiliation(s)
| | - D B Ojji
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - B Rayner
- University of Cape Town, Division of Nephrology and Hypertension, Department of Medicine, Faculty of Clinical Sciences,, Cape Town, South Africa
| | - E Ogola
- University of Nairobi, Department of Clinical Medicine and Therapeutics, Nairobi, Kenya
| | - A Damasceno
- Eduardo Mondlane University, Maputo, Mozambique
| | - J Erika
- University of Cape Town, Division of Nephrology and Hypertension, Department of Medicine, Faculty of Clinical Sciences,, Cape Town, South Africa
| | - A Dzudie
- University Hospital of Douala, Douala, Cameroon
| | - O Ogah
- Ibadan University College Hospital, Cardiology Unit, Department of Medicine, Ibadan, Nigeria
| | - N Poulter
- Imperial College London, Imperial Clinical Trials Unit, School of Public Health, London, United Kingdom
| | - M U Sani
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - F Barasa
- Moi Teaching and referral Hospital, Eldoret, Kenya
| | - G Shedul
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - J Mukisa
- Makerere University College of Health Sciences, Department of Medicine, MakNCD D43 project, Kampala, Uganda
| | - D Mukunya
- Makerere University College of Health Sciences, Department of Medicine, MakNCD D43 project, Kampala, Uganda
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