Undiagnosed comorbidities among individuals hospitalised with COVID-19 in South African public hospitals.
S Afr Med J
; 112(9): 747-752, 2022 08 30.
Article
in English
| MEDLINE | ID: covidwho-2067142
ABSTRACT
BACKGROUND:
Previous studies have reported comorbid disease, including hypertension, diabetes mellitus, chronic cardiac and renal disease, malignancy, HIV, tuberculosis (TB) and obesity, to be associated with COVID19 mortality. National demographic surveys have reported a high proportion of undiagnosed and untreated comorbid disease in South Africa (SA).OBJECTIVES:
To determine the number of individuals with previously undiagnosed HIV, TB and non-communicable diseases (NCDs) among patients hospitalised with COVID19, and the level of medical control of these chronic diseases.METHODS:
We conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals with COVID19 admitted to 16 secondary-level public hospitals in six of the nine provinces of SA. Trained surveillance officers approached all patients who met the surveillance case definition for inclusion in the study, and consenting patients were enrolled. The data collection instrument included questions on past medical history to determine the self-reported presence of comorbidities. The results of clinical and laboratory testing introduced as part of routine clinical care for hospitalised COVID19 patients were collected for the study, to objectively determine the presence of hypertension, diabetes, HIV and TB and the levels of control of diabetes and HIV.RESULTS:
On self-reported history, the most prevalent comorbidities were hypertension (n=1 658; 51.5%), diabetes (n=855; 26.6%) and HIV (n=603; 18.7%). The prevalence of self-reported active TB was 3.1%, and that of previous TB 5.5%. There were 1 254 patients admitted with COVID19 (39.0%) who met the body mass index criteria for obesity. On clinical and laboratory testing, 87 patients were newly diagnosed with HIV, 29 with TB, 215 with diabetes and 40 with hypertension during their COVID19 admission. There were 151/521 patients living with HIV (29.0%) with a viral load >1 000 copies/mL and 309/570 (54.2%) with a CD4 count <200 cells/µL. Among 901 patients classified as having diabetes, 777 (86.2%) had a glycated haemoglobin (HbA1c) level ≥6.5%.CONCLUSION:
The study revealed a high prevalence of comorbid conditions among individuals with COVID19 admitted to public hospitals in SA. In addition, a significant number of patients had previously undiagnosed hypertension, diabetes, HIV and active TB, and many and poorly controlled chronic disease, as evidenced by high HbA1c levels in patients with diabetes, and high viral loads and low CD4 levels in patients with HIV. The findings highlight the importance of strengthening health systems and care cascades for chronic disease management, which include prevention, screening for and effectively treating comorbidities, and ensuring secure and innovative supplies of medicines in primary healthcare during the COVID19 pandemic.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Tuberculosis
/
HIV Infections
/
Diabetes Mellitus
/
Noncommunicable Diseases
/
COVID-19
/
Hypertension
Type of study:
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Variants
Limits:
Humans
Country/Region as subject:
Africa
Language:
English
Journal:
S Afr Med J
Year:
2022
Document Type:
Article
Affiliation country:
SAMJ.2022.v112i9.16417
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