ABSTRACT
BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in Wuhan, China in 2019 and since then has engulfed the entire globe at an unprecedented pace. The virus has infected all age groups, both males and females with or without symptoms and with significant variations. In this study, we wanted to analyse the data related to demographic features of COVID-19-infected patients mainly focusing on their age, gender and symptoms. METHODS: This was a hospital-based retrospective study that included all laboratory-confirmed COVID-19 cases which were declared SARS-COV-2 real-time RT-PCR positive by VRDL, SMCH, Silchar from March 2020 to August 2021. Data related to the demographic characteristics of patients with COVID-19 infection was retrieved from the ICMR-COVID-19 portal of the laboratory and analysed. RESULTS: The study included 8065 laboratory-confirmed COVID-19 cases which involved 5605 cases during the first wave and 2460 cases during the second wave of COVID-19, diagnosed from different districts of South Assam. The majority of infected patients were of the younger age group of 20-30 years. The mean age of the patients was almost similar in both waves i.e. 35.9 and 38.4 years. Of the total enrolled patients, 91.7% were reported asymptomatic while 8.3% were symptomatic with fever and cough being the commonest ones. CONCLUSIONS: The COVID-19 pandemic is a huge burden on healthcare facilities. The majority of the infected patients presenting to our hospital were young and asymptomatic, thus posing risk to the community. Hence, it is crucial to practice proper hygiene, wearing of masks and complete the vaccination schedule to achieve better vigilance to combat the COVID-19 pandemic more efficiently and effectively.
ABSTRACT
Background: Following acute COVID-19, some (~10-20%) individuals continue to experience a persistent variety of symptoms often referred to as long COVID- 19. However, evidence on long COVID-19 is limited from countries in Africa. We sought to describe the clinical presentation and factors associated with long COVID-19 in Zambia. Method(s): We conducted a cross-sectional analysis of routinely collected clinical information from patients receiving care in Zambia following SARS-CoV- 2 infection. Data were collected from 13 'post-acute COVID-19' (PAC-19) clinics established across Zambia to care for people following their acute infection. Long COVID-19 was defined as experiencing persistent symptoms >=4 weeks after initial diagnosis. Comorbidities detected at the time of SARS-CoV-2 infection were considered newly diagnosed. Severe illness was defined as acute COVID-19 that required supplemental oxygen therapy. We analyzed data from the first visit to the PAC-19 clinics and developed logistic regression models to assess factors associated with long COVID-19 at first visit to a PAC-19 clinic. Result(s): In total, 1,238 persons (< 1%) had >=1 visit to a PAC-19 clinic from August 2020 to April 2022 (out of ~319,500 confirmed cases in Zambia). Eight hundred twenty-three (66%) persons had been hospitalized for acute COVID-19 and the median length of stay was 8 days (interquartile range [IQR]: 4-16 days). Of these 1,238 persons, 641 (52%) were female while 403 (33%) had long COVID-19. The median age in persons with long COVID-19 was 54 years (IQR: 44-63) compared to 50 years (IQR: 37-61) in those without (p< 0.001). Cough (22%), fatigue (21%), and shortness of breath (15%) were frequently reported symptoms among persons with long COVID-19, while 4% had forgetfulness. Having severe illness (adjusted odds ratio [aOR] 2.8) and hospitalization for acute COVID-19 with length of stay >=15 days (aOR 13) were associated with having long COVID-19 (Table 1). Conclusion(s): Long COVID-19 was common among people attending PAC-19 clinics in Zambia, yet few persons with COVID-19 had attended a PAC-19 clinic. Those with severe illness were more likely to experience long COVID-19, which is consistent with other studies of long COVID-19. Given the burden of COVID-19 in Zambia, systems to care for patients with long COVID-19 might be needed in the future. Scaling up PAC-19 services and integrating into routine clinical care could improve access and further aid in understanding long COVID-19 in Zambia. (Table Presented).
