Clinical manifestations and mortality among hospitalized COVID-19 patients in Tanzania, 2021-2022
Dr Elisha Osati, Grace A Shayo, Tumaini Nagu, Raphael Z Sangeda, Candida Moshiro, Naveeda Adams, Athumani Ramadhani, Bahati Wanja, Albert Muniko, Jeremia Seni, Mary A Nicholaus, Kajiru G Kilonzo, Gervas Nyaisonga, Christian Mbije, John Meda, Denis Rainer, Martha Nkya, Paulo Mhame, Lucy Samwel, Liggyle Vumilia, Seif Shekalaghe, Abel Makubi
doi:10.1101/2023.07.13.23292643
Background There have been differential mortality rates from Corona Virus Disease of 2019 (COVID-19) in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this study in a Sub-Saharan African country. The aim of this study was to describe clinical manifestations and outcome of patients diagnosed with COVID-19 in selected tertiary hospitals in Tanzania.
Methods and Findings A retrospective analysis of archived data from 26 th March, 2021 to 30 th September, 2022 was done for adults aged ≥18 years who were admitted in five tertiary-level hospitals in Tanzania. Information collected included socio-demographic, radiological and clinical characteristics of the patients as well as outcome of the admission (discharge vs death). Categorical variables were presented as frequencies and proportions and compared using Chi square test. Logistic regression was used to assess the relationship between COVID-19 mortality and the collected variables. Out of 1387 COVID-19 patients, approximately 52% were males. The median age was 60 years [ (IQR)= (19-102)). The most common symptoms were dyspnea (943,68%), cough (889, 64%), fever (597,43%) and fatigue (570, 41%). Inhospital mortality was (476, 34%). Mortality significantly increased with increasing age, being the most in age >90 years [aOR (95% CI) =6.72 (1.94-20.81), P<0.001. Other predictors of death were not possessing a health insurance, [aOR (95% CI) = 2.78 (2.09-3.70), P<0. 001], dyspnea [aOR (95% CI) = 1.40(1.02-2.06), P=0.03]; chest pain, [aOR (95% CI) = 1.78 (1.12-3.21), P=0.03]; HIV positivity, [aOR (95% CI) = 4.62 (2.51-8.73), P<0.001]; neutrophilia, [aOR (95% CI) = 1.02 (1.01 -1.03), P=0.02]; none use of ivermectin, [aOR (95% CI) = 1.46 (1.09 -2.22), P=0.02] and non-use of steroid, [aOR (95% CI) = 1.40 (1.2 -2.5), P=0.04]. Retrospective nature of this study which based on documented patients records, with a large number of patients left out of the analysis due to missed data, this might in a way affect the results of the present study.
Conclusions The most common presenting symptoms were dyspnea, cough and fever, just as what was common elsewhere in the world. Mortality increased significantly with age, in HIV-infected patients, in those without a health insurance, those presenting with dyspnea, chest pain, or neutrophilia and those who did not use steroid or ivermectin. Clinicians should actively look for the predictors of mortality and take appropriate management to reduce mortality.
Similar to other studies 7, 24, 25 , the majority of patients in this study were male. One-third of COVID-19 patients died in the hospital. The odds ratio of death increased significantly as patients age increased above 60 years. There were almost 3-folds increased odds of dying in the age group 60-74 years while the odds of dying were almost 7-folds in the age above 90 years. The relationship between age and COVID-19 deaths in this study reflects not only WHO data, 1 but also the findings of other studies of COVID-19 done elsewhere. For example, a study done in Sudan by Hasabo E, et al, 7 Lombardy Region, Italy by Cecconi M, et al 24 and Grasselli G, et al 25 which indicated that majority of confirmed COVID-19 deaths were among patients aged above 60 years. Male sex has been found to be an independent factor associated with severe COVID-19 and mortality. 14, 15, 23 In our study sex was not found to be a risk factor for death. Patients who died were more likely to be unemployed, uninsured and with no formal education. The risk of deaths was almost 3-fold in uninsured group compared to insured one. Being .
Competing Interests Authors declare that they have no conflict of interest.
Author's Contribution Elisha Osati designed the study. Elisha Osati, Naveeda Adams, Dr. Athumani Ramadhani, Mary Nicolaus, Denis Rainer, Christian Mbije, Martha Nkya, did data collection. Elisha Osati, Grace Shayo, Kajiru Kilonzo, John Meda, Gervas Nyaisonga, Bahati Wanja, Albert Muniko..
