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3.
BMC Res Notes ; 14(1): 468, 2021 Dec 24.
Article in English | MEDLINE | ID: covidwho-1582017

ABSTRACT

OBJECTIVE: The proliferation of false information on COVID-19 mostly through social media is adversely affecting control efforts. The objective of this study was to identify areas where targeted effective messaging can be useful in demystifying misinformation against COVID-19. RESULTS: The study showed high levels of misinformation on COVID-19 in the study area [mean score 2.71; standard deviation (SD) 1.5]. The highest levels of misinformation were observed in Dr. Ruth Segomotsi Mompati district, North West province (mean score: 3.84; SD: 2.1) and Sedibeng district, Gauteng province (mean score: 3.56; SD 1.7). Higher levels of misinformation were reported by those aged 18-24 years (mean score: 3.48; SD: 1.8), and men (mean score: 2.73; SD: 1.8). Across the two provinces, we identified geospatial hot and coldspots of misinformation highlighting the need to implement point of care strategies such as targeted messaging. Findings showed the need for targeted interventions to young people, students, those with low levels of education and the self-employed in the two districts more importantly, as South Africa expands its nationwide vaccination roll-out.


Subject(s)
COVID-19 , Adolescent , Communication , Geography , Humans , Male , SARS-CoV-2 , South Africa
4.
PLoS One ; 16(12): e0260613, 2021.
Article in English | MEDLINE | ID: covidwho-1581780

ABSTRACT

There is widespread recognition that stressors related to Coronavirus Disease 2019 (COVID-19) jeopardize the development of emerging adults, more particularly those living in disadvantaged communities. What is less well understood is what might support emerging adult resilience to COVID-19-related stressors. In response, this article reports a 5-week qualitative study with 24 emerging adults (average age: 20) living in a South African township. Using digital diaries and repeated individual interviews, young people shared their lived experiences of later (i.e., month 4 and 7) lockdown-related challenges (i.e., contagion fears; livelihood threats; lives-on-hold) and how they managed these challenges. An inductive thematic analysis showed that personal and collective compliance, generous ways-of-being, and tolerance-facilitators enabled emerging adult resilience to said challenges. Importantly, these resilience-enablers drew on resources associated with multiple systems and reflected the situational and cultural context of the township in question. In short, supporting emerging adult resilience to COVID-19-related stressors will require contextually aligned, multisystemic responses.


Subject(s)
COVID-19/psychology , Resilience, Psychological , Adolescent , COVID-19/economics , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Male , Medicine, African Traditional , South Africa/epidemiology , Vulnerable Populations/psychology , Young Adult
5.
PLoS One ; 16(12): e0261339, 2021.
Article in English | MEDLINE | ID: covidwho-1581750

ABSTRACT

BACKGROUND: Gauteng province, with 26.3% of South Africa's population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa's reported COVID-19 cases. AIM: The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. MATERIAL AND METHODS: Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data. RESULTS: Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response. CONCLUSION: Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.


Subject(s)
COVID-19/epidemiology , Pandemics , Primary Health Care/statistics & numerical data , Adult , Female , Government Programs/organization & administration , Humans , Male , Qualitative Research , South Africa/epidemiology , Surveys and Questionnaires
6.
Int J Environ Res Public Health ; 19(1)2021 12 30.
Article in English | MEDLINE | ID: covidwho-1580785

ABSTRACT

The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27). A positive correlation was found between not breastfeeding and not going to the health clinic. The odds of hungry mothers breastfeeding were significantly lower (OR = 0.66; p = 0.045). This result also holds in a multivariate framework, including covariates such as depressive symptoms, attendance of a PHC facility, and whether the infant was older than 3 months. Support for breastfeeding must include support, such as economic support, for breastfeeding mothers, to enable them to access nutritious diets. Mothers also need reassurance on the quality of their breastmilk and their ability to breastfeed and should be encouraged to continue to attend the health clinic regularly.