ABSTRACT
The evolution of online food delivery system started in India in the late 2000’s and since then many Food Aggregators have come up with a variety of prospects for the customers. This process of Business to Customer services had found itself to be very popular especially in the last few years and after the COVID 19 attack the business had flourished to a large extent. People do not prefer to come out of their abodes and try to procure the eatables by maintaining proper social distancing. There have been a number of local Food Aggregators that have emerged in the Cachar District only recently and post 2020 especially in the lockdown phase they have accelerated their operations in the Valley by joining hands with a number of food outlets. These local entrepreneurial efforts are still in the growth phase and are trying to meet the customer demands to enhance their satisfaction level. Speaking of enhancing the satisfaction of the customers, there are many factors that work before meeting their overall satisfaction and these factors if are considered carefully would not only increase the customer loyalty towards the respective. Purposive Sampling was used in this study to get the responses from the online food buyers. It used Artificial Neural Networks to understand the pattern of the buying behavior of customers in this area and tried to create a model that would enhance the understanding of the Food Aggregators in regards to the buying frequency of the customers and take steps accordingly. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Background: Corticosteroids are recommended for management of patients with severe COVID-19 who require supplemental oxygen. Despite limited evidence on their benefits in sub-Saharan Africa, corticosteroids were adopted as part of COVID-19 management guidelines by many African countries, including Zambia. We report on the use of corticosteroids and related clinical outcomes among hospitalized patients in Zambia. Methods: Patients with SARS-CoV-2 infection who were admitted in one of nine COVID-19 treatment centers across Zambia between March 2020 and September 2021 were included. Patient demographic and clinical information were collected, including corticosteroid use and in-patient disposition (discharged or died). Severe COVID-19 at admission was defined as having an oxygen saturation <90%, respiratory rate >30 breaths/minute, or a need for oxygen therapy. Primary outcomes for the study were prolonged hospitalization (i.e., ≥5 days in the treatment center among patients who were discharged) and in-hospital mortality. We used mixed-effects logistic regression to assess associations between corticosteroid use and primary outcomes among patients with severe COVID-19 at admission. Models were adjusted for age, sex, number of comorbid conditions, and COVID-19 treatment center. Results: The study included 2,630 patients, 1,751 (67%) of whom had severe COVID-19 at admission. Of those, 1,587 (91%) received corticosteroids with 1,470 (93%) initiating at or before treatment center admission. The median duration of treatment with corticosteroids was 3 days (interquartile range: 1-6) and 95% of patients received dexamethasone. Regression analyses indicated that receiving corticosteroids was associated with prolonged hospitalization for discharged patients (adjusted odds ratio (aOR): 2.98;95% confidence interval (CI): 1.78-5.22), but not with in-hospital mortality (aOR: 1.14;95% CI: 0.76-1.75)). Conclusion: Use of corticosteroids was common among admitted patients with severe COVID-19, but not associated with improved COVID-19 outcomes. While our study was not designed to assess the effectiveness of corticosteroids, these results suggest a need to both comprehensively assess their use relative to national guidelines and investigate their benefits in the African context. Important differences in epidemiology and healthcare system capacity could modify the effect of corticosteroids in Zambia relative to countries where the evidence for their use was generated.
ABSTRACT
Background: Multiple vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have demonstrated high effectiveness for reducing severe COVID-19 and mortality. However, vaccine effectiveness data from the African region, where COVID-19 epidemiology and SARS-CoV-2 vaccine coverage differs from other regions, are limited. This study aimed to assess vaccine effectiveness in preventing in-hospital COVID-19 mortality in Zambia. Methods: The study included patients hospitalized with SARS-CoV-2 infection at eight COVID-19 treatment centers across Zambia between May 1, 2021, and October 27, 2021, coinciding with the period of SARS-CoV-2 vaccine availability in Zambia. Patient's demographic and clinical information was collected, including vaccination status and in-patient disposition (discharged or died). The study used mixed-effects logistic regression to assess the odds of in-hospital mortality by vaccination status, adjusted for age, sex, number of comorbid conditions, disease severity, and COVID-19 treatment center (random-effects term). Vaccine effectiveness was defined as 1 minus the adjusted odds ratio (aOR) times 100%. Results: During the study period for Zambia, 729 patients ≥18 years being treated in one of the participating COVID-19 treatment centers had data describing their hospitalization course and SARS-CoV-2 vaccination status. Forty-eight (6.6%) patients had received ≥1 vaccine dose at the time they were admitted to the hospital. Forty-two (87.5%) received AstraZeneca, three (6.3%) received Janssen, and three (6.3%) were unknown vaccine type. Only five (11.9%) of AstraZeneca recipients had received two vaccine doses. The age and sex of vaccinated patients was not different than unvaccinated patients (median age 60 years vs. 57 years, respectively, p=0.6;50.0% females vs. 42.9% females, respectively, p=0.4). In-hospital mortality was 16.7% for patients reporting ≥1 vaccine dose and 32.0% for unvaccinated patients (aOR: 0.3 [95% confidence interval (CI): 0.1-0.7). SARS-CoV-2 vaccine effectiveness for in-hospital mortality was 65.8% (95% CI: 25.9-85.9%). Conclusion: Consistent with evidence from other countries, vaccinated patients demonstrated lower odds of in-hospital mortality than those who were unvaccinated in Zambia. The low vaccine coverage in Zambia and among patients in this study likely impacted the precision of the estimate for the odds of in-hospital mortality. Vaccination is a critical tool for reducing the consequences of the SARS-CoV-2 epidemic in Zambia.
