RT Journal Article
SR Electronic
T1 Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa: descriptive observational study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e047016
DO 10.1136/bmjopen-2020-047016
VO 11
IS 1
A1 Robert James Mash
A1 Mellisa Presence-Vollenhoven
A1 Adeloye Adeniji
A1 Renaldo Christoffels
A1 Karlien Doubell
A1 Lawson Eksteen
A1 Amee Hendrikse
A1 Lauren Hutton
A1 Louis Jenkins
A1 Paul Kapp
A1 Annie Lombard
A1 Heleen Marais
A1 Liezel Rossouw
A1 Katrin Stuve
A1 Abi Ugoagwu
A1 Beverley Williams
YR 2021
UL http://bmjopen.bmj.com/content/11/1/e047016.abstract
AB Objectives To describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals.Design A descriptive observational cross-sectional study.Setting District hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians.Participants All patients who presented to the hospitals’ emergency centre and who tested positive for COVID-19 between March and June 2020.Primary and secondary outcome measures Source of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location.Results 1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0–3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality.Conclusion District hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.