References
Ahmad, Beg, Majeed, Epidemiological and Clinical Characteristics of COVID-19: A Retrospective Multi-Center Study in Pakistan,
doi:10.3389/fpubh.2021.644199Beckerman, Gori, Jeyakumar, Remdesivir for the treatment of patients hospitalized with COVID-19 receiving supplemental oxygen: a targeted literature review and meta-analysis, Sci Rep,
doi:10.1038/s41598-022-13680-6Cecconi, Piovani, Brunetta, Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy, J Clin Med,
doi:10.3390/jcm9051548Changeux, Amoura, Rey, Miyara, A nicotinic hypothesis for Covid-19 with preventive and therapeutic implications, C R Biol,
doi:10.5802/crbiol.8Charpentrat, Miracle" drug ivermectin unproven against COVID, scientists warn. CTV News
Danwang, Naubiap, Robert, Yombi, Outcomes of patients with HIV and COVID-19 co-infection_ a systematic review and meta-analysis -PubMed,
doi:10.1186/s12981-021-00427-yEsr, None
Fernández-De-Las-Peñas, Navarro-Santana, Gómez-Mayordomo, Headache as an acute and post-COVID-19 symptom in COVID-19 survivors: A meta-analysis of the current literature, Eur J Neurol,
doi:10.1111/ene.15040Fukumoto, Leung, Jr, Oxidative stress induces club cell proliferation and pulmonary fibrosis in Atp8b1 mutant mice, Aging (Albany NY)
Gallo Marin, Aghagoli, Lavine, Predictors of COVID-19 severity: A literature review, Rev Med Virol,
doi:10.1002/rmv.2146Gallo Marin, Aghagoli, Lavine, Predictors of COVID-19 severity: A literature review, Rev Med Virol,
doi:10.1002/rmv.2146Grasselli, Zangrillo, Zanella, Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy, JAMA,
doi:10.1001/jama.2020.5394Harris, Taylor, Thielke, Payne, Gonzalez et al., Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform,
doi:10.1016/j.jbi.2008.08.010Hasabo, Ayyad, Eldeen, Clinical manifestations, complications, and outcomes of patients with COVID-19 in Sudan: a multicenter observational study, Trop Med Health,
doi:10.1186/s41182-021-00382-4Hawkins, Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study, J Prev Med Public Health,
doi:10.3961/jpmph.20.256Hernández-Garduño, Obesity is the comorbidity more strongly associated for Covid-19 in Mexico. A case-control study, Obes Res Clin Pract,
doi:10.1016/j.orcp.2020.06.001Mutair, Alhumaid, Alhuqbani, Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: an observational cohort study, Eur J Med Res,
doi:10.1186/s40001-020-00462-xRodríguez-Molinero, Gálvez-Barrón, Miñarro, Association between COVID-19 prognosis and disease presentation, comorbidities and chronic treatment of hospitalized patients, PLoS One,
doi:10.1371/journal.pone.0239571Rubin, Ryerson, Haramati, The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society, Radiology,
doi:10.1148/radiol.2020201365Shi, Han, Jiang, Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study, Lancet Infect Dis,
doi:10.1016/S1473-3099Sohrabi, Amin, Maher, Sociodemographic determinants and clinical risk factors associated with COVID-19 severity: a cross-sectional analysis of over 200,000 patients in Tehran, Iran, BMC Infect Dis,
doi:10.1186/s12879-021-06179-4Soni, Gopalakrishnan, Vaishya, Prabu, D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases, Diabetes & Metabolic Syndrome: Clinical Research & Reviews,
doi:10.1016/j.dsx.2020.11.007Stefano, Kream, Stefano, A Novel Vaccine Employing Non-Replicating Rabies Virus Expressing Chimeric SARS-CoV-2 Spike Protein Domains: Functional Inhibition of Viral/Nicotinic Acetylcholine Receptor Complexes, Med Sci Monit,
doi:10.12659/MSM.926016Stewart, Hartley, Johnson, Marks, Du Pré et al., Renal dysfunction in hospitalised children with COVID-19, Lancet Child Adolesc Health,
doi:10.1016/S2352-4642Stokes, Zambrano, Anderson, MMWR -Coronavirus Disease 2019 Case Surveillance -United States
Tang, Li, Wang, Sun, Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia, J Thromb Haemost,
doi:10.1111/jth.14768Who, Tuberculosis deaths and disease increase during the COVID-19 pandemic. WHO Newsletters News release 27th October
Who, WHO Coronavirus (COVID-19) Dashboard _ WHO Coronavirus (COVID-19) Dashboard With Vaccination Data
Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Lancet Respir Med,
doi:10.1016/S2213-2600(20)30079-5Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3
