Health system factors related to COVID-19 mortality in Eastern India: Hospital-based cross-sectional study
Dinesh Prasad Sahu1, Arvind Kumar Singh1, Baijayantimala Mishra2
1Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Insights
Investigating COVID-19 deaths in India revealed significant delays in care, with a median of 4 days from symptom onset to testing and admission. Addressing health system factors is crucial to reduce avoidable mortality, especially in low-resource settings.
Area of Science:
- Public Health
- Epidemiology
- Health Systems Research
Background:
- The coronavirus disease 2019 (COVID-19) pandemic caused widespread mortality across diverse populations.
- COVID-19-related deaths are often attributed to multiple contributing