International Journal of Infectious Diseases (original) (raw)
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International Journal of Infectious Diseases
Background: : Identifying preventable causes of COVID-19 deaths is key to reducing mortality. We investigated possible preventable causes of COVID-19 deaths over a six-month period in Uganda. Methods: A case-patient was a person testing reverse transcription polymerase chain reaction-positive for SARS-CoV-2 who died in Kampala Metropolitan Area hospitals from August 2020 to February 2021. We reviewed records and interviewed health workers and case-patient caretakers. Results: We investigated 126 (65%) of 195 reported COVID-19 deaths during the investigation period; 89 (71%) were male, and the median age was 61 years. A total of 98 (78%) had underlying medical conditions. Most (118, 94%) had advanced disease at admission to the hospital where they died. A total of 44 (35%) did not receive a COVID-19 test at their first presentation to a health facility despite having consistent symptoms. A total of 95 (75%) needed intensive care unit admission, of whom 45 (47%) received it; 74 (59%) needed mechanical ventilation, of whom 47 (64%) received it. Conclusion: Among hospitalized patients with COVID-19 who died in this investigation, early opportunities for diagnosis were frequently missed, and there was inadequate intensive care unit capacity. Emphasis is needed on COVID-19 as a differential diagnosis, early testing, and care-seeking at specialized facilities before the illness reaches a critical stage. Increased capacity for intensive care is needed.
Interdisciplinary Perspectives on Infectious Diseases, 2022
Data on clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in private health facilities in Uganda is scarce. We conducted a retrospective cohort study of patients hospitalized with COVID-19 at Case Hospital, Kampala, Uganda, between June 2020 and September 2021. Data of 160 participants (median age 45 years (interquartile range [IQR]: 37-57) and 63.5% male) was analyzed. Seventy-seven (48.1%) participants had non-severe, 18 (11.3%) severe, and 83 (51.9%) critical COVID-19 illness. In 62 participants with chest computed tomography ndings, 54 (87%) had bilateral disease, with 22 (35%) having ground-glass opacities. e median duration of hospitalization was 5 days (IQR: 3-9 days). Overall, 18 (11.3%) participants died. Survival at 14 and 28 days was 89% and 72%, respectively. Factors strongly associated with all-cause mortality were as follows: age >50 years (odds ratio [OR]: 8.
Open Forum Infectious Diseases, 2021
Background We evaluated clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in the second wave of the pandemic in a national COVID-19 treatment unit (CTU) in Uganda. Methods We conducted a retrospective cohort study of COVID-19 patients hospitalized at the Mulago National Referral Hospital CTU between May 1 and July 11, 2021. We performed Kaplan-Meier analysis to evaluate all-cause in-hospital mortality. Results Of the 477 participants, 247 (52%) were female, 15 (3%) had received at least 1 dose of the COVID-19 vaccine, and 223 (46%) had at least 1 comorbidity. The median age was 52 (interquartile range, 41–65) years. More than 80% of the patients presented with severe (19%, n=91) or critical (66%, n=315) COVID-19 illness. Overall, 174 (37%) patients died. Predictors of all-cause in-hospital mortality were as follows; age ≥50 years (adjusted odds ratio [aOR], 1.9; 95% confidence interval [CI], 1.2–3.2; P=.011), oxygen saturation at admission of ≥92% (...
