Rural Southwest Research Articles

Dual Caregivers of Persons living with Dementia: The Added Stress of COVID-19 Pandemic.

Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.

Knowledge and Practice of Dietary Diversity among Pregnant Women: Evaluation of a Large Scale Social and Behaviour Change Program in Bangladesh

The objective of this study was to evaluate the effectiveness of a U.S. Agency for International Development (USAID) supported large-scale social and behaviour change (SBC) intervention, SHIKHA Project, in improving dietary diversity among pregnant women. Cross-sectional survey was conducted in rural southwest Bangladesh and 509, 515, and 1,275 randomly selected pregnant women were interviewed at baseline, midline, and end-line; 514 and 1016 pregnant women from non-intervention areas were also included. SBC intervention was provided to pregnant women at both individual and group levels by trained community health workers during the antenatal and postnatal period. Dietary diversity scores (DDS) and knowledge scores were calculated by summing the number of food groups (from nine defined food groups) consumed by women during 24 hours and from unprompted responses on how many food groups pregnant women should eat. The mean knowledge score for dietary diversity was 5.04 at baseline and significantly increased by 1.68 units (95% CI: 1.51, 1.85) at the end-line. The mean DDS at baseline was 4.28 and significantly increased by 0.45 units (95% CI: 0.34, 0.57) at the end-line. The SBC intervention was effective in improving the dietary diversity of pregnant women, which may help to meet their additional nutritional requirements and improve pregnancy outcomes. Bangladesh J. Nutr. Vol. 34, December 2020, P: 65-75

A mobile cesarean birth center as a solution to improve access to surgical birth in rural Ethiopia: a mixed methods research protocol

BackgroundAs an evidence-based intervention to prevent maternal and neonatal morbidity and mortality, cesarean birth at rates of under 2%, which is the case in rural Southwest Ethiopia, is an unacceptable public health problem and represents an important disparity in the use of this life-saving treatment compared to more developed regions. The objective of this study is to explore an innovative clinical solution (a mobile cesarean birth center) to low cesarean birth rates resulting from the Three Delays to emergency obstetric care in isolated and underserved regions of Ethiopia, and the world.MethodsWe will use mixed but primarily qualitative methods to explore and prepare the mobile cesarean birth center for subsequent implementation in communities in Bench Sheko and West Omo Zones. This will involve interviews and focus groups with key stakeholders and retreat settings for user-centered design activities. We will present stakeholders with a prototype surgical truck that will help them conceive of the cesarean birth center concept and discuss implementation issues related to staffing, supplies, referral patterns, pre- and post-operative care, and relationship to locations for vaginal birth.DiscussionCompletion of our study aims will allow us to describe participants’ perceptions about barriers and facilitators to cesarean birth and their attitudes regarding the appropriateness, acceptability, and feasibility of a mobile cesarean birth center as a solution. It will also result in a specific, measurable, attainable, relevant, and timely (SMART) implementation blueprint(s), with implementation strategies defined, as well as recruitment plans identified. This will include the development of a logic model and process map, a timeline for implementation with strategies selected that will guide implementation, and additional adaptation/adjustment of the mobile center to ensure fit for the communities of interest.Trial registrationThere is no healthcare intervention on human participants occurring as part of this research, so the study has not been registered.

Sodium content of menu and commissary provisions in rural jail exceeds heart-healthy dietary recommendations.

This paper determined sodium provisions from a seven-day cycle menu and commissary at a rural Southwest County jail and compared it to Dietary Reference Intakes (DRI) and Dietary Approaches to Stop Hypertension (DASH) recommendations for sodium. A seven-day cycle menu and commissary items were used to determine sodium content for each meal and commissary pack. Estimates for the menu and commissary packs paired with the menu (commissary scenarios) were converted to a daily average of sodium and compared to DRI and DASH recommendations. Menu provisions provided 167% of daily DRI sodium recommendations and 256% of daily DASH sodium recommendations. The sodium content for individual commissary scenarios averaged 218% of DRI and 334% of DASH recommendations. Commissary items are notably high in sodium and if eaten can significantly exceed dietary recommendations. Small changes to one meal within the cycle menu and the inclusion of fresh or frozen produce could reduce sodium content to align with DRI and DASH recommendations.

