Clinical features and risk factors associated with morbidity and mortality among patients with COVID-19 in northern Ethiopia

Highlights

• Compulsory quarantine of all Ethiopian patients with confirmed severe acute respiratory syndrome coronavirus-2 infection enabled analysis of the proportion of asymptomatic cases.

• Comprehensive clinical features and representative morbidity and mortality outcomes of patients with coronavirus disease 2019 (COVID-19) in Sub-Saharan Africa were determined.

• A significant proportion of patients were asymptomatic or presymptomatic at clinical presentation.

• Co-infection with human immunodeficiency virus is a significant risk factor for developing severe COVID-19.

Abstract

Objective

To describe the clinical features and assess the determinants of severity and in-hospital mortality of patients with coronavirus disease 2019 (COVID-19) from a unique setting in Ethiopia.

Methods

Consecutive patients admitted to a COVID-19 isolation and treatment centre were included in this study. The overall clinical spectrum of COVID-19, and factors associated with risk of severe COVID-19 and in-hospital mortality were analysed.

Results

Of 2617 quarantined patients, three-quarters (n = 1935, 74%) were asymptomatic and only 114 (4.4%) presented with severe COVID-19. Common characteristics among the 682 symptomatic patients were cough (n = 354, 50.6%), myalgia (n = 212, 31.1%), headache (n = 196, 28.7%), fever (n = 161, 23.6%), dyspnoea (n = 111, 16.3%), anosmia and/or dysgeusia (n = 90, 13.2%), sore throat (n = 87, 12.8%) and chest pain (n = 77, 11.3%). Factors associated with severe COVID-19 were older age [adjusted relative risk (aRR) 1.78, 95% confidence interval (CI) 1.61–1.97; P < 0.0001], diabetes (aRR 2.00, 95% CI 1.20–3.32; P = 0.007), cardiovascular disease (aRR 2.53, 95% CI 1.53–4.17; P < 0.0001), malignancy (aRR 4.57, 95% CI 1.62–12.87; P = 0.004), surgery/trauma (aRR 23.98, 95% CI 10.35–55.57; P < 0.0001) and human immunodeficiency virus infection (aRR 4.24, 95% CI 1.55–11.61; P = 005). Factors associated with risk of in-hospital mortality included older age (aRR 2.37, 95% CI 1.90–2.95; P < 0.001), malignancy (aRR 6.73, 95% CI 1.50–30.16; P = 0.013) and surgery/trauma (aRR 59.52, 95% CI 12.90–274.68; P < 0.0001).

Conclusions

A significant proportion of cases of COVID-19 were asymptomatic, and key comorbid conditions increased the risk of severe COVID-19 and in-hospital mortality. These findings could help in the design of appropriate management strategies for patients.