ABSTRACT
The effect of HIV infection on COVID-19 outcomes remains an urgent question in sub-Saharan Africa, where many countries are experiencing dual HIV and COVID-19 epidemics, and capacity to treat severe COVID-19 is limited. Using data from patients with probable or confirmed COVID-19 admitted to specialized treatment centers during March-December 2020 in Zambia, the Zambian Ministry of Health and CDC assessed the relationship between HIV infection and severe COVID-19 and COVID-19-associated death. Among 443 patients included in the study, 122 (28%) were HIV-positive, and of these, 91 (89%) were receiving ART at the time of hospitalization. HIV status alone was not significantly associated with severe COVID-19 at admission or during hospitalization or with COVID-19-associated death. However, among HIV-positive persons, those with severe HIV disease were more likely to develop severe COVID-19 and were at increased risk for COVID-19-associated death. Ensuring that persons maintain HIV disease control, including maintaining ART continuity and adherence, achieving viral suppression, and addressing and managing underlying medical conditions, could help reduce COVID-19-associated morbidity and mortality in sub-Saharan Africa.
ABSTRACT
Background: Zambia-where HIV prevalence is 11.5% - is experiencing widespread transmission of COVID-19. Studies of clinical outcomes of COVID-19 among HIV-infected individuals have shown mixed results of the impact of HIV status on disease severity or mortality. However, unlike Zambia, most of these studies originated from countries with low prevalence of HIV, with the HIV-infected individuals comprising a small fraction of the overall COVID-19 patient population. We describe the clinical outcomes of patients with SARSCoV2 infections who were admitted in COVID-19 treatment facilities in Zambia. Specifically, we assessed associations between HIV infection and COVID-19 severity and mortality. Methods: We collected demographic and clinical information from all adult patients admitted with SARS-CoV2 infection across five inpatient facilities in Zambia from July to October 2020. Logistic regression was utilized to examine the association between HIV status and COVID-19 severity, defined as the need for supplemental oxygen at any point during admission;and survival analyses were employed to explore the relationship between HIV status and 28-day mortality. Regression analyses were adjusted for age, sex, and facility. Results: There were 182 cases of severe COVID-19 among 271 enrolled patients. Overall, 66 (24%) patients were HIV-infected, 146 (54%) were male, and 53 (20%) were >60 years. Most HIV-infected patients (87%) were on antiretroviral therapy (ART) and among those with viral load results, 86% were virally suppressed (<1000 cp/ml). Compared to HIV-uninfected patients, those who were HIV-infected had lower BMI (mean: 26.0 vs. 28.0, p=0.05), and were less likely to be hypertensive (34.8% vs. 47.4%, p=0.01). HIV infection was not a significant predictor of severe disease (adjusted odds ratio: 1.71, 95% CI: 0.88 - 3.46), nor was it associated with 28-day mortality (adjusted hazard ratio: 0.87, 95% CI: 0.39 - 1.94). Conclusion: In this study from a sub-Saharan African (SSA) country with a generalized HIV epidemic, HIV had no statistically significant impact on COVID-19 severity or mortality. Most of the HIV-infected population in this study were virally suppressed and this may indicate that with optimal ART and achievement of HIV viral suppression, the risk of severe disease or mortality from COVID-19 among people living with HIV (PLHIV) can be minimized. Additional studies that assess impact of COVID-19 on PLHIV not on ART are needed, as this group continues to make up a large portion of PLHIV in SSA.