According to the observational survey of 64 hospitals in 10 African countries, the death rate in adults in the 30 days after admission to the ICU with suspected or confirmed COVID-19 infection was significantly higher in Africa (48.2 percent average; 1,483) / 3,077 patients) than worldwide (average 31.5 percent; from a meta-analysis of 34,859 patients).
The researchers, who are all based on the continent, identified a critical factor in these excessive deaths This could be a lack of critical care resources and insufficient use of available resources. For example, half of the patients died without oxygen, while 68 percent of the hospitals had access to kidney dialysis, as only 10 percent of the seriously ill patients received it.
Estimates assume dialysis was seven times lower, despite the availability of oxygenate blood (ECMO) was 14 times lower than required for adequate treatment of COVID-19 patients.
The results have important implications for the management of critical patients in resource-constrained environments where there is a lack of deprivation
Head of studies in Nigeria, Prof. Akinyinka Omigbodun from University College Hospital, Ibadan, and Prof. Adesoji Ademuyiwa from Lagos University Teaching Hospital (LUTH), Idi-Araba, reported that the challenges faced by this group of people faced, could be partially mitigated by not only ensuring the availability of the human and material resources required for their care, but also the necessary attention is paid o the distribution of these resources among all centers providing intensive care services across the country.
Prof. Bruce Biccard from Groote Schuur Hospital and the University of Cape Town, South Africa, who co-directed the research, indicated that the work should first give a full picture of what is happening to these people.
So far Little is known about how the pandemic seriously affected this group of people in the face of insufficient resources.
To fill this gap, the African COVID-19 Critical Care Outcomes Study (ACCCOS) identifies the human and hospital resources, underlying conditions, and critical care interventions responsible for adult (aged 18+) mortality or survival who were admitted to the intensive care unit or intensive care unit. Nursing units in Africa.
The study focused on 64 hospitals in the above countries.
Between May and December 2020, around half (3,752 / 6,779) of the patients referred with suspicion or confirmed COVID-19 infection for critical care have been approved. 3,140 of these patients took part in the study. All participants received standard care and were followed up for at least 30 days unless they died or were discharged. The modeling was used to identify risk factors associated with death.
After 30 days, almost half (48 percent, 1,483 / 3,077) of the critically ill patients had died. The analysis estimates that the death rates in these African patients were 11 percent (at best) to 23 percent (at worst) higher than the global average of 31.5 percent.
Of the survivors, 16 remained Percent (261 / 1,594) in hospital, and 84 percent (1,333 / 1,594) had been discharged. The outcome of 63 patients is unknown.
The study estimates that dialysis care needs to be increased seven-fold and ECMO increased 14-fold to be adequate for the critically ill COVID-19 patients in this study to supply. For example, even inexpensive basic equipment was in short supply, as only 86 percent (49/57) of the devices were able to provide pulse oximetry (for monitoring blood oxygen levels) to all patients in intensive care medicine. Similarly, 17 percent (10/57) of hospitals had access to ECMO, but despite the evidence of its use in COVID-19 patients with respiratory failure, less than one percent of patients were offered it.
The The majority of the patients were men (61 percent; 1,890 / 3,118 patients, mean age 56 years) with few chronic underlying diseases. Among participants with available data, the most common underlying diseases were high blood pressure (51 percent, 1,572 / 3,104), diabetes (38 percent, 1,175 / 3,090), human immuno-deficiency virus (HIV) / acquired immune deficiency syndrome (AIDS) 7.7 percent, 237 / 3,084), chronic kidney disease (7.7 percent, 241/3085), and coronary artery disease (7.7 percent, 237/3093).
People with pre-existing medical conditions were at the highest risk for bad results. Chronic kidney disease or HIV / AIDS has almost doubled the risk of death, while chronic liver disease has more than tripled the risk of death. Diabetes was also linked to poor survival (75 percent increased risk of death). However, unlike previous studies, masculinity was not associated with increased mortality.
“The finding that men did not have any worse outcomes than women is unexpected,” says co-head Professor Dean Gopalan of the University of KwaZulu-Natal, South Africa. “It could be that the African women in this study had a higher risk of death because they had disabled access to care or had care and limitations or prejudices in care when they were seriously ill.”
Im Compared to survivors, deceased patients were also more likely to have a higher degree of organ dysfunction (SOFA score (Sequential Organ Failure Assessment)) and required more respiratory and cardiovascular support when admitted to the intensive care unit. However, resources for this care are limited.
According to Gopalan, “The Rapid SOFA Score could be a simple tool that can be used to assist clinicians with critical admissions in low resource environments To identify patients with poor prognosis an early stage and to avoid delays in starting the necessary organ support. “
The researchers said that although intensive care units reported relatively high staffing rates with 24-hour medical care seven days a week and a nurse, the mortality rate was high, possibly with a patient ratio of 1: 2 due to the lack of specialist staff.
According to co-author Dr. Vanessa Msosa of Kamuzu Central Hospital in Malawi: “This cross-continental collaboration has provided much-needed data on our unique CO need for VID-19 patient care. Although our younger population means that most countries in Africa have avoided the high mortality rates seen in many parts of the world, hospital mortality suffers from inadequate resources with only half of referrals being admitted to critical care for lack of beds. Patient outcomes will continue to be severely impacted until the lack of critical care resources is addressed. “
The authors noted some limitations to their study, including that it was mainly conducted in university-affiliated, government-funded, and tertiary hospitals, and it is likely that the results will be obtained in lower-level hospitals with less critical resources Care units could be worse. In addition, the study cohort was younger than other COVID-19 intensive cohorts and, adjusted for age, is likely to represent an overestimation of excess mortality. They add that while this is the largest dataset for critically ill patients from underserved facilities, it represents only 10 African countries and most hospitals were in the relatively well-resourced countries of South Africa and Egypt, which could affect the generalizability of the results / p>
Dr. Bruce Kirenga and Dr. Pauline Byakika-Kibwika of Makerere University, Uganda (who were not involved in the study) write in a linked comment: “The inadequate use of resources is a fascinating finding. Contrary to popular belief that resources are scarce, it is important to talk about to think beyond the availability of resources and also to consider functionality issues. In Africa it is common to have expensive equipment that is inoperable due to poor maintenance or a lack of skilled workers. In 2017, the Tropical Health and Education Trust reported that 40 percent of medical devices in Africa were out of service, 80 percent of medical devices were donated, 70 percent to 90 percent of devices donated had never been used, and only two were in African Countries there were professional biomedical engineers. “The study was funded in part by a grant from the Critical Care Society of Southern Africa. ACCCOS) investigators carried it out.