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. 2024 Apr 16;19(1):34.
doi: 10.5334/gh.1314. eCollection 2024.

Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa

Lina Hahnle  1   2   3 , Mathilda Mennen  1   2   3 , Freedom Gumedze  4 , Daniel Mutithu  2   3   5 , Marguerite Adriaanse  1   2   3 , Daniel Egan  1 , Simthandile Mazondwa  1 , Rochelle Walters  1   2   3 , Lambert Tetteh Appiah  6 , Francisca Inofomoh  7 , Okechukwu Ogah  8 , Olukemi Adekanmbi  9 , Fastone Goma  10 , Elijah Ogola  11 , Kieran Mwazo  12 , Ahmed Suliman  13 , Kavita Singh  14   15 , Lana Raspail  16 , Dorairaj Prabhakaran  17   18   19 , Pablo Perel  18   20 , Karen Sliwa  18   21 , Ntobeko A B Ntusi  1   2   18   22
Affiliations

Greater Disease Severity and Worse Clinical Outcomes in Patients Hospitalised with COVID-19 in Africa

Lina Hahnle et al. Glob Heart. .

Abstract

Background: COVID-19 cardiovascular research from Africa is limited. This study describes cardiovascular risk factors, manifestations, and outcomes of patients hospitalised with COVID-19 in the African region, with an overarching goal to investigate whether important differences exist between African and other populations, which may inform health policies.

Methods: A multinational prospective cohort study was conducted on adults hospitalised with confirmed COVID-19, consecutively admitted to 40 hospitals across 23 countries, 6 of which were African countries. Of the 5,313 participants enrolled globally, 948 were from African sites (n = 9). Data on demographics, pre-existing conditions, clinical outcomes in hospital (major adverse cardiovascular events (MACE), renal failure, neurological events, pulmonary outcomes, and death), 30-day vitality status and re-hospitalization were assessed, comparing African to non-African participants.

Results: Access to specialist care at African sites was significantly lower than the global average (71% vs. 95%), as were ICU admissions (19.4% vs. 34.0%) and COVID-19 vaccination rates (0.6% vs. 7.4%). The African cohort was slightly younger than the non-African cohort (55.0 vs. 57.5 years), with higher rates of hypertension (48.8% vs. 46.9%), HIV (5.9% vs. 0.3%), and Tuberculosis (3.6% vs. 0.3%). In African sites, a higher proportion of patients suffered cardiac arrest (7.5% vs. 5.1%) and acute kidney injury (12.7% vs. 7.2%), with acute kidney injury (AKI) appearing to be one of the strongest predictors of MACE and death in African populations compared to other populations. The overall mortality rate was significantly higher among African participants (18.2% vs. 14.2%).

Conclusions: Overall, hospitalised African patients with COVID-19 had a higher mortality despite a lower mean age, contradicting literature that had previously reported a lower mortality attributed to COVID-19 in Africa. African sites had lower COVID-19 vaccination rates and higher AKI rates, which were positively associated with increased mortality. In conclusion, African patients were hospitalized with more severe COVID-19 cases and had poorer outcomes.

Keywords: Africa; COVID-19; cardiovascular disease; mortality; sub-Saharan Africa.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1 Central figure displaying participating sites and key study findings.
Figure 1
Central figure displaying participating sites and key study findings.
Figure 2 Hospital level resources and ICU admissions by regions. Figure 1 shows that sites in the African region had significantly lower rates of specialist care, advanced care, and ICU admissions compared to non-African sites.
Figure 2
Hospital level resources and ICU admissions by regions. Figure 1 shows that sites in the African region had significantly lower rates of specialist care, advanced care, and ICU admissions compared to non-African sites.
See this image and copyright information in PMC

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