Subject(s)
Breast Feeding , COVID-19 , Child , Communicable Disease Control , Cross-Sectional Studies , Female , Humans , Hunger , Infant , Mothers , Pandemics , Pregnancy , SARS-CoV-2 , South Africa/epidemiology
7.
Afr J Prim Health Care Fam Med ; 13(1): e1-e9, 2021 Dec 09.
Article in English | MEDLINE | ID: covidwho-1580227

ABSTRACT

BACKGROUND: The coronavirus pandemic has put extreme pressure on health care services in South Africa. AIM: To describe the design, patients and outcomes of a field hospital during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. SETTING: The Cape Town International Convention Centre was the first location in Cape Town to be commissioned as a field hospital that would serve as an intermediate care bed facility. METHODS: This was a retrospective descriptive study of patients admitted to this facility between 8th June 2020 and 14th August 2020 using deidentified data extracted from patient records. RESULTS: There were 1502 patients admitted, 56.4% female, with a mean age of 58.6 years (standard deviation [s.d.]: 14.2). The majority of patients (82.9%) had at least one comorbidity, whilst 15.4% had three or more. Nearly 80.0% (79.8%) of patients required oxygen and 63.5% received steroids, and only 5.7% of patients were required to be transferred for escalation of care. The mean length of stay was 6 days (s.d.: 4.8) with an overall mortality of 5.7%. CONCLUSION: This study highlights the role of a field hospital in providing surge capacity. Its use halved the predicted duration of stay at acute care hospitals, allowing them the capacity to manage more unstable and critical patients. Adaptability and responsivity as well as adequate referral platforms proved to be crucial. Daily communication with the whole health care service platform was a critical success factor. This study provides information to assist future health planning and strategy development in the current pandemic and future disease outbreaks.


Subject(s)
COVID-19 , Female , Humans , Male , Middle Aged , Mobile Health Units , Retrospective Studies , SARS-CoV-2 , South Africa/epidemiology , United States
8.
Rev Med Virol ; 31(6): e2231, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574317

ABSTRACT

The Spike protein is the target of both antibody-based therapeutics (convalescent plasma, polyclonal serum, monoclonal antibodies) and vaccines. Mutations in Spike could affect efficacy of those treatments. Hence, monitoring of mutations is necessary to forecast and readapt the inventory of therapeutics. Different phylogenetic nomenclatures have been used for the currently circulating SARS-CoV-2 clades. The Spike protein has different hotspots of mutation and deletion, the most dangerous for immune escape being the ones within the receptor binding domain (RBD), such as K417N/T, N439K, L452R, Y453F, S477N, E484K, and N501Y. Convergent evolution has led to different combinations of mutations among different clades. In this review we focus on the main variants of concern, that is, the so-called UK (B.1.1.7), South African (B.1.351) and Brazilian (P.1) strains.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antibodies, Neutralizing/therapeutic use , COVID-19/therapy , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , Antibodies, Monoclonal/chemistry , Antibodies, Monoclonal/metabolism , Antibodies, Neutralizing/chemistry , Antibodies, Neutralizing/metabolism , Antibodies, Viral/chemistry , Antibodies, Viral/metabolism , Antibodies, Viral/therapeutic use , Brazil/epidemiology , COVID-19/epidemiology , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Gene Expression , Humans , Immune Evasion , Immunization, Passive/methods , Mutation , Phylogeny , Protein Binding , Risk Assessment , SARS-CoV-2/classification , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , South Africa/epidemiology , Spike Glycoprotein, Coronavirus/immunology , United Kingdom/epidemiology
9.
Sci Rep ; 11(1): 24059, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1574866

ABSTRACT

During lockdowns associated with the COVID-19 pandemic, individuals have experienced poor sleep quality and sleep regularity, changes in lifestyle behaviours, and heightened depression and anxiety. However, the inter-relationship and relative strength of those behaviours on mental health outcomes is still unknown. We collected data between 12 May and 15 June 2020 from 1048 South African adults (age: 32.76 ± 14.43 years; n = 767 female; n = 473 students) using an online questionnaire. Using structural equation modelling, we investigated how insomnia symptoms, sleep regularity, exercise intensity/frequency and sitting/screen-use (sedentary screen-use) interacted to predict depressive and anxiety-related symptoms before and during lockdown. We also controlled for the effects of sex and student status. Irrespective of lockdown, (a) more severe symptoms of insomnia and greater sedentary screen-use predicted greater symptoms of depression and anxiety and (b) the effects of sedentary screen-use on mental health outcomes were mediated by insomnia. The effects of physical activity on mental health outcomes, however, were only significant during lockdown. Low physical activity predicted greater insomnia symptom severity, which in turn predicted increased depressive and anxiety-related symptoms. Overall, relationships between the study variables and mental health outcomes were amplified during lockdown. The findings highlight the importance of maintaining physical activity and reducing sedentary screen-use to promote better sleep and mental health.