Profound racial disparities in COVID-19 associated hospitalizations in rural Southwest Georgia

BackgroundThe coronavirus disease 2019 (COVID-19) is responsible for one of the largest public health crises the United States has seen to date. This study explores the outcomes of African American and non-African American COVID-19-positive patients hospitalized in rural Southwest Georgia to identify differences in morbidity and mortality between the groups. MethodsWe performed a retrospective cohort analysis among adults aged ≥18 years admitted with COVID-19 between March 2, 2020 and June 17, 2020 at Phoebe Putney Health System. Data on demographics, comorbidities, presenting symptoms, and hospital course were obtained. Patients were divided into two groups: African Americans and non-African Americans. We examined differences in patient characteristics between groups using chi-square tests for categorical variables, t-test for parametric continuous variables, and Wilcoxon rank-sum tests for non-parametric continuous variables. Statistical Analysis Software (SAS) version 9.4 was used for statistical analysis. ResultsAmong 710 patients, median age was 63 years, 43.8% were males, and 83.3% were African Americans. African Americans had higher prevalence of obesity and hypertension, were more likely to present with fever, and present with longer duration of symptoms prior to presentation. In-hospital mortality was similar between the groups, as was need for mechanical ventilation, ICU care, and new dialysis. African Americans were more likely to be discharged home compared to non-African Americans. ConclusionsThere was no difference in in-hospital mortality; however, African Americans had disproportionately higher hospitalizations, likely to significantly increase the morbidity burden in this population. Urgent measures are needed to address this profound racial disparity.

Dietary diversity, environment and health-related factors of under-five children: evidence from cassava commercialization households in rural South-West Nigeria.

Diverse and quality diets are crucial to sustainable growth and development of under-five children, especially those of rural farming households. This study investigated the dietary diversity, environment, and health-related factors of young children. The study employed the use of cross-sectional survey data from 140 under-five children of cassava farming households in Ogun and Oyo states, South-West Nigeria. The study estimated factors influencing dietary diversity of under-five children and assessed children dietary diversity, and the availability of some environment and health-related factors of the farming households. The findings indicated that 98.7% and 97.5% of children consumed grains, with roots and tubers while 36.7% and 36.3% consumed legumes in Ogun and Oyo states respectively. The results also found that 48.6% of children sampled met the minimum cut-off point of 4 food groups with dietary diversity mean score of 3.28. The logit regression analysis indicated that child’s age, mothers’ age, distance to farm, and food expenditure were among the significant determinants of children dietary diversity. Therefore, this study seeks the collaborative efforts of stakeholders in providing nutrition-sensitive intervention programs for household members, especially mothers and young children in order to promote consumption of diversified diets and enhance healthy living of rural farming households.

Gender differences in time-poverty among rural householdsin Southwest Nigeria

This study seeks to assess gender inequality in and correlates of time poverty among 360 rural households in Southwest, Nigeria. A person is deemed to be time poor if (s)he works more than 10.5 hours per day, the internationally accepted threshold. Using the time allocation domain of the Abbreviated Women’s Empowerment in Agriculture Index, the study found that on the average, rural women and men spent about 10.3 hours and 8 hours, respectively, on work activities on a daily basis. Work activities for women were found to be diverse, spreading across reproductive and productive domains largely farming, own business e. g. trading, cooking and domestic work, while for men, work activities centred on productive economic activities, dominated by farming. Using a Probit regression model, the study found experience in agriculture and adoption of television to reduce the likelihood of time poverty among rural men. Surprisingly, participation in empowerment projects was found to increase the likelihood of time poverty among rural women. In conclusion, empowerment programmes should be expanded to address the non-material aspects of human well-being. Hence, the study recommends a gender-sensitive approach to intervention programmes in agriculture and adoption of a broader definition of empowerment which not only focus on expanding access to markets and increasing income but enhances control over time. This is more important for women who are already under the double burden of paid and unpaid domestic work.

Experience of intimate partner violence among rural women in Southwest, Nigeria.

Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally. Women's experiences of IPV in rural southwest Nigeria was examined in this study, conducted between July and August, 2019. A total of 677 women participated in this survey which employed a mobile phone application. Results revealed that the prevalence of experience of IPV was 39.4%. Experience of IPV was significantly higher among women who had been married longer (AOR = 2.09, 95% CI: 1.23, 2.93), completed secondary school (AOR = 1.81, 95% CI: 1.07, 3.05), were in the middle or richer wealth tertiles (AOR (95% CI= 1.59, 1.02, 2.51 and 1.84, 1.19, 2.84 respectively), and who justified IPV (AOR = 1.44, 95% CI: 1.00, 2.06). The prevalence of IPV among women in southwest Nigeria is high and determining factors are multi-faceted, hence the need for community sensitization interventions designed to address social norms that justify partner violence.

