Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states?
ABSTRACT: Objectives: To determine risk factors for death in patients with coronavirus disease 2019 (COVID-19) admitted to the main hospital in Somalia, and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. Methods: A survival analysis was condu...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971221008651 |
| _version_ | 1819097800857616384 |
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| author | Mohamed Mahmoud Ali Mamunur Rahman Malik Abdulrazaq Yusuf Ahmed Ahmed Muhammad Bashir Abdulmunim Mohamed Abdulkadir Abdi Majdouline Obtel |
| author_facet | Mohamed Mahmoud Ali Mamunur Rahman Malik Abdulrazaq Yusuf Ahmed Ahmed Muhammad Bashir Abdulmunim Mohamed Abdulkadir Abdi Majdouline Obtel |
| author_sort | Mohamed Mahmoud Ali |
| collection | DOAJ |
| description | ABSTRACT: Objectives: To determine risk factors for death in patients with coronavirus disease 2019 (COVID-19) admitted to the main hospital in Somalia, and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. Methods: A survival analysis was conducted of all patients with COVID-19 admitted to the main hospital in Somalia from 30 March to 12 June 2020. Results: Of the 131 patients admitted to the hospital with COVID-19, 52 (40%) died and 79 (60%) survived. The main factors associated with the risk of in-hospital death were age ≥60 years {survival probability on day 21 was 0.789 [95% confidence interval (CI) 0.658–0.874] in patients aged <60 years vs 0.339 (95% CI 0.205–0.478) in patients aged ≥60 years}, cardiovascular disease [survival probability 0.478 (95% CI 0.332–0.610) in patients with cardiovascular disease vs 0.719 (95% CI 0.601–0.807) in patients without cardiovascular disease] and non-invasive ventilation on admission (patients who were not ventilated but received oxygen were significantly more likely to survive than patients who were ventilated; P<0.001). Conclusion: Considering the risk factors (age ≥60 years, presence of cardiovascular disease and use of non-invasive ventilation) is critical when managing patients with severe COVID-19, especially in low-resource settings where availability of skilled healthcare workers for critical care units is limited. These findings also highlight the importance of use of medical oxygen for severely ill patients, and the critical aspect of deciding whether or not to ventilate critical patients with COVID-19 in order to improve clinical outcome. |
| first_indexed | 2024-12-22T00:20:51Z |
| format | Article |
| id | doaj.art-60e1a3dedf5c4e378564639f70afd0f8 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-12-22T00:20:51Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-60e1a3dedf5c4e378564639f70afd0f82022-12-21T18:45:10ZengElsevierInternational Journal of Infectious Diseases1201-97122022-01-01114202209Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states?Mohamed Mahmoud Ali0Mamunur Rahman Malik1Abdulrazaq Yusuf Ahmed2Ahmed Muhammad Bashir3Abdulmunim Mohamed4Abdulkadir Abdi5Majdouline Obtel6Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Corresponding author. Address: Research Leadership and Capacity Building, Department of Sexual and Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Tel.: +41 22 791 3530.World Health Organization Country Office, Mogadishu, SomaliaDe Martino Hospital, Ministry of Health and Human Services, Federal Government of Somalia, Mogadishu, SomaliaDe Martino Hospital, Ministry of Health and Human Services, Federal Government of Somalia, Mogadishu, Somalia; Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, SomaliaWorld Health Organization Country Office, Mogadishu, SomaliaWorld Health Organization Country Office, Mogadishu, SomaliaWorld Health Organization Country Office, Mogadishu, Somalia; Laboratory of Community Health (Public Health, Preventive Medicine and Hygiene) and Laboratory of Biostatistics, Epidemiology and Clinical Research, Department of Public Health, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, MoroccoABSTRACT: Objectives: To determine risk factors for death in patients with coronavirus disease 2019 (COVID-19) admitted to the main hospital in Somalia, and identify interventions contributing to improved clinical outcome in a low-resource and fragile setting. Methods: A survival analysis was conducted of all patients with COVID-19 admitted to the main hospital in Somalia from 30 March to 12 June 2020. Results: Of the 131 patients admitted to the hospital with COVID-19, 52 (40%) died and 79 (60%) survived. The main factors associated with the risk of in-hospital death were age ≥60 years {survival probability on day 21 was 0.789 [95% confidence interval (CI) 0.658–0.874] in patients aged <60 years vs 0.339 (95% CI 0.205–0.478) in patients aged ≥60 years}, cardiovascular disease [survival probability 0.478 (95% CI 0.332–0.610) in patients with cardiovascular disease vs 0.719 (95% CI 0.601–0.807) in patients without cardiovascular disease] and non-invasive ventilation on admission (patients who were not ventilated but received oxygen were significantly more likely to survive than patients who were ventilated; P<0.001). Conclusion: Considering the risk factors (age ≥60 years, presence of cardiovascular disease and use of non-invasive ventilation) is critical when managing patients with severe COVID-19, especially in low-resource settings where availability of skilled healthcare workers for critical care units is limited. These findings also highlight the importance of use of medical oxygen for severely ill patients, and the critical aspect of deciding whether or not to ventilate critical patients with COVID-19 in order to improve clinical outcome.http://www.sciencedirect.com/science/article/pii/S1201971221008651COVID-19Non-invasive ventilationHospital mortalitySomaliaSurvival analysisRisk factors |
| spellingShingle | Mohamed Mahmoud Ali Mamunur Rahman Malik Abdulrazaq Yusuf Ahmed Ahmed Muhammad Bashir Abdulmunim Mohamed Abdulkadir Abdi Majdouline Obtel Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states? International Journal of Infectious Diseases COVID-19 Non-invasive ventilation Hospital mortality Somalia Survival analysis Risk factors |
| title | Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states? |
| title_full | Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states? |
| title_fullStr | Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states? |
| title_full_unstemmed | Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states? |
| title_short | Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March–12 June 2020: which interventions are proving effective in fragile states? |
| title_sort | survival analysis of all critically ill patients with covid 19 admitted to the main hospital in mogadishu somalia 30 march 12 june 2020 which interventions are proving effective in fragile states |
| topic | COVID-19 Non-invasive ventilation Hospital mortality Somalia Survival analysis Risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S1201971221008651 |
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