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?. (January 2022)

• Record Type: Journal Article
• Authors: Ali, Mohamed Mahmoud; Malik, Mamunur Rahman; Ahmed, Abdulrazaq Yusuf; Bashir, Ahmed Muhammad; Mohamed, Abdulmunim; Abdi, Abdulkadir; Obtel, Majdouline
• Is Part Of: International journal of infectious diseases. Volume 114(2022)
• Page Start: 202
• Page End: 209
• Publication Date: 2022-01
• Subjects: COVID-19 -- Non-invasive ventilation -- Hospital mortality -- Somalia -- Survival analysis -- Risk factors -- Critical illness -- Comorbidities -- SARS-CoV-2 -- Fragile state -- Mogadishu; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.11.018
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Survival analysis was conducted for 131 patients with coronavirus disease 2019 (COVID-19) in Somalia. Interventions to improve outcomes in this low-resource and fragile setting were examined. Risk factors for deaths included age ≥60 years, cardiovascular disease and use of non-invasive ventilation. Patients who received oxygen alone were more likely to survive than patients who were ventilated. Optimizing critical care for patients with COVID-19 in fragile states requires policy discourse. 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.