Laboratory biomarkers associated with mortality in COVID-19 patients in Addis Ababa, Ethiopia (preprint)

Background: Laboratory biomarkers are amongst the best imperative predictors of disease outcomes in hospital-admitted COVID-19 patients. Although data is available in this regard at a global level, there is a paucity of information in Ethiopia. Thus, this study aimed to assess the laboratory biomarkers association with death among COVID-19 patients in Ethiopia. Methods: A health facility-based longitudinal study was conducted from 2020 to 2022 among RT-PCR-confirmed COVID-19 patients admitted and on treatment follow-up at COVID-19 treatment hospitals in Addis Ababa. A robust Poisson regression model was fitted to assess the association between demographic, clinical, and laboratory factors and death. Significance was determined at p<0.05, and variables with p < 0.15 in bivariate analyses were included in the final multivariable models. Incidence rate ratio (IRR) with a 95% confidence interval (CI) was used to describe associations. Results: Of the 2357 COVID-19 patients, 248 (10.5%) died. The median age of participants was 59 (IQR= 45- 70) years, and the majority (64.9%) of them were male. Lower median RBC was observed among those who died at 4.58 (4.06-5.07) as compared to those who survived at 4.69 (4.23-5.12) whereas high median (IQR) WBC was a predictor of mortality with 11.2 (7.7-15.9). After adjusting for confounders, death was associated with age >74 years having adjusted incidence rate ratio [aIRR (95%CI): 2.46 (1.40-4.34)], and critical clinical situations [aIRR (95% CI): 4.04 (2.18-7.52)]. Conclusion: Our results demonstrate that abnormal liver function tests, abnormal white blood cells, age of the patients, and clinical status of the patients during admission are associated with unfavorable outcomes of COVID-19. Hence, timely monitoring of these laboratory results at the earliest phase of the disease was highly commendable.

Effects of climatic factors on COVID-19 transmission in Ethiopia.

Climatic conditions play a key role in the transmission and pathophysiology of respiratory tract infections, either directly or indirectly. However, their impact on the COVID-19 pandemic propagation is yet to be studied. This study aimed to evaluate the effects of climatic factors such as temperature, rainfall, relative humidity, sunshine duration, and wind speed on the number of daily COVID-19 cases in Addis Ababa, Ethiopia. Data on confirmed COVID-19 cases were obtained from the National Data Management Center at the Ethiopian Public Health Institute for the period 10th March 2020 to 31st October 2021. Data for climatic factors were obtained from the Ethiopia National Meteorology Agency. The correlation between daily confirmed COVID-19 cases and climatic factors was measured using the Spearman rank correlation test. The log-link negative binomial regression model was used to fit the effect of climatic factors on COVID-19 transmission, from lag 0 to lag 14 days. During the study period, a total of 245,101 COVID-19 cases were recorded in Addis Ababa, with a median of 337 new cases per day and a maximum of 1903 instances per day. A significant correlation between COVID-19 cases and humidity was observed with a 1% increase in relative humidity associated with a 1.1% [IRRs (95%CI) 0.989, 95% (0.97-0.99)] and 1.2% [IRRs (95%CI) 0.988, (0.97-0.99)] decrease in COVID-19 cases for 4 and 5 lag days prior to detection, respectively. The highest increase in the effect of wind speed and rainfall on COVID-19 was observed at 14 lag days prior to detection with IRRs of 1.85 (95%CI 1.26-2.74) and 1.078 (95%CI 1.04-1.12), respectively. The lowest IRR was 1.109 (95%CI 0.93-1.31) and 1.007 (95%CI 0.99-1.02) both in lag 0, respectively. The findings revealed that none of the climatic variables influenced the number of COVID-19 cases on the day of case detection (lag 0), and that daily average temperature and sunshine duration were not significantly linked with COVID-19 risk across the full lag period (p > 0.05). Climatic factors such as humidity, rainfall, and wind speed influence the transmission of COVID-19 in Addis Ababa, Ethiopia. COVID-19 cases have shown seasonal variations with the highest number of cases reported during the rainy season and the lowest number of cases reported during the dry season. These findings suggest the need to design strategies for the prevention and control of COVID-19 before the rainy seasons.

COVID 19 epidemic trajectory modeling results for Ethiopia. (Special Issue: The Ethiopian health information system: where are we? and where are we going?)

Background: An outbreak of "pneumonia of unknown etiology" later renamed as Novel Corona Virus (COVID 19) was first reported from Hubei Province, China on 31 December 2019. The cases have increased exponentially;the pandemic has reached all countries in the world with 81.2 million confirmed cases and over 1.8 million by December 28, 2020. Ethiopia reported its first case on March 13, 2020, and as of December 28, 2020, the country had 122864 confirmed COVID-19 cases and 1909 deaths. Being a new pandemic its epidemiologic trajectories across regions and populations remains unknown. Mathematical models are widely used to understand and predict the possible courses of an outbreak, given a set of underlying assumptions.

The Indirect Impact of COVID-19 Pandemic on Maternal and Child Mortality in Ethiopia: A Modelling Study (preprint)

Background: According to the Ethiopian Federal Ministry of Health daily pandemic report, COVID-19 has caused considerable morbidity and mortality directly due to the virus. The occurrence of COVID-19 has caused serious interruption to high impact essential health services in Ethiopia like in many other countries. However, the indirect impact of the pandemic due to the interruption of other essential health services on maternal and child mortality has not been examined. Therefore, this study aimed to estimate the indirect impact of COVID-19 pandemic on maternal and child mortality in Ethiopia. Methods: We used the Lives Saved Tool (LiST) to estimate the impact of COVID-19. By varying the coverage of essential Maternal and Child Health (MCH) services from the baseline, we build four plausible scenarios that represent possible service interruptions possibilities. Scenario-1 represents a 25% average decrement in MCH service for a year, scenario-2 represents a 35% average service coverage decrement for a year, scenario-3 represents a 50% average service coverage decrement for a year, and the scenario-4 represent a 35% service coverage decrement for a half year duration. Ethiopian Demographic and Health Survey 2016 (EDHS 2016), Ethiopia Mini Demographic and Health Survey 2019 (EMDHS 2019) and for those variable which were not included in EDHS 2016 and EMHDS 2019, multivariate analysis estimates conducted on population-level coverage were used to estimate the baseline coverage and the impact of MCH interventions. Results: Based on scenario-1, additional 10,252 child deaths, 379 maternal deaths, and 1,673 stillbirths would occur per year. Based on scenario-2, over a year, additional 26,307 child deaths, 2,197 maternal deaths and 7,876 stillbirths would occur. Based on scenario-3, additional 41,945 under-5 deaths, 4,038 maternal deaths, and 13,294 stillbirths would result in a year. Wasting was the most predominant factor contributing about 16% to 30% of the additional under-5 deaths.Conclusion: A significant number of additional maternal and child deaths would occur in Ethiopia if the essential health service interruption persists, as seen in the first few months of the pandemic. This is more than the mortality caused by the pandemic itself.