Subject(s)
Anxiety/epidemiology , COVID-19/psychology , Depression/epidemiology , Exercise/statistics & numerical data , Students/psychology , Adult , Anxiety/etiology , Depression/etiology , Female , Humans , Male , Middle Aged , Quarantine/psychology , Sedentary Behavior , South Africa , Young Adult
10.
Clin Transl Med ; 11(12): e685, 2021 12.
Article in English | MEDLINE | ID: covidwho-1568018

ABSTRACT

The recently discovered Omicron variant of SARS-CoV-2 has rapidly burst into the public and scientific eye, being detected in more than 26 countries around the world. Given its more than 50 mutations, there is widespread concern about its public health impact, leading the World Health Organization to designate it a variant of concern. This Commentary provides a summary of current knowledge and unknowns about this viral variant as of December 2, 2021 and summarizes the key questions that need to be rapidly answered.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , SARS-CoV-2/genetics , Angiotensin-Converting Enzyme 2/genetics , Botswana , COVID-19 Vaccines , Global Health , Humans , Mutation , Netherlands , Pandemics , South Africa , World Health Organization
11.
Clin Transl Med ; 11(12): e680, 2021 12.
Article in English | MEDLINE | ID: covidwho-1568017

ABSTRACT

Omicron variants are part of the "Coronavirus disease 2019 [COVID-19] Variants of Concerns" and has the potential to spread around the world rapidly and can harm human life. We can anticipate that the endemic state of COVID-19 will be characterized by the development of new strains with surges that will predominate in unvaccinated and immunodeficient populations. Thus, there will be an important role in promoting vaccinations, boosters and accessible testing to prevent disease transmission and to rapidly detect surges. There is an urgent need to explore the virology and biology of Omicron variants, define clinical phenomes and therapies, monitor dynamics of genetic changes, and translate the knowledge of COVID-19 into new variants. Clinical and translational medicine will be impactful in addressing these challenges by providing new insights for understanding and predicting new variants-associated transmissibility, disease severity, immune escape, diagnostic or therapeutic failure.


Subject(s)
COVID-19/prevention & control , COVID-19/virology , SARS-CoV-2/genetics , /methods , COVID-19 Vaccines , Humans , Immune System , Mutation , South Africa , Vaccination
12.
S Afr Med J ; 111(12): 1174-1180, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1561763

ABSTRACT

BACKGROUND: The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. OBJECTIVES: To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. METHODS: We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. RESULTS: One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. CONCLUSIONS: In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.


Subject(s)
COVID-19/complications , HIV Infections/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Adult , CD4 Lymphocyte Count , Cohort Studies , Female , Humans , Infant, Newborn , Maternal Mortality , Pregnancy , Pregnancy Complications, Infectious/virology , Pregnancy, High-Risk , Prospective Studies , South Africa
13.
S Afr Med J ; 111(12): 1181-1189, 2021 12 02.
Article in English | MEDLINE | ID: covidwho-1560405

