Severe COVID-19 in Uganda across Two Epidemic Phases: A Prospective Cohort Study.

Barnabas Bakamutumaho,Richard Natuhwera,Moses Muwanga,Joyce Namulondo,Bernard Kikaire,Nicholas Owor,Lucy Wanyenze,Alice Ndazarwe,Josephine Achan,Henry Kyobe Bosa,Ruth Nakanjako,Felix Ocom,John Kayiwa,Timothy Byaruhanga,Roselyn Mutonyi,Annet Nsangi,Christopher Nsereko,Emmanuel Rwamutwe,Matthew J Cummings,Julius J Lutwama,Max O’donnell

doi:10.4269/ajtmh.21-0551

Abstract

ABSTRACT.Among a prospective cohort of children and adults admitted to a national COVID-19 treatment unit in Uganda from March to December 2020, we characterized the epidemiology of and risk factors for severe illness. Across two epidemic phases differentiated by varying levels of community transmission, the proportion of patients admitted with WHO-defined severe COVID-19 ranged from 5% (7/146; 95% CI: 2–10) to 33% (41/124; 95% CI: 25–42); 21% (26/124; 95% CI: 14–29%) of patients admitted during the peak phase received oxygen therapy. Severe COVID-19 was associated with older age, male sex, and longer duration of illness before admission. Coinfection with HIV was not associated with illness severity; malaria or tuberculosis coinfection was rare. No patients died during admission. Despite low mortality, hospital incidence of severe COVID-19 during the first epidemic peak in Uganda was substantial. Improvements in vaccine deployment and acute care capacity, including oxygen delivery, are urgently needed to prevent and manage severe COVID-19 in sub-Saharan Africa.

Highlights

Little is known about the clinical epidemiology of severe COVID-19 in sub-Saharan Africa (SSA)
Across two epidemic phases differentiated by varying levels of community transmission, the proportion of patients admitted with WHO-defined severe COVID-19 ranged from 5% (7/146; 95% CI: 2–10) to 33% (41/124; 95% CI: 25–42); 21% (26/124; 95% CI: 14–29%) of patients admitted during the peak phase received oxygen therapy
Based on criteria established by WHO, we considered patients to have severe COVID-19 if they fulfilled at least one of the following criteria during admission: 1) oxygen saturation, 90% on room air, 2) respiratory rate . 30 breaths/minute, 3) showed signs of respiratory distress, or 4) received oxygen therapy.[6]

Summary

Introduction

Little is known about the clinical epidemiology of severe COVID-19 in sub-Saharan Africa (SSA). We characterize the epidemiology of and risk factors for severe COVID-19 among a prospective cohort of children and adults admitted to a national COVID-19 treatment unit in Uganda during the first two phases of the epidemic

Methods

Results

Conclusion