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Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa: descriptive observational study.
Mash, Robert James; Presence-Vollenhoven, Mellisa; Adeniji, Adeloye; Christoffels, Renaldo; Doubell, Karlien; Eksteen, Lawson; Hendrikse, Amee; Hutton, Lauren; Jenkins, Louis; Kapp, Paul; Lombard, Annie; Marais, Heleen; Rossouw, Liezel; Stuve, Katrin; Ugoagwu, Abi; Williams, Beverley.
  • Mash RJ; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa rm@sun.ac.za.
  • Presence-Vollenhoven M; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
  • Adeniji A; Metro Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Christoffels R; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
  • Doubell K; Rural Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Eksteen L; Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.
  • Hendrikse A; Metro Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Hutton L; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
  • Jenkins L; Rural Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Kapp P; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
  • Lombard A; Rural Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Marais H; Metro Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Rossouw L; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
  • Stuve K; Rural Health Services, Western Cape Provincial Government, Cape Town, South Africa.
  • Ugoagwu A; Family Medicine and Primary Care, University of Stellenbosch, Stellenbosch, Western Cape, South Africa.
  • Williams B; Rural Health Services, Western Cape Provincial Government, Cape Town, South Africa.
BMJ Open ; 11(1): e047016, 2021 01 26.
Article in English | MEDLINE | ID: covidwho-1050403
ABSTRACT

OBJECTIVES:

To describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals.

DESIGN:

A descriptive observational cross-sectional study.

SETTING:

District hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians.

PARTICIPANTS:

All patients who presented to the hospitals' emergency centre and who tested positive for COVID-19 between March and June 2020. PRIMARY AND SECONDARY OUTCOME

MEASURES:

Source of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location.

RESULTS:

1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%) hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0-5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0-3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality.

CONCLUSION:

District hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 / Hospitals, District Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-047016

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 / Hospitals, District Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-047016