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OBJECTIVES To determine risk factors for death in patients with COVID-19 admitted to the main public sector hospital in Somalia and identify interventions contributing to improved clinical outcome in a low resource and fragile setting. SETTING Main public sector tertiary hospital in Mogadishu, Somalia. PARTICIPANTS All 131 laboratory confirmed COVID19 patients admitted to the main public tertiary hospital in Somalia between 30 March and 12 June 2020. MAIN OUTCOME MEASURES We extracted demographic and clinical data from hospital records of all 131 COVID19 patients admitted to hospital until their death or recovery. We used Kaplan Meier statistics to estimate survival probabilities and the logrank test to assess significant differences in survival between groups. We used the Cox proportional hazard model to estimate likelihood of death and assess the effect of risk factors on survival. RESULTS Of the 131 patients, 52 (40%) died in the hospital and 79 (60%) survived to discharge. The factors independently associated with increased risk of in-hospital death were: age ≥ 60 years survival probability on day 21 in patients < 60 years was 0.789 (95% confidence interval (CI): 0.658,0.874) compared with 0.339 (95% CI: 0.205,0.478) in patients ≥ 60 years; cardiovascular disease (survival probability 0.478 (95% CI: 0.332,0.610) in patients with cardiovascular disease compared with 0.719 (95% CI: 0.601, 0.807) in patients without cardiovascular disease); and non-invasive ventilation on admission patients who were not ventilated were significantly more likely to survive than those who were (P < 0.001). CONCLUSION Our study, which includes the largest cohort of COVID19 patients admitted to a single hospital in a sub-Saharan African country, confirms that underlying conditions and age are associated with increased risk of in hospital death in patients with COVID-19. Our results show the advantage of medical oxygen over non-invasive ventilation in the treatment of patients with severe COVID-19 symptoms.

BACKGROUND The establishment of empirical evidence in the Eastern Mediterranean Region (EMR) necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile ofCOVID-19 patients. OBJECTIVE Hence, this study aimed to to assess the patterns of COVID-19 severity and mortality in seven countries and to determine the risk factors of COVID-19 severity and mortality. METHODS This multi-country study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study included data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. RESULTS A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (HT)(24.7%)and diabetes (22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. CONCLUSIONS The study confirmed the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognosis in early stages of