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

Lina Hahnle; Mathilda Mennen; Freedom Gumedze; Daniel Mutithu; Marguerite Adriaanse; Daniel Egan; Simthandile Mazondwa; Rochelle Walters; Lambert Tetteh Appiah; Francisca Inofomoh; Okechukwu Ogah; Olukemi Adekanmbi; Fastone Goma; Elijah Ogola; Kieran Mwazo; Ahmed Suliman; Kavita Singh; Lana Raspail; Dorairaj Prabhakaran; Pablo Perel; Karen Sliwa; Ntobeko A B Ntusi

doi:10.5334/gh.1314

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

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

Authors

Lina Hahnle^{1

2

3}, Mathilda Mennen^{1

2

3}, Freedom Gumedze⁴, Daniel Mutithu^{2

3

5}, Marguerite Adriaanse^{1

2

3}, Daniel Egan¹, Simthandile Mazondwa¹, Rochelle Walters^{1

2

3}, Lambert Tetteh Appiah⁶, Francisca Inofomoh⁷, Okechukwu Ogah⁸, Olukemi Adekanmbi⁹, Fastone Goma¹⁰, Elijah Ogola¹¹, Kieran Mwazo¹², Ahmed Suliman¹³, Kavita Singh^{14

15}, Lana Raspail¹⁶, Dorairaj Prabhakaran^{17

18

19}, Pablo Perel^{18

20}, Karen Sliwa^{18

21}, Ntobeko A B Ntusi^{1

2

18

22}

Affiliations

¹ Department of Medicine, University of Cape Town, South Africa.
² UCT/SAMRC Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, South Africa.
³ ARUA/GUILD Cluster of Research Excellence on Noncommunicable Diseases and associated multimorbidities, South Africa.
⁴ Department of Statistical Sciences, University of Cape Town, South Africa.
⁵ Cape Heart Institute, University of Cape Town, South Africa.
⁶ Department of Medicine, Kwame Nkrumah University of Science & Technology (KNUST) and Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁷ Internal Medicine Department, Olabisi Onabanjo University Teaching Hospital, Nigeria.
⁸ Department of Medicine, College of Medicine, University of Ibadan, and University College Hospital Ibadan, Nigeria.
⁹ Department of Medicine, University College Hospital Ibadan, Nigeria.
¹⁰ Centre for Primary Care Research, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia.
¹¹ The Mombasa Hospital, Kenya.
¹² Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya.
¹³ Faculty of Medicine, University of Khartoum, Sudan.
¹⁴ Public Health Foundation of India, Gurugram, Haryana and Centre for Chronic Disease Control, New Delhi, IN.
¹⁵ Heidelberg Institute of Global Health, University of Heidelberg, Germany.
¹⁶ World Heart Federation, Geneva, CH.
¹⁷ Public Health Foundation India, Centre for Chronic Disease Control, IN.
¹⁸ World Heart Federation, CH.
¹⁹ London School of Hygiene & Tropical Medicine, GB.
²⁰ Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, GB.
²¹ Cape Heart Institute, Department of Medicine & Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa.
²² J46 (J floor) Old Main Building, Groote Schuur Hospital Observatory, 7925, Cape Town, South Africa.

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.

MeSH terms

Acute Kidney Injury* / epidemiology
Adult
Africa / epidemiology
COVID-19 Vaccines
COVID-19* / complications
COVID-19* / epidemiology
Humans
Prospective Studies
Retrospective Studies
Risk Factors

Substances

COVID-19 Vaccines

Grants and funding

Prof Ntusi acknowledges funding support from the South African Medical Research Council, National Research Foundation, the Lily and Ernst Hausmann Trust, and the Maueberger Foundation Trust. Prof Karen Sliwa acknowledges support for this study from the South African Medical Research Council.