Cardiovascular risk factors and clinical outcomes of patients hospitalized with COVID-19 pneumonia in Somalia

Abstract

Background: Coronavirus disease-2019 (COVID-19) is a potentially life-threatening illness with no established treatment. Cardiovascular risk factors (CRFs) exacerbate COVID-19 morbidity and mortality. Objective: To determine the prevalence of CRF and clinical outcomes of patients hospitalized with COVID-19 in a tertiary hospital in Somalia. Methods: We reviewed the medical records of patients aged 18 years or older with a real-time polymerase chain reaction (RT-PCR)–confirmed COVID-19 hospitalized at the De Martino Hospital in Mogadishu, Somalia, between March and July 2020. Results: We enrolled 230 participants; 159 (69.1%) males, median age was 56 (41–66) years. In-hospital mortality was 19.6% ( n = 45); 77.8% in the intensive care unit (ICU) compared with 22.2%, in the general wards ( p < 0.001). Age ⩾ 40 years [odds ratio (OR): 3.6, 95% confidence interval (CI): 1.2–10.6, p = 0.020], chronic heart disease (OR: 9.3, 95% CI: 2.2–38.9, p = 0.002), and diabetes mellitus (OR: 3.2, 95% CI: 1.6–6.2, p < 0.001) were associated with increased odds of mortality. Forty-three (18.7%) participants required ICU admission. Age ⩾ 40 years (OR: 7.5, 95% CI: 1.7–32.1, p = 0.007), diabetes mellitus (OR: 3.2, 95% CI: 1.6–6.3, p < 0.001), and hypertension (OR: 2.5, 95% CI: 1.2–5.2, p = 0.014) were associated with ICU admission. For every additional CRF, the odds of admission into the ICU increased threefold (OR: 2.7, 95% CI: 1.2–5.2, p < 0.001), while the odds of dying increased twofold (OR: 2.1, 95% CI: 1.3–3.2, p < 0.001). Conclusions: We report a very high prevalence of CRF among patients hospitalized with COVID-19 in Somalia. Mortality rates were unacceptably high, particularly among those with advanced age, underlying chronic heart disease, and diabetes.

Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center in Herat, Afghanistan

“…A total of 165 (14.8%) patients experienced an adverse outcome, which is low compared to similar cohorts. While the Libyan study found a mortality rate of 12.3%, other studies for example in Yemen, Somalia and Sudan described mortality rates of 35, 22 and 21% respectively [ 47 , 52 , 57 , 58 ]. Another survival analysis performed on 131 patients hospitalized in the main hospital in Mogadishu even documented a mortality rate of 40% [ 59 ].…”

“…Of our 1113 included hospitalized patients, a total of 78 (7%) experienced complications, with respiratory complications such as ARDS (3.3%) and respiratory failure (1.8%) being the most common. This number is comparatively low when regarding similar cohorts [ 47 , 57 ]. As an example, one retrospective study including 811 hospitalized patients in Libya reported that respiratory distress syndrome occurred in 14.3% of recorded patients [ 47 ].…”

Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center run by Médecins sans Frontières in Herat, Afghanistan

“…This number is comparatively low when regarding similar cohorts. 43, 53 As an example, one retrospective study including 811 hospitalized patients in Libya reported that respiratory distress syndrome occurred in 14.3% of recorded patients. 43 Such differences in complication rates and adverse outcomes between settings are likely multifactorial, however vaccination status, access to confirmatory testing, oxygen therapy for hypoxaemic patients, prompt administration of steroids for patients requiring oxygen, close nursing monitoring, prone positioning physiotherapy techniques, adequate management of co-morbidities and coexisting pathologies, are all clinical aspects which are likely to vary significantly between settings and health care facilities and will have an impact on patient disease course.…”

“…While the Libyan study found a mortality rate of 12.3%, other studies for example in Yemen, Somalia and Sudan described mortality rates of 35, 22 and 21% respectively. 43,48,53,54 Another survival analysis performed on 131 patients hospitalized in the main hospital in Mogadishu even documented a mortality rate of 40%. 55 The proportion of adverse outcomes in our study population is low even in comparison with studies from high income countries.…”