Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study

Abstract

Background

There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda.

Methods

We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation <94%, lung infiltrates >50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance.

Results

Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32–6.82; p = 0.009) and altered mental state (GCS <15) (HR: 6.89, 95% CI: 1.48–32.08, p = 0.014) were significant predictors of 30-day mortality.

Conclusion

There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.

Keywords:

• COVID-19
• Uganda
• mortality
• young and middle-aged adults

Abbreviations

COVID –19, Corina Virus Disease 2019; SARS-CoV-2, severe acute respiratory syndrome corona virus 2; SSA, sub-Saharan Africa; WHO, World Health Organization; PCR, Polymerase Chain Reaction; CT, Computed Tomography; TB, Tuberculosis; CTU, COVID-19 treatment units; GCS, Glasgow Coma Scale; EDC, Electronic Data Capture; BMI, Body Mass Index; COPD, Chronic Obstructive Pulmonary Disease; AST, Aspartate aminotransferase; ALT, Alanine aminotransferase; ICU, Intensive Care Unit; SD, Standard Deviation; aHR, adjusted Hazards Ratio; CI, Confidence Interval; ARDS, Acute Respiratory Distress Syndrome.

Data Sharing Statement

The datasets used during this study are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

The study was approved by the Research Ethics Committee of Mbarara University of Science and Technology under reference number MUST-2022-435. The ethics committee waived the requirement for consent. Permission for access to medical records was granted by the necessary boards at respective hospitals. Study codes were used to ensure the anonymity of participants’ data. Data generated from the study shall be used for research purposes only and shall be private and confidential at all times. All principles of data transfer and principles of protection of human research participants outlined in the Declaration of Helsinki were observed.

Acknowledgments

The authors acknowledge hospital directors; Dr. Celestino Barigye, Dr. Nathan Onyachi, Dr. Anne Marion Namutebi, Dr. Alex Adaku and Mr. Isaac Ijuka for granting approval to collect data from respective health facilities. We also acknowledge Ms. Charity Kakuru, Ms. Fausita Nakibuule, Mr. Jackline Tukwasibwe for participating in data collection.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This study was funded by the Mbarara University Faculty of Medicine Seed grant. Edwin Nuwagira is also supported by the American Thoracic Society (Diversity grant 2022) and the NIH’s Fogarty international Centre (D43TW011632).