Epidemiology and Infection
We conducted a retrospective cross-sectional population-based survey among recovered COVID-19 cases to establish the case presentations of the 2 nd wave SARS-CoV-2 infections. We retrospectively interviewed 1120 recovered COVID-19 cases from 10 selected districts in Uganda. We further conducted 38 Key Informant Interviews of members of the COVID-19 District Taskforce and 19 indepth interviews among COVID-19 survivors from March to June 2021. Out of the 1,120 recovered COVID-19 cases interviewed, 62% were aged 39 years and below and 51.5% female with 90.9% under home based care management. Cases were more prevalent in business (25.9%), students (16.2%), farmers (16.1%) and health workers (12.4%) and 69.9% developed COVID-19 symptoms mainly cough, flu, and fever. Being asymptomatic was found to be associated with not seeking healthcare (APR 2, P <0.001). The mortality rate was 3.6% mostly among the elderly (6.3%) and 31.3% aged 40 years and above had comorbidities of high blood pressure, diabetes, and asthma. Being young, asymptomatic, under Home-Based Care Management (HBCM), working/operating/studying at schools, not being vaccinated were among the major drivers of the second wave of the resurgence of COVID-19 in Uganda. Managing future COVID-19 waves calls for proactive efforts for improving homebased care services, ensuring strict observation of SOPs in schools but increasing the uptake of COVID-19 vaccination. To continue protecting populations from emerging variants/strains of SARS-COV2, all stakeholders (Policy makers, health workers, non-government organizations, public and researchers) need to work together in ensuring vigilant surveillance services at community/home level and uptake of COVID-19 vaccinations.
2022
BackgroundThe COVID-19 continued to pose several public health, social, economic challenges and the drivers for the occurrence of different COVID-19 waves remains undocumented in Uganda. We conducted a cross-sectional population-based survey among recovered COVID-19 cases to establish the drivers of SAR-CoV-2 infections. We performed a retrospective study and interviewed 1120 recovered COVID-19 cases from 10 selected districts in Uganda. We further conducted 38 Key Informant Interviews of members of the COVID-19 District Taskforce and 19 in-depth interviews among COVID-19 survivors from March to June, 2021. Results Out of the 1120 recovered COVID-19 cases interviewed, 62% were aged 39 years and below and 51.5% females with 90.9% under home based care management. Cases were more prevalent in business (25.9%), students (17.2%), farmers (17.1%) and health workers (12.4%) and 79.9% developed COVID-19 symptoms mainly cough, flu, and fever. Being asymptomatic was found to be associated wi...
2021
Background Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease that results from infection with a new coronavirus (SARS-CoV-2). One of the most critical issues related to the COVID-19 is the high rate of spread, millions of people have been infected around the world, and hundreds of thousands of people have died till now. However, reports from Africa paint a different picture of the SARS-CoV-2 and its effects on the population. Objectives The objective of this study was to describe the characteristics of the COVID-19 patients treated at the Gulu Regional Referral Hospital and determine factors associated with COVID-19 manifestations, socio-demographic characteristics, and treatment outcomes from March 2020 to October 2021. Methods A retrospective data abstraction of all COVID-19 hospital admissions registered in the Gulu Health Management Information System (HMIS) database and other tools were conducted. The period of study was March 2020 to October 2021. Data that m...
Academia Letters, 2021
Since the first report of a novel virus in Wahun, China in late December, 2019 which came to be known as Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2)(Kupferschmidt & Cohen, 2020) was later declared a pandemic in early March 2020 (Cucinotta & Vanelli, 2020). To date, the virus has spread globally to 192 countries/regions of the world and has far affected over 99 million people and caused over 2 million deaths (Dong et al., 2020). Further, the pandemic has posed the greatest challenge ever and even overwhelmed most of the well-established health systems, disrupted the social and economic set up of all nations, affected millions of lives leading to loss of many lives. Uganda registered its first confirmed case of COVID19 on 21st March 2020, a few weeks following institution of the first preventive measures by closing schools and halting public transport. Further measures were instituted after confirmation of the first COVID 19 case, declaring a total lockdown on 30th March, 2020. The instituted lockdown measures together with prohibition of social gathering, keeping social distance, wearing of face masks and surveillance and case management helped to keep the number of COVID19 cases very low for months compared to other countries. However, by october 2020, the virus surged with cumulative confirmed cases of about 15,000 and over 100 death following ease of lockdown measures(MOH, n.d.). Given the prevailing COVID19 situation in the country with several community transmissions, I befell COVID19 victim and was confirmed positive with my elderly mother of 75 years old on 28th October, 2020.
