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Death rates in admitted Covid-19 patients higher in Africa than rest of the world – study

Healthcare workers and patients in the temporary area outside Steve Biko Academic Hospital, created to screen and treat suspected Covid-19 cases.

Healthcare workers and patients in the temporary area outside Steve Biko Academic Hospital, created to screen and treat suspected Covid-19 cases.

PHOTO: Gallo Images/Alet Pretorius

  • Death rates in admitted Covid-19 patients higher in Africa than elsewhere in the world, according to a recent study. 
  • The study found that this might be due to a lack of access to life-saving interventions like dialysis. 
  • The study observed 3140 adult patients in 10 African countries. 

Critically ill Covid-19 patients in African countries are far more likely to pass away than those in other continents, which could be because of a lack of critical care equipment, according to a study published in The Lancet.

The study observed 3140 adult coronavirus patients admitted to intensive care units in 64 hospitals across 10 African countries, including South Africa, between May and December last year. Almost half of them died within 30 days of admission.

The study found that the death rates of the patients appear considerably higher in Africa with an average of 48.2% patients dying after admission to intensive care compared to a global average of 31.5% in Asia, Europe and the Americas.

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According to the researchers, an explanation for the excess deaths may be a lack of intensive care resources and under-use of those available. For example, half of patients died without being given oxygen and 68% of hospitals had access to renal dialysis, but only 10% of severely ill patients received it.

“Our study is the first to give a detailed and comprehensive picture of what is happening to people who are severely ill with Covid-19 in Africa, with data from multiple countries and hospitals. Sadly, it indicates that our ability to provide sufficient care is compromised by a shortage of critical care beds and limited resources within intensive care units,” Professor Bruce Biccard, deputy head of the Department of Anesthesia and second chair in Anaesthesia at the University of Cape Town, who co-led the research said. 

Biccard said a lack of access to life-saving interventions like dialysis, proning (turning patients on their front to improve breathing), and blood oxygen monitoring could be some of the contributing factors in the deaths.

Biccard added:

It may also partly explain why one in eight patients had therapy withdrawn or limited. We hope these findings can help prioritise resources and guide the management of severely ill patients – and ultimately save lives – in resource-limited settings around the world.

The study was a collaboration between researchers across the continent who wanted to investigate how Covid-19 affects critically ill patients in Africa.

Researchers aimed to identify which human and hospital resources, underlying conditions, and critical care interventions might be associated with mortality or survival in adults admitted to intensive care or high-care units in Africa.

All the 3 140 patients who participated in the study were followed for at least 30 days while in hospital unless they died or were discharged.  

After 30 days, almost half of the critically ill patients had died. The analysis estimates that death rates in these African patients were 11% in best-case scenario to 23% in worst-case scenario – higher than the global average of 31.5%.

Of the survivors, 16% remained in hospital, and 84% had been discharged. The outcome of 63 patients is unknown.

The study estimates that the provision of dialysis needs to increase approximately seven-fold in hospitals to provide adequate care for the critically ill Covid-19 patients. 

People with pre-existing conditions had the highest risk of poor outcomes. Having chronic kidney disease or HIV/A almost doubled the risk of death, while chronic liver disease more than tripled the risk of dying. Diabetes was also associated with poor survival at a 75% increased risk of death. However, contrary to previous studies, being male was not linked with increased mortality.

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“The finding that men did not have worse outcomes than women are unexpected. It might be that the African women in this study had a higher risk of death because of barriers to accessing care, or care and limitations or biases in care when critically ill,” says co-lead Professor Dean Gopalan from the University of KwaZulu-Natal, South Africa. 

According to co-author Dr Vanessa Msosa from Kamuzu Central Hospital in Malawi: “This cross-continental collaboration has provided much-needed data about unique Covid-19 patient care needs.

“Although our younger demographic means that most countries in Africa have avoided the large-scale mortality seen in many parts of the world, in-hospital mortality is suffering from being under-resourced, with only half of referrals admitted to critical care because of bed shortages.”

Msosa added that patient outcomes will continue to be severely compromised until the shortfall in critical care resources is addressed.

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