ABSTRACT

BACKGROUND: To prevent the spread of SARS-CoV-2, many countries instituted lockdown measures. As the virus was initially slow to spread to rural areas in South Africa, Mopani district in Limpopo Province did not experience a high incidence of COVID-19 until the second wave in December 2020. Until then, lockdown measures were more likely than SARS-CoV-2 infections to have an adverse impact on health services. OBJECTIVES: To analyse HIV, tuberculosis (TB) and prevention of mother-to-child transmission of HIV (PMTCT) indicator trends in Mopani during the COVID-19 lockdown and two COVID-19 waves. METHODS: Using monthly data from the District Health Information System from February 2019 to December 2020, we conducted a retrospective review of data elements and indicators that fall into the following domains: primary healthcare head count (HC), HIV, antiretroviral treatment (ART), PMTCT and TB. Aggregated data were analysed, and an interrupted time series analysis was conducted. We assessed percentage changes between the January - March 2020 and April - June 2020 periods, and differences in means for the period April - December 2019 v. the period April - December 2020 were assessed for statistical significance. RESULTS: At the start of the first wave in April 2020, a statistically significant decline of 10% was recorded for total HC utilisation rates (p=0.1). We also found declines of 665 HIV tests (from 1 608 to 942) and 22 positive HIV tests (from 27 to 4) for children between the ages of 18 months and 14 years (p=0.05), with no recovery. Significant declines were also recorded for children aged <15 years starting (change from 35 to 21) and remaining (change from 4 032 to 3 986) on ART, as well as for adults starting ART (change from 855 to 610) at the onset of the first wave (p=0.01). No significant change was detected in PMTCT and TB indicators during the first wave. Pronounced decreases in HC were recorded in December, during the country's second wave (change from 237 965 to 227 834). CONCLUSION: Declines were recorded for most indicators in Mopani, with HC being affected the most at the start of the first wave and not showing any significant recovery between waves. Strategies are required to mitigate the effects of future COVID-19 waves and encourage positive health-seeking behaviour.


Subject(s)
COVID-19/prevention & control , HIV Infections/epidemiology , Infectious Disease Transmission, Vertical/statistics & numerical data , Tuberculosis/epidemiology , Adolescent , Adult , COVID-19/epidemiology , Child , Child, Preschool , Delivery of Health Care/statistics & numerical data , Female , Humans , Infant , Pregnancy , Retrospective Studies , South Africa/epidemiology , Young Adult
14.
Math Biosci Eng ; 19(1): 1058-1077, 2022 01.
Article in English | MEDLINE | ID: covidwho-1560152

ABSTRACT

The year 2020 brought about a pandemic that caught most of the world population by surprise and wreaked unimaginable havoc before any form of effective reaction could be put in place. COVID-19 is proving to be an epidemic that keeps on having an upsurge whenever it looks like it is being curbed. This pandemic has led to continuous strategizing on approaches to quelling the surge. The recent and welcome introduction of vaccines has led to renewed optimism for the population at large. The introduction of vaccines has led to the need to investigate the effect of vaccination among other control measures in the fight against COVID-19. In this study, we develop a mathematical model that captures the dynamics of the disease taking into consideration some measures that are easier to implement majorly within the African context. We consider quarantine and vaccination as control measures and investigate the efficacy of these measures in curbing the reproduction rate of the disease. We analyze the local stability of the disease-free equilibrium point. We also perform sensitivity analysis of the effective reproduction number to determine which parameters significantly lowers the effective reproduction number. The results obtained suggest that quarantine and a vaccine with at least 75% efficacy and reducing transmission probability through sanitation and wearing of protective gears can significantly reduce the number of secondary infections.


Subject(s)
COVID-19 , Humans , Pandemics , SARS-CoV-2 , South Africa/epidemiology , Vaccination
15.
Emerg Infect Dis ; 27(12): 3020-3029, 2021 12.
Article in English | MEDLINE | ID: covidwho-1556378

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections may be underestimated because of limited access to testing. We measured SARS-CoV-2 seroprevalence in South Africa every 2 months during July 2020-March 2021 in randomly selected household cohorts in 2 communities. We compared seroprevalence to reported laboratory-confirmed infections, hospitalizations, and deaths to calculate infection-case, infection-hospitalization, and infection-fatality ratios in 2 waves of infection. Post-second wave seroprevalence ranged from 18% in the rural community children <5 years of age, to 59% in urban community adults 35-59 years of age. The second wave saw a shift in age distribution of case-patients in the urban community (from persons 35-59 years of age to persons at the extremes of age), higher attack rates in the rural community, and a higher infection-fatality ratio in the urban community. Approximately 95% of SARS-CoV-2 infections were not reported to national surveillance.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Child , Humans , Middle Aged , Rural Population , Seroepidemiologic Studies , South Africa/epidemiology
18.
S Afr Med J ; 111(11): 1050-1054, 2021 11 05.
Article in English | MEDLINE | ID: covidwho-1538769

