COVID-19 Disease Severity and Associated Factors among Ethiopian Patients: A study of the Millennium COVID-19 Care Center

Abstract

AbstractBackgroundThe COVID-19 pandemic started a little later in Ethiopia than Europe and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting.ObjectiveThe study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity.MethodsA cross-sectional study was conducted from June to August 2020 among 686 randomly selected 686 patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify risk factors of COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing.ResultsHaving moderate as compared with mild disease was significantly associated with having hypertension (AOR=2.30, 95%CI=1.27,4.18, p-value=0.006), diabetes mellitus (AOR=2.61, 95%CI=1.31,5.19, p-value=0.007 for diabetes mellitus), fever (AOR=6.12, 95%CI=2.94,12.72, p-value=0.0001) and headache (AOR=2.69, 95%CI=1.39,5.22, p-value=0.003). Similarly, having severe disease as compared with mild disease was associated with age group (AOR=4.43, 95%CI=2.49,7.85, p-value=0.0001 for 40-59 years and AOR=18.07, 95%CI=9.29,35.14, p-value=0.0001 for ≥ 60 years), sex (AOR=1.84, 95%CI=1.12,3.03, p-value=0.016), hypertension (AOR=1.97, 95%CI=1.08,3.59, p-value=0.028), diabetes mellitus (AOR=3.93, 95%CI=1.96,7.85, p-value=0.0001), fever (AOR=13.22, 95%CI=6.11, 28.60, p-value=0.0001) and headache (AOR=4.82, 95%CI=2.32, 9.98, p-value=0.0001). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR=4.87, 95%CI=2.85, 8.32, p-value=0.0001 for 40-59 years and AOR=18.91, 95%CI=9.84,36.33, p-value=0.0001 for ≥ 60 years), fever (AOR=2.16, 95%CI=1.29,3.63, p-value=0.004) and headache (AOR=1.79, 95%CI=1.03, 3.11, p-value=0.039).ConclusionsRisk factors associated with severe COVID-19 in Ethiopia are being greater than 60 years old, male, a diagnosis of hypertension, and diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in Ethiopia were less than 60 years of age with fewer health problems.