Comparative epidemiologic analysis of COVID-19 patients during the first and second waves of COVID-19 in Uganda, 2022
Introduction: Uganda was affected by two major waves of coronavirus disease 2019 (COVID-19). The first wave during late 2020 and the second wave in late April 2021. This study compared epidemiologic characteristics of hospitalized (HP) and non-hospitalized patients (NHP) with COVID-19 during the two waves of COVID-19 in Uganda. Methods: Wave 1 was defined as November-December 2020, and Wave 2 was defined as April-June 2021. In total, 800 patients were included in this study. Medical record data were collected for HP (200 for each wave). Contact information was retrieved for NHP who had polymerase-chain-reaction-confirmed COVID-19 (200 for each wave) from laboratory records; these patients were interviewed by telephone. Findings: A higher proportion of HP were male in Wave 1 compared with Wave 2 (73% vs 54%; P = 0.0001). More HP had severe disease or died in Wave 2 compared with Wave 1 (65% vs 31%; P < 0.0001). NHP in Wave 2 were younger than those in Wave 1, but this difference was not significant (mean age 29 vs 36 years; P = 0.13). HP were significantly older than NHP in Wave 2 (mean age 48 vs 29 years; P < 0.0001), but not Wave 1 (mean age 48 vs 43 years; P = 0.31). Interpretation: Demographic and epidemiologic characteristics of HP and NHP differed between and within Waves 1 and 2 of COVID-19 in Uganda. Research in context Evidence before this study PubMed was searched for research articles published in English from 21 March 2020 to 28 April 2021 using the terms 'SARS-CoV-2' [severe acute respiratory syndrome coronavirus-2], 'COVID-19' [coronavirus disease 2019], 'wave', 'hospitalization', 'mortality' and/or 'variants'. In total, 45 articles were found on these topics. The SARS-CoV-2 Delta variant has been shown to be more transmissible and associated with more severe disease than earlier SARS-CoV-2 variants (Fisman and Tuite, 2021; Sheikh et al., 2021). At the time this study was conducted, little
Infection and Drug Resistance, 2022
Background: COVID-19 has created a burden on the healthcare system globally. Severe COVID-19 is linked with high hospital mortality. Data regarding 30-day in-hospital mortality and its factors has not been explored in southwestern Uganda. Methods: We carried out a retrospective, single-center cohort study, and included all in-patients with laboratory-confirmed, radiological, or clinical severe COVID-19 admitted between April 2020 and September 2021 at Mbarara Regional Referral Hospital (MRRH). Demographic, laboratory, treatment, and clinical outcome data were extracted from patients' files. These data were described comparing survivors and non-survivors. We used logistic regression to explore the factors associated with 30-day inhospital mortality. Results: Of the 283 patients with severe COVID-19 admitted at MRRH COVID-19 unit, 58.1% were male. The mean age ± standard deviation (SD) was 61±17.4 years; there were no differences in mean age between survivors and non-survivors (59 ± 17.2 versus 64.4 ±17.3, respectively, p=0.24) The median length of hospital stay was 7 (IQR 3-10) days (non-survivors had a shorter median length of stay 5 (IQR 2-9) days compared to the survivors; 8 (IQR 5-11) days, p<0.001. The most frequent comorbidities were hypertension (30.5%) and diabetes mellitus (30%). The overall 30-day in-hospital mortality was 134 of 279 (48%) mortality rate of 47,350×10 5 with a standard error of 2.99%. The factors associated with 30-day in-hospital mortality were age: 65 years and above (aOR, 3.88; 95% CI, 1.24-11.70; P =0.020) a neutrophil to lymphocyte ratio above 5 (aOR, 4.83; 95% CI, 1.53-15.28; P =0.007) and oxygen requirement ≥15L/min (aOR, 15.80; 95% CI, 5.17-48.25; P <0.001). Conclusion: We found a high 30-day in-hospital mortality among patients with severe forms of COVID-19. The identified factors could help clinicians to identify patients with poor prognosis at an early stage of admission.