September 2024
Issue 33
Characteristics of hospitalized COVID-19 patients at admission and factors associated with clinical severity in low- and middle-income countries: an observational study
The SARS-CoV-2 virus, which emerged in December 2019 in Wuhan, China, rapidly spread worldwide. As of March 10, 2023, there were 676,609,955 confirmed COVID-19 cases and 6,881,955 deaths globally. Although the WHO declared the end of the COVID-19 global emergency on May 5, 2023, the virus continues to circulate despite widespread immunization efforts.
The pattern of COVID-19, including symptoms, recovery, and mortality rates, is influenced by the epidemiologic triangle: pathogen, host, and environment. Host-related factors such as older age and underlying comorbidities are independent risk factors for COVID-19 severity and mortality. In low- and middle-income countries (LMICs) like those in West Africa and South Asia, the population is predominantly young adults, suggesting potentially milder disease and lower mortality rates. However, the high prevalence of comorbidities among younger adults in LMICs may elevate the risk of severe disease. Additionally, overcrowded housing, co-circulation of various infectious agents, and weaker health systems lacking adequate intensive care units (ICUs) could impact disease outcomes in LMICs.
Despite extensive research on COVID-19 in high-income countries, little is known about the clinical characteristics and outcomes of patients in LMICs. This study aimed to describe the clinical features and outcomes of laboratory-confirmed COVID-19 patients hospitalized in six LMICs during the first year of the pandemic. The observational, prospective, hospital-based multicentric study included participants from Bangladesh, Guinea, Ivory Coast, Lebanon, Madagascar, and Mali, from March 5, 2020, to May 4, 2021.
The study analyzed the clinical severity of COVID-19, defined as ICU admission or death, using multivariate logistic regression models to identify independent variables associated with disease severity. A total of 1,096 patients were included, with a median age of 49.0 years, ranging from 38.0 years in Mali to 63.0 years in Guinea. The overall clinical severity of COVID-19 was 12.3%, varying from 6.4% in Mali to 18.8% in Guinea. Cardiovascular diseases were independently associated with clinical severity in both age groups (<60 and ≥60 years), while diabetes was also a significant factor in patients under 60.
The study concluded that COVID-19 severity and mortality in LMICs are primarily driven by older age, but chronic diseases significantly increase severity risk, particularly in younger patients.
This study has been recently published in the American Journal of Tropical Medicine and Hygiene: https://www.ajtmh.org/view/journals/tpmd/aop/article-10.4269-ajtmh.23-0456/article-10.4269-ajtmh.23-0456.xml
We would like to thank all those involved in the study for their support in producing this relevant work at this difficult time for COVID-19, and we look forward to future collaborations. All co-authors are cited in alphabetical order.
Marianne Abifadel, Kaousar Ahmmed, Sayera Banu, Ibrahima Camara, Fahmida Chowdhury, Daouda Coulibaly, Georges Dabar, Cedric Dananché, Rachel Daw, Zakiul Hassan, Magali Hervé, Ariful Islam, Florence Komurian-Pradel, Jean-Pierre Kouamé, Bourema Kouriba, Josette Najjar-Pellet, Andoniaina Rakotonaivo, Felana Ranaivo-Rabetokotany, Mandranto Rasamoelina, Tiavina Rasolofoarison, Moussa Riachi, Mitra Saadatian-Elahi, Luc Samison, Valentina Sanchez Picot, Sita Savané, Ismaila Thera, Abdoulaye Touré, and Philippe Vanhems