ABSTRACT
BackgroundThe COVID-19 pandemic is a respiratory illness that has spread to over 210 countries and killed over 6 million people. There is no specific treatment for COVID-19, but vaccines have been developed that can help prevent severe illness and death. A number of studies have investigated the effect of vaccination on disease severity and outcome, and the findings indicate that vaccination is linked to a significant reduction in the risk of hospitalization, intensive care unit admission, and death from the disease. However, there is a scarcity of evidence in Africa in general, and no similar study has been conducted in Ethiopia yet. Therefore, the study aimed to assess the effect of vaccination on COVID-19 disease severity and need for Intensive Care Unit (ICU) admission among hospitalized patients at a private specialty clinic in Ethiopia. MethodsA retrospective cohort study was conducted among 126 patients with COVID-19, 41 vaccinated and 85 unvaccinated, who were hospitalized between September 2021 and May 2022. Data was summarized using frequency (percentage) and median (interquartile range). To compare the characteristics of the two groups, Chi-square/ Fishers Exact and Mann Whitney U tests at p-value of [≤] 0.05 were used. To identify the effect of vaccination on COVID-19 disease severity, Marginal Structural Model (MSM) with inverse probability weighting (IPW) approach using robust poisson regression model was fitted and adjusted relative risk (ARR) and 95% CI for ARR were used for interpreting the result. ResultsThe cohort included groups that were fairly comparable in terms of their sociodemographic and clinical characteristics. More than half of the participants were older than 60 years (52.4%), were males (56.3%) and had one or more comorbid illness (52.4%). At admission 85 (67.5%) had severe disease and 11 (8.7%) progressed after hospitalization and required ICU admission, of which three unvaccinated cases died. From the final model, vaccination was found to be associated with a 62% decreased risk of developing severe COVID-19 disease if infected, compared to not getting vaccinated (ARR=0.38, 95% CI=0.23-0.65, p<0.0001). ConclusionsThe studys findings support previous reports that vaccinated people are less likely to develop severe COVID-19 disease if infected with the virus, emphasizing the importance of continuing efforts to promote COVID-19 vaccination not only to safeguard individuals but also to confer community-level immunity.
Subject(s)
Infections , Death , COVID-19 , Respiratory InsufficiencyABSTRACT
Background: Studies show that having some symptoms seems to be associated with more severe disease and poor prognosis. Therefore, knowing who is more susceptible to symptomatic COVID-19 disease is important to provide targeted preventive and management practice. The aim of the study was to assess the determinants of having symptomatic disease among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.Methods: A case-control study was conducted from August to September 2020 among a randomly selected 765 COVID-19 patients (372 Asymptomatic and 393 Symptomatic patients). Chi-square test and independent t-test were used to detect the presence of a statistically significant difference in the characteristics of the cases (symptomatic) and controls (asymptomatic), where p-value of <0.05 considered as having a statistically significant difference. Multivariable binary logistic regression was used to assess a statistically significant association between the independent variables and developing symptomatic COVID-19 where Adjusted Odds ratio (AOR), 95% CIs for AOR, and P-values were used for testing significance and interpretation of results. Results: The result of the multivariable binary logistic regression shows that age group (AOR= 1.818, 95% CI= 1.210, 2.731, p-value=0.004 for 30-39 years; AOR= 1.611, 95% CI= 1.016, 2.554, p-value=0.043 for 40-49 years and AOR= 4.076, 95% CI= 2.582, 6.435, p-value=0.0001 for years and above), sex (AOR= 1.672, 95% CI= 1.216, 2.299, p-value=0.002) and history of diabetes mellitus (AOR= 2.406, 95% CI= 1.384, 4.181, p-value=0.002) were found to be significant factors that determine the development of symptomatic disease in COVID-19 patients.Conclusions: Developing a symptomatic COVID-19 disease was found to be determined by exposures of old age, male sex, and being diabetic. Therefore, patients with the above factors should be given enough attention in the prevention and management process, including inpatient management, to pick symptoms earlier and to manage accordingly so that these patients can have a favorable treatment outcome.
Subject(s)
COVID-19 , Diabetes MellitusABSTRACT
Aim: To estimate time to recovery/convalescence and identify determinants among COVID-19 infected patients admitted to Millennium COVID-19 Care Center in Addis Ababa, Ethiopia. Methods: A prospective cohort study was conducted among a randomly selected sample of 360 COVID-19 patients who were on follow up from 2nd June to 5th July 2020. Kaplan Meier plots, median survival times, and Log-rank test were used to describe the data and compare survival distribution between groups. Association between time to recovery/ convalescence and determinants was assessed using the Cox proportional hazard survival model, where hazard ratio, P-value, and 95% CI for hazard ratio were used for testing significance. Results: The mean age of the participants was 32.4 years (+/_ 12.5 years). On admission, 86.9 % had mild COVID-19, 78.6% were asymptomatic and 11.4% of the patients had a history of pre-existing co-morbid illness. The Median time to recovery/ convalescence among the study population was 16 days. The log-rank test shows that having non-mild (moderate and severe) disease, having one or more symptoms at presentation, and presenting with respiratory and constitutional symptoms seems to extend the time needed to achieve recovery. The Final Cox regression result shows that the presence of symptom at presentation was found to be a significant factor that affects time to recovery/ convalescence, the rate of achieving recovery/ convalescence among symptomatic patients was 44% lower than patients who were asymptomatic at presentation (HR= 0.560, 95% CI= 0.322-0.975, p-value=0.040). Conclusions: Presence of symptom was found to be associated with delayed viral clearance. This implies symptomatic patients are more likely to be infectious because of the prolonged viral shedding in addition to the presence of a more concentrated virus in the upper respiratory tract that enhances the transmission. Therefore, attention should be given in the isolation and treatment practice of COVID-19 patients with regard to presence of symptom.
Subject(s)
COVID-19 , InfectionsABSTRACT
Background: As the number of new cases and death due to COVID-19 is increasing, understanding the characteristics of severe COVID-19 patients and identifying characteristics that lead to death is a key to make an informed decision. In Ethiopia, as of September 27, 2020, a total of 72,700 cases and 1165 deaths were reported. Objective: The study aimed to assess the determinants of death in Severe COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia. Methods: A case-control study of 147 Severe COVID-19 patients (49 deaths and 98 discharged alive cases) was conducted from August to September 2020. A comparison of underlying characteristics between cases (death) and controls (alive) was assessed using a chi-square test and an independent t-test with a p-value of <0.05 considered as having a statistically significant difference. Multivariable binary logistic regression was used to assess a statistically significant association between the predictor variables and outcome of Severe COVID-19 (Alive Vs Death) where Adjusted Odds ratio (AOR), 95% CIs for AOR, and P-values were used for testing significance and interpretation of results. Results: Having diabetes mellitus (AOR= 3.257, 95% CI= 1.348, 7.867, p-value=0.00), fever (AOR=0.328, 95% CI: 0.123, 0.878, p-value= 0.027) and Shortness of breath (AOR= 4.034, 95% CI= 1.481, 10.988, p-value=0.006) were found to be significant predictors of death in Severe COVID-19 patients. Conclusions: The outcome of death in Severe COVID-19 patients is found to be associated with exposures to being diabetic and having SOB at admission. On the other hand, having a fever at admission was associated with a favorable outcome of being discharged alive.