ABSTRACT

A previously healthy 10-year-old girl, living in a sheep-farming community in South Africa with exposure to dogs, presented to her local hospital with generalised tonic-clonic seizures. The initial clinical assessment and laboratory work-up were unremarkable. When she presented with further seizures 6 months later, attempts to arrange neuroimaging and specialist assessment were unsuccessful owing to restrictions on routine healthcare services during the SARS-CoV-2 nationwide lockdown. Subsequently, 11 months after her first presentation, she developed focal neurological signs suggestive of raised intracranial pressure. A brain computed tomography scan revealed a left-sided cerebral cyst and imminent tonsillar herniation. An emergency burr-hole procedure was performed to relieve the raised intracranial pressure, followed by definitive neurosurgical excision of cysts. Hydatid protoscolices and hooklets were seen on microscopy of cyst fluid, and treatment with albendazole and praziquantel was initiated. While her infection was treated successfully, long-term sequelae including permanent blindness and hemiparesis could potentially have been prevented with early neuroimaging and surgical intervention.


Subject(s)
Anticestodal Agents/administration & dosage , Brain Diseases/diagnosis , COVID-19 , Echinococcosis/diagnosis , Albendazole/administration & dosage , Brain Diseases/drug therapy , Brain Diseases/parasitology , Child , Delayed Diagnosis , Echinococcosis/drug therapy , Female , Humans , Intracranial Hypertension/parasitology , Praziquantel/administration & dosage , Seizures/parasitology , South Africa , Tomography, X-Ray Computed
19.
S Afr Med J ; 111(11): 1092-1097, 2021 11 05.
Article in English | MEDLINE | ID: covidwho-1534501

ABSTRACT

BACKGROUND: The availability of well and functional healthcare workers (HCWs) and support staff is pivotal to a country's ability to manage the COVID-19 pandemic effectively. While HCWs have been identified as being at increased risk for acquisition of SARS-CoV-2 infection, there is a paucity of data pertaining to South African (SA) HCW-related infection rates. Global and provincial disparities in these numbers necessitate local data in order to mitigate risks. OBJECTIVES: To ascertain the overall SARS-CoV-2 infection rates and outcomes among all hospital staff at three hospitals in the Tshwane district of Gauteng Province, SA, and further determine associations with the development of severe COVID-19 disease. METHODS: This retrospective audit was conducted across three academic hospitals in the Tshwane district for the period 1 June - 31 August 2020. Deidentified data from occupational health and safety departments at each hospital were used to calculate infection rates. A more detailed analysis at one of the three hospitals included evaluation of demographics, work description, possible source of SARS-CoV-2 exposure (community or hospital), comorbidities and outcomes. RESULTS: The period prevalence of SARS-CoV-2 infections ranged from 6.1% to 15.4% between the three hospitals, with the average period prevalence being 11.1%. The highest incidence of SARS-CoV-2 infections was observed among administrative staff (2.8 cases per 1 000 staff days), followed by nursing staff (2.7 cases per 1 000 staff days). Medical doctors had the lowest incidence of 1.1 cases per 1 000 staff days. SARS-CoV-2 infections were categorised as either possibly community or possibly healthcare facility acquired for 26.6% and 73.4% of the infections, respectively. The administrative group had the highest proportion of possible community-acquired infections (41.8%), while doctors had the lowest (6.1%). The mean age of individuals with mild and severe disease was 41 years and 46.1 years, respectively (p=0.004). The presence of comorbidities was significantly associated with severity of disease (p=0.002). CONCLUSIONS: This study highlights that hospital staff, including administrative staff, are clearly at high risk for acquisition of SARS-CoV-2 infection during a surge.


Subject(s)
Academic Medical Centers , COVID-19/epidemiology , Personnel, Hospital/statistics & numerical data , Adult , Age Distribution , COVID-19/physiopathology , Female , Humans , Incidence , Male , Middle Aged , Patient Acuity , Prevalence , Retrospective Studies , Risk Factors , South Africa/epidemiology
20.
S Afr Med J ; 111(11): 1084-1091, 2021 11 05.
Article in English | MEDLINE | ID: covidwho-1534500

ABSTRACT

BACKGROUND: There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA). OBJECTIVES: To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19. METHODS: Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values <0.001. RESULTS: Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100 000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100 000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites. CONCLUSIONS: The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Hospitalization/statistics & numerical data , /statistics & numerical data , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , COVID-19/mortality , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Risk Factors , Sex Distribution , Socioeconomic Factors , South Africa/epidemiology , Young Adult
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