In-hospital COVID-19 mortality higher in 10 African countries

COVID-19 in Africa

COVID-19 has caused the deaths of more than 3.4 million people globally. Researchers have noted that African countries have tended to have lower mortality rates.

Some researchers believe that this is due to the lower average population age, life expectancy, and mortality rate for people over the age of 65 years prior to the pandemic. They also note that fewer people live with cardiovascular illnesses in these areas. Others have praised Africa’s prompt and effective response to the pandemic.

While overall mortality rates for COVID-19 have generally been low in African countries, there have not been enough data to determine whether the same holds true for in-hospital mortality.

People receiving care for COVID-19 in the hospital are likely to have a more severe case of the disease, which could mean that the overall mortality trend does not apply to this group.

Furthermore, some have suggested that countries in Africa tend to have a smaller clinical workforce and fewer critical care resources than many other countries. As a consequence, the authors of the new study argue, there are reasons to think that in-hospital COVID-19 deaths in African countries may be higher than global averages.

3,140 participants

To explore this further, the researchers conducted a study involving 64 hospitals in Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger, Nigeria, and South Africa.

Between May and December 2020, 3,752 adults were admitted to intensive care and critical care units with suspected or confirmed COVID-19. Of these individuals, 3,140 participated in the study.

The researchers tracked the individuals for 30 days from admission.

48.2% in-hospital mortality

The researchers found that 48.2% of the participants died with COVID-19 within the 30-day window. This meant that there were 11–23 additional deaths per 100 people compared with global averages.

Of the participants who survived, 84% were discharged, while 16% stayed in the hospital.

A total of 51% of the participants had high blood pressure, and 38% had diabetes. People with HIV, those with chronic kidney disease, and those with coronary artery disease each made up 7.7% of the participants.

The researchers also saw a connection between underlying health conditions and the risk of mortality. People with either HIV or chronic kidney disease were twice as likely to die in the hospital, while chronic liver disease more than tripled the risk.

The study authors suggest that a lack of access to resources and the underutilization of available resources may account for the relatively high in-hospital mortality rates. Limited resources include critical care beds, oximeters, and dialysis machines.

For corresponding author Prof. Bruce Biccard, of the Department of Anesthesia and Perioperative Medicine at the University of Cape Town, South Africa, the findings suggest: “We need to have minimum standards for critical care. Only once we have regulation for minimum standards can we demand for these resources and thereby have the resources to deliver the care necessary to improve quality of care.”

In a linked commentary article, Dr. Bruce J. Kirenga and Prof. Pauline Byakika-Kibwika, of Makerere University College of Health Sciences, Uganda, point out that even when critical care resources are available, “it is common in Africa to have expensive equipment that is nonfunctional due to poor maintenance or lack of skilled human resources.”

For Prof. Biccard, the findings also make clear the need for COVID-19 vaccinations in Africa.

“There is a real need for vaccination across Africa as soon as possible. We do not have enough critical care beds to care for severely ill patients, and vaccination prevents severe infection. Importantly, we cannot afford to have a scenario similar to what is happening in India happen in Africa,” Prof. Biccard told Medical News Today.

Study findings not generalizable

The researchers note that their study has some significant limitations.

For example, there are 54 countries in Africa, and the researchers only gathered data on 10, leaving much unknown about whether it is possible to generalize these results across the continent.

Originally, 40 countries received invitations to participate in the study, and 26 agreed, but regulatory or ethical approval issues meant that only 10 of them eventually took part. Overall, 36% of the included hospitals were based in South Africa and Egypt, which may have access to more critical care resources.

For Prof. Biccard, the limited spread of countries in the study is itself due to the limited access to healthcare resources that some countries face.

“The clinicians are working in very stressful situations where they have extremely limited resources, and to conduct research at the same time is extremely difficult, especially during a pandemic,” Prof. Biccard told MNT.

“Further, in a number of places in Africa, research has limited capacity, with almost universally no dedicated research staff. This results in a massive increase in time required to ensure that all the necessary ethics and regulatory requirements can be addressed.”

Nonetheless, the research represents the largest cohort of in-hospital COVID-19 patients from African countries with fewer critical care resources.

“Our study is the first to give a detailed and comprehensive picture of what is happening to people who are severely ill with COVID-19 in Africa, with data from multiple countries and hospitals,” says Prof. Biccard. “Sadly, it indicates that our ability to provide sufficient care is compromised by a shortage of critical care beds and limited resources within intensive care units.”

“We hope these findings can help prioritize resources and guide the management of severely ill patients — and ultimately save lives — in resource-limited settings around the world.”

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