Clinical manifestations and mortality among hospitalized COVID-19 patients in Tanzania, 2021-2022

Abstract

BackgroundThere have been differential mortality rates from Corona Virus Disease of 2019 (COVID-19) in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this study in a Sub-Saharan African country. The aim of this study was to describe clinical manifestations and outcome of patients diagnosed with COVID-19 in selected tertiary hospitals in Tanzania.Methods and FindingsA retrospective analysis of archived data from 26thMarch, 2021 to 30thSeptember, 2022 was done for adults aged ≥18 years who were admitted in five tertiary-level hospitals in Tanzania. Information collected included socio-demographic, radiological and clinical characteristics of the patients as well as outcome of the admission (discharge vs death). Categorical variables were presented as frequencies and proportions and compared using Chi square test. Logistic regression was used to assess the relationship between COVID-19 mortality and the collected variables. Out of 1387 COVID-19 patients, approximately 52% were males. The median age was 60 years [(IQR)= (19-102)). The most common symptoms were dyspnea (943,68%), cough (889, 64%), fever (597,43%) and fatigue (570, 41%). In hospital mortality was (476, 34%). Mortality significantly increased with increasing age, being the most in age >90 years [aOR (95% CI) =6.72 (1.94-20.81), P<0.001. Other predictors of death were not possessing a health insurance, [aOR (95% CI) = 2.78 (2.09-3.70), P<0. 001], dyspnea [aOR (95% CI) = 1.40(1.02-2.06), P=0.03]; chest pain, [aOR (95% CI) = 1.78 (1.12-3.21), P=0.03]; HIV positivity, [aOR (95% CI) = 4.62 (2.51-8.73), P<0.001]; neutrophilia, [aOR (95% CI) = 1.02 (1.01 – 1.03), P=0.02]; none use of ivermectin, [aOR (95% CI) = 1.46 (1.09 – 2.22), P=0.02] and non-use of steroid, [aOR (95% CI) = 1.40 (1.2 – 2.5), P=0.04]. Retrospective nature of this study which based on documented patients records, with a large number of patients left out of the analysis due to missed data, this might in a way affect the results of the present study.ConclusionsThe most common presenting symptoms were dyspnea, cough and fever, just as what was common elsewhere in the world. Mortality increased significantly with age, in HIV-infected patients, in those without a health insurance, those presenting with dyspnea, chest pain, or neutrophilia and those who did not use steroid or ivermectin. Clinicians should actively look for the predictors of mortality and take appropriate management to reduce mortality.