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Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African
Jean B Nachega1,2,3,4, Nadia A Sam-Agudu5,6,7,8, Rhoderick N Machekano9
1Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
COVID-19 significantly impacted children and adolescents in sub-Saharan Africa, with infants and those with comorbidities facing higher risks of severe outcomes and death. Targeted vaccination and treatments are crucial for this vulnerable population.
Area of Science:
- Pediatric Infectious Diseases
- Global Health
- Epidemiology
Background:
- Limited data exists on COVID-19 outcomes in sub-Saharan African children and adolescents.
- Preexisting comorbidities are common in this demographic, potentially influencing disease severity.
Purpose of the Study:
- To evaluate clinical outcomes of hospitalized children and adolescents with COVID-19 in sub-Saharan Africa.
- To identify factors associated with adverse outcomes in this population.
Main Methods:
- Retrospective cohort study analyzing data from 469 hospitalized patients (0-19 years) across 6 sub-Saharan African countries.
- Data collected from March to December 2020.
- Outcomes assessed using an ordinal scale including hospitalization, oxygen use, ICU admission, mechanical ventilation, and death; length of stay was a secondary outcome.
Main Results:
- 8.3% of patients died, with higher mortality among those requiring ICU admission (31.9%).
- Infants (<1 year) had significantly higher odds of severe outcomes (aOR=4.89) compared to older adolescents.
- Hypertension, chronic lung disease, and hematological disorders were associated with severe COVID-19 outcomes.
Conclusions:
- High morbidity and mortality rates were observed in hospitalized children and adolescents with COVID-19 in sub-Saharan Africa.
- Infants and those with noncommunicable disease comorbidities are particularly vulnerable.
- Urgent need for COVID-19 vaccination and therapeutic interventions for pediatric populations in the region.
Importance:
Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.
Objective:
To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.
Design, Setting, And Participants:
This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.
Exposures:
Age, sex, preexisting comorbidities, and region of residence.
Main Outcomes And Measures:
An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
Results:
Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
Conclusions And Relevance:
In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
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