Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study

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.

Circulation of SARS-CoV-2 and co-infection withPlasmodium falciparumin Equatorial Guinea

“…Apart from this study, SARS-CoV-2 and malaria co-infection population studies have been conducted on nine malaria-endemic countries with heterogeneous results depending on the study design and the population or subpopulation studied ( S1 Table in S1 Text ). Most studies have evaluated malaria co-infection prevalence among COVID-19 confirmed patients reporting a wide range of prevalence from 0.63% to 100% (17–21,23,26). Among the few studies that have analysed a random population sample, the low co-infection prevalence that we found in Equatorial Guinea (0.4%) is in the range with what has been reported from Nigeria (0.32%) (16), India (0.73%) (27), Burkina Faso (1.9%) (15), Angola (1.9%) (25) and Gabon (2.2%) (24).…”

“…Some other studies have addressed the clinical consequences of malaria and COVID-19 co-infection but with contradictory results. Recent retrospective studies of COVID-19 patients have found that malaria co-infection is associated with prolonged hospitalisation (26) and had greater mortality risk compared with just SARS-CoV-2 infection (23). However, other studies report that patients with SARS-CoV-2 and malaria did not seem to have a worst disease outcome, but previous malaria exposure seems to be related to less frequency of severe COVID-19 (20).…”

“…Most studies have evaluated malaria co-infection prevalence among COVID-19 confirmed patients reporting a wide range of prevalence from 0.63% to 100% (17)(18)(19)(20)(21)23,26). Among the few studies that have analysed a random population sample, the low co-infection prevalence that we found in Equatorial Guinea (0.4%) is in the range with what has been reported from Nigeria (0.32%) (16), India (0.73%) (27), Burkina Faso (1.9%) (15), Angola (1.9%) (25) and Gabon (2.2%) (24).…”

“…Some other studies have addressed the clinical consequences of malaria and COVID-19 co-infection but with contradictory results. Recent retrospective studies of COVID-19 patients have found that malaria co-infection is associated with prolonged hospitalisation (26) and had greater is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint…”

“…Besides these collateral effects, the circulation of COVID-19 in malaria-endemic countries raises the possibility of co-infection. The frequency and consequences of coinfection at the population level have been assessed in eight African (15,16,25,26,(17)(18)(19)(20)(21)(22)(23)(24) and one Indian (27) malaria-endemic countries. However, these studies have shown very heterogeneous results depending on the study design and the population or subpopulation sampled (S1 Equatorial Guinea is among the moderate to high malaria transmission countries in the African Region, which accounts for 95% of cases and 96% of malaria deaths globally.…”