Level and predictors of dietary diversity among pregnant women in rural South-West Ethiopia: a community-based cross-sectional study

ObjectiveTo assess the magnitude of dietary diversity and associated factors among pregnant women in the rural communities of Jimma Zone, south-west Ethiopia.DesignA community-based cross-sectional study was conducted from 1 June...

How Are Rural Youths’ Agricultural Skills? Empirical Results and Implications in Southwest China

Global agriculture is facing an aging workforce and successor crisis, while the degradation of rural youths’ agricultural skills, which is indeed a concrete manifestation of young agricultural labor loss, has received little attention. Based on data from 1902 questionnaires in rural Southwest China, this study draws on a qualitative and quantitative analysis of the degradation of their skills to deepen the insights into the relationship between rural youth and agriculture. We found that rural youth have much lower agricultural skills than rural middle-aged and elderly residents, and their agricultural skills vary depending on gender, age, and occupation. Rural young non-agricultural workers’ large proportion among rural youth and low skills are the main sources of the reduction in rural youths’ skills. According to ordered logistic regression analysis, rural young non-agricultural workers who are older, have less education per person in their household, and have a larger cultivated land size have higher skills. As for rural students, 65.44% of the rural students have no skills, age and family’s agricultural income are significant positive influencing factors of their agricultural skills, and female youth have higher agricultural skills. The results provide references for policymakers to formulate targeted policies to cultivate rural young agricultural successors.

The Influence of Health Literacy and Social Support on Loneliness Among Patients With Severe Mental Illness in Rural Southwest China.

Loneliness is an important risk factor for poor health outcomes among adults, especially among those with severe mental illnesses (SMIs). Existing research has shown that adults with SMIs often lack health literacy, which contributes to more restricted social networks and low levels of social support. The objective of this cross-sectional study was to examine the influence of health literacy and social support on the loneliness of patients with SMI in rural Southwest China. We recruited 300 patients with SMI in rural Southwest China between December, 2017 to May, 2018 via a multi-stage stratified random sampling approach. We used structural equation modeling (SEM) test the hypothesized relationships among the variables of the 270 patients who completed the survey. Results of the SEM showed that health literacy was both directly and indirectly associated with loneliness, with social support playing a mediating role. These findings suggest psychoeducation for SMI patients, and their informal caregivers, may offer beneficial effects toward reducing loneliness in this vulnerable population. Further, social support is another potential target for intervention development for improving patient outcomes.

Towards malaria control in Nigeria: implications of the malaria parasite rate and spleen rate among children living in a rural community in southwest Nigeria.

The World Health Organization prioritizes malaria surveillance for accurate tracking of progress of intervention programmes. The malaria parasite rate (PR) and spleen rate (SR) are economical surveillance tools. There has been a global decline in the burden of malaria over the last decade, but most African countries, like Nigeria, have a slow rate of decline. There is a need for adequate malaria surveillance to guide malaria control strategies and policymaking. A community-based cross-sectional study was conducted among 363 children ages 1-15y in rural southwest Nigeria. The participants' PR was determined by microscopy and the SR was determined by palpation and ultrasonography. The associations between PR and SR and other covariates were assessed. The PR was 26.7% and the SR was 12.9%. There was no significant association between PR or SR across age groups, but low social class was significantly associated with PR (55 [33.5%], p=0.004) and SR (29 [17.3%], p=0.013). The odds of having splenomegaly doubled with malaria parasitaemia (odds ratio 2.03 [95% confidence interval 1.06 to 3.88). The PR and SR suggest that the study area is meso-endemic. The PR in the study area was almost equal across age groups; our findings suggest there may be a need for policy review to plan malaria intervention programmes and include older children, not just children <5y of age. Routine malaria surveillance using simple tools such as the PR and SR are necessary for reviewing malaria control programmes in the community.

