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Clinical Management and Mortality among COVID-19 Cases in Sub-Saharan Africa: A retrospective study from Burkina Faso and simulated case data analysis
Laura Skrip; Karim Derra; Mikaila Kaboré; Navideh Noori; Adama Gansané; Innocent Valéa; Halidou Tinto; Bicaba W. Brice; Mollie Van Gordon; Brittany Hagedorn; Hervé Hien; Benjamin Muir Althouse; Edward Wenger; André Lin Ouédraogo.
  • Laura Skrip; Institute for Disease Modeling
  • Karim Derra; IRSS - Clinical Research Unit of Nanoro, Burkina Faso
  • Mikaila Kaboré; Ministry of Health, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso; Ministry of Health, Teaching Hospital Tengandogo, Ouagadougou, Burkina Faso
  • Navideh Noori; Institute for Disease Modeling
  • Adama Gansané; Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso; Ministry of Health, Ouagadougou, Burkina Faso
  • Innocent Valéa; IRSS - Clinical Research Unit of Nanoro, Burkina Faso
  • Halidou Tinto; IRSS - Clinical Research Unit of Nanoro, Burkina Faso
  • Bicaba W. Brice; Centre des Operations de Réponses aux Urgences Sanitaires, Ouagadougou, National Public Heath Institute
  • Mollie Van Gordon; Institute for Disease Modeling
  • Brittany Hagedorn; Institute for Disease Modeling
  • Hervé Hien; Centre MURAZ, Institut National de Sante Publique, Ouagadougou, Burkina Faso
  • Benjamin Muir Althouse; Institute for Disease Modeling
  • Edward Wenger; Institute for Disease Modeling
  • André Lin Ouédraogo; Institute for Disease Modeling
Preprint in English | medRxiv | ID: ppmedrxiv-20119784
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BackgroundAbsolute numbers of COVID-19 cases and deaths reported to date in the sub-Saharan Africa (SSA) region have been significantly lower than those across the Americas, Asia, and Europe. As a result, there has been limited information about the demographic and clinical characteristics of deceased cases in the region, as well as the impacts of different case management strategies. MethodsData from deceased cases reported across SSA through May 10, 2020 and from hospitalized cases in Burkina Faso through April 15, 2020 were analyzed. Demographic, epidemiological, and clinical information on deceased cases in SSA was derived through a line-list of publicly available information and, for cases in Burkina Faso, from aggregate records at the Center Hospitalier Universitaire de Tengandogo in Ouagadougou. A synthetic case population was derived probabilistically using distributions of age, sex, and underlying conditions from populations of West African countries to assess individual risk factors and treatment effect sizes. Logistic regression analysis was conducted to evaluate the adjusted odds of survival for patients receiving oxygen therapy or convalescent plasma, based on therapeutic effectiveness observed for other respiratory illnesses. ResultsAcross SSA, deceased cases for which demographic data are available have been predominantly male (63/103, 61.2%) and over 50 years of age (59/75, 78.7%). In Burkina Faso, specifically, the majority of deceased cases either did not seek care at all or were hospitalized for a single day (59.4%, 19/32); hypertension and diabetes were often reported as underlying conditions. After adjustment for sex, age, and underlying conditions in the synthetic case population, the odds of mortality for cases not receiving oxygen therapy was significantly higher than those receiving oxygen, such as due to disruptions to standard care (OR 2.07; 95% CI 1.56 - 2.75). Cases receiving convalescent plasma had 50% reduced odds of mortality than those who did not (95% CI 0.24 - 0.93). ConclusionInvestment in sustainable production and maintenance of supplies for oxygen therapy, along with messaging around early and appropriate use for healthcare providers, caregivers, and patients could reduce COVID-19 deaths in SSA. Further investigation into convalescent plasma is warranted, as data on its effectiveness specifically in treating COVID-19 becomes available. The success of supportive or curative clinical interventions will depend on earlier treatment seeking, such that community engagement and risk communication will be critical components of the response.
Full text: Available Collection: Preprints Database: medRxiv Language: English Year: 2020 Document Type: Preprint
Full text: Available Collection: Preprints Database: medRxiv Language: English Year: 2020 Document Type: Preprint