Characteristics of Resilient Hospice Workers From Their Administrators’ Perspectives: A Qualitative Study

This study explores hospice administrators’ perceptions of the characteristics of resilient hospice workers. This qualitative phenomenological study included ten participants from five hospice organizations in rural and urban Southwest Missouri communities. All participants were current hospice administrators. Administrators identified six characteristics of resilient hospice workers. These characteristics included (a) relationship building with clients, (b) having a supportive team, (c) ongoing education, (d) positivity, (e) strong boundaries, and (f) the importance of spirituality. Authors suggest identifying and encouraging these characteristics in hospice workers may lead to less employee turnover, healthier employees, and a better work environment.

Abstract 007: Rural Southwest County Jail May Not Meet Recommendations For A Heart-healthy Diet During Pregnancy; A Descriptive Study

Introduction: Pregnancy aged women are the fastest growing incarcerated population in the US. These women have little to no autonomy while incarcerated, including their nutritional intake. Inadequate macro and micronutrients during pregnancy can increase a mother’s risk for preeclampsia, gestational diabetes, and coronary heart disease. However, it is unknown whether jails in the US provide adequate amounts of macro and micronutrients essential for pregnancy specific heart health while individuals are incarcerated. Hypothesis: We hypothesized that provisions from a rural Southwest county jail’s 7 day cycle menu, a weekly repeating menu of three meals a day, will not meet pregnancy specific heart healthy diet recommendations. Specifically, provisions of the menu will exceed recommendations of sodium, saturated fat, omega 6 fatty acid, and added sugars, and fail to meet recommendations of whole grains. Methods: The 7 day cycle menu was manually inputted into NutritionCalc Plus and ASA24, dietary assessment tools used to measure macro and micronutrient quantities of inputted food items. Average weekly sodium (mg), saturated fat (g), omega 6 (g), added sugar (g), and whole grain (% in comparison to refined grains) provisions were determined by summing total provisions over the 3 meals per day for 7 days and diving by 7. Excess or deficiency of macro and micronutrient provisions in the menu were estimated by determining as the proportions of macro and micronutrient provisions compared to heart healthy recommendations. Results: Average daily provisions of the 7 day menu were 3,847mg sodium, 26g saturated fat, 15g omega 6, and 12g of added sugar. These provisions translate into 167% of sodium (3,847 of 2,300), 200% saturated fat (26 of 13), 125% omega 6 (15 of 12), and 50% added sugar (12 of 24) guidelines of the heart healthy recommendations for pregnancy. Compared to whole grain recommendations of at least half of grain servings per day as whole, the provisions from the menu were 23% (1.75 of 7.70). Conclusions: In conclusion, although added sugar provisions from a rural Southwest county jail’s 7 day cycle menu were appropriate for a pregnancy specific heart healthy diet, provisions of sodium, saturated fat, and omega 6 exceeded guidelines, with a deficiency in whole grains. County jails should consider providing meals that limit sodium, saturated fat, and omega 6 and emphasize whole grains to ensure pregnant women in jail meet heart healthy recommendations to reduce cardiovascular disease risk. This research warrants larger epidemiological studies and cardiovascular health outcomes among pregnant women in jail.

Hemoglobin Level and Associated Factors among Pregnant Women in Rural Southwest Ethiopia.

Background Anemia is a situation in which the number and size of red blood cells, or the concentration of hemoglobin, fall below established cut-off values. Low hemoglobin level during pregnancy favors the alteration of placental angiogenesis and resulted in restricting the availability of nutrients to the fetus and consequently causing fetal growth retardation and low weight at birth. This study is aimed at assessing the hemoglobin level and associated factors among pregnant women in rural communities of Jimma zone, Southwest Ethiopia. Methods A community-based cross-sectional study design was carried out among 367 pregnant women from June 1 to 30, 2020. Systematic random sampling was used to select study subjects. Hemoglobin level was measured by using HemoCue HB 301. An interviewer-administered structured questionnaire was used to collect the data. Descriptive statistics were used to describe the study subjects. A multivariable linear regression model was employed after the linearity, normality, multicollinearity, and homoscedasticity assumptions were checked. The unstandardized beta (β) coefficient along with a 95% confidence interval was computed to estimate the association between explanatory and dependant variables. Statistical significance was declared at P value < 0.05. Results The mean (± SD) hemoglobin level of the respondents was 12.66 (±1.44) g/dl. The overall magnitude of anemia (hemoglobin level < 11 g/dl) among pregnant women was found to be 85 [23.16%, (95% CI: 18.3%-27.5%)]. Meal frequency [β = 0.40, (95% CI: 0.12, 0.69), P = 0.005], interpregnancy interval [β = 0.08, (95% CI: 0.02, 0.15), P = 0.007], mid-upper arm circumference measurement [β = 0.13, (95% CI: 0.07, 0.20), P ≤ 0.001], own fruits/vegetable [β = 0.55, (95% CI: 0.79, 0.31), P ≤ 0.001], coffee consumption [β = −1.00, (95% CI: -1.31, -0.68), P ≤ 0.001], and having history of still birth [β = −0.63, (95% CI: -1.06, -0.20), P = 0.004] were significantly associated with the hemoglobin level of pregnant women. Conclusions Anemia was identified to be a moderate public health problem in the study area. Therefore, nutritional counseling should focus on the necessity of at least one extra meal, promotion of fruits/vegetable consumption, and improving the nutritional status of the women during antenatal care follow-up. Moreover, early screening and management of women with a history of stillbirth for anemia are also essential.

Timeliness, completeness, and timeliness-and-completeness of serial routine vaccinations among rural children in Southwest China: A multi-stage stratified cluster sampling survey

IntroductionVaccination coverage is widely used as metric of vaccination programme performance. However, VPDs outbreaks were reported in areas with high vaccination coverage. Timeliness and completeness have been considered more important assessment indicators of routine vaccination than overall vaccination coverage, but little is known in rural China. This study aimed to assess the timeliness and completeness of serial routine vaccinations among children in rural Southwest China. MethodsA multi-stage stratified cluster survey was conducted among 1062 children aged 18–48 months in rural Guangxi. Vaccination status was obtained from child’s vaccination certificate. We calculated timely vaccination coverage, complete vaccination coverage, timely-and-complete vaccination coverage and 95% CI for routine vaccination through weighted estimation analysis. Weighted Kaplan-Meier analyses were applied to estimate the median delay periods for each dose of serial routine vaccines, including one-dose BCG, three-dose HepB, three-dose OPV, four-dose DTP, two-dose MCV, two-dose JEV and two-dose MPV-A. Complete coverage, and timely-and-complete coverage for combined 5-vaccine series were calculated. ResultsFor each dose of routine vaccines, overall vaccination coverages were over 90%, but timely vaccination coverage ranged from the lowest of 44.4% for JEV1 to the highest of 92.5% for MPV-A1. For multi-dose routine vaccines, complete vaccination coverages varied from the lowest of 92.9% for MCV to the highest of 100% for HepB, and timely-and-complete vaccination coverages were lower than 80%, ranging from the lowest of 30% for JEV to the highest of 77.2% for MPV-A. For combined 5-vaccine series, complete coverage was 77%, while timely-and-complete coverage was 12.1%. MPV-A1 had the longest median delay of 176 days, but BCG and HepB1 had the shortest of 1 day. ConclusionsThe overall coverages of serial routine vaccinations were high, but the timeliness and completeness were poor. Relevant agencies of vaccination service should address timeliness-and-completeness into the assessment indicators of routine vaccination service quality.

Subcounty administration in rural southwest China (1950-2000): changing state spatiality, persistent village territoriality and implications for the current urban transformation

ABSTRACT This article is a historical ethnography of how village communities in southwest China had maintained a certain amount of autonomy amid the expanding state spatiality in the second half of the twentieth century. Shortly after the Chinese Communist Party took power in 1949, the party-state built up three successive subcounty administrative systems – the district-township system, the people’s commune system, and the current township system – to expand its institutional terrains in the rural areas. Meanwhile, village communities under the jurisdiction of these penetrating administrative structures strove to maintain their social and physical boundaries through a series of traditional mechanisms. The interaction between the state’s attempts to establish a socialist order and villages’ tenacity to maintain their special territorial status resulted in a three-layered land rural land ownership, under which villages were able to maintain a certain degree of extraterritoriality. Such a situation has made the state territorial control in rural areas incomplete and porous.

Very young adolescent perceptions of growing up in rural southwest Uganda: Influences on sexual development and behavior.

Very young adolescents (VYAs) are at the beginning of major physical, cognitive, emotional, and social changes that will set the course for a lifetime of health risks or resilience and yet, they have been largely an invisible group in global health research. The study explored perceptions of VYAs of the context for adolescence in rural Uganda and how these perceptions relate to sexual and reproductive health. Twenty VYAs, aged 11-14 from a southwest province in Uganda participated; 10 girls and 10 boys. All were of low socioeconomic status and attending school. With Institutional Review Board approval, a community-based participatory design was used with community advisory board (CAB) guidance. Community mapping and photovoice were data collection strategies as deemed developmentally appropriate for this age group. VYAs narrated their maps and photographs in focus groups. Field notes were taken on observations of adolescent life in the villages. The CAB assisted in the interpretation of data. Focus group interview transcripts and field notes were thematically analyzed and triangulated with observational field notes to verify and amplify findings. VYAs dichotomized people and places that offered support and protection or exposure to risk and vulnerability. Cultural norms (gendered expectations for roles and responsibilities, the primacy of work), the influences of significant others (peers, family, other important adults) and places in their environment that represented either safe havens or danger zones comprised the major themes. VYA perceptions of their context and experiences will contribute to design of developmentally appropriate and community tailored interventions to promote their health.

Family function fully mediates the relationship between social support and perinatal depression in rural Southwest China

BackgroundPerinatal depression is the most common complication of gestation and childbearing affecting women and their families, and good social support and family function are considered protective and modifiable factors. This study aimed to investigate depression status and explore inter-relationships between social support and perinatal depression considering the influence of family function in rural areas of Southwest China.MethodsThis is a cross-sectional study. The following instruments were used: the Edinburgh Postpartum Depression Scale, the APGAR Family Care Index Scale, and the Social Support Rate Scale. A structural equation modelling was used to test the hypothesis relationships among the variables.ResultsA total of 490 rural antenatal (N = 249) and postpartum (N = 241) women (mean age (standard deviation), 28.17 ± 5.12) participated. We found that the prevalence of depression symptoms was 10.4%. Path analysis showed that family function had a direct negative correlation with depression (β = − 0.251, 95%CI: − 0.382 to − 0.118). Social support had a direct positive correlation with family function (β =0.293, 95%CI: 0.147 to 0.434) and had an indirect negative correlation with depression (β = − 0.074, 95%CI: − 0.139 to − 0.032), family function fully mediated the relationship between social support and depression.ConclusionsFindings of this study highlight that family function should be considered as the key target for interventions aiming to lower the prevalence of perinatal depression. Family members interventions are critical to reduce depression among antenatal and postpartum women.

Altered mental status is an independent predictor of mortality in hospitalized COVID-19 patients.

Background/aimsLimited data exists on the outcomes of COVID-19 patients presenting with altered mental status (AMS). Hence, we studied the characteristics and outcomes of hospitalized COVID-19 patients who presented with AMS at our hospital in rural southwest Georgia.MethodsData from electronic medical records of all hospitalized COVID-19 patients from March 2, 2020, to June 17, 2020, were analyzed. Patients were divided in 2 groups, those presenting with and without AMS. Primary outcome of interest was in-hospital mortality. Secondary outcomes were needed for mechanical ventilation, need for intensive care unit (ICU) care, need for dialysis, and length of stay. All analyses were performed using SAS 9.4 and R 3.6.0.ResultsOut of 710 patients, 73 (10.3%) presented with AMS. Majority of the population was African American (83.4%). Patients with AMS were older and more likely to have hypertension, chronic kidney disease (CKD), cerebrovascular disease, and dementia. Patients with AMS were less likely to present with typical COVID-19 symptoms, including dyspnea, cough, fever, and gastrointestinal symptoms. Predictors of AMS included age ≥ 70 years, CKD, cerebrovascular disease, and dementia. After multivariable adjustment, patients with AMS had higher rates of in-hospital mortality (30.1% vs 14.8%, odds ratio (OR) 2.139, p = 0.019), ICU admission (43.8% vs 40.2%, OR 2.59, p < 0.001), and need for mechanical ventilation (27.4% vs 18.5%, OR 2.06, p = 0.023). Patients presenting with AMS had increased length of stay.ConclusionsPatients with COVID-19 presenting with AMS are less likely to have typical COVID-19 symptoms, and AMS is an independent predictor of in-hospital mortality, need for ICU admission, and need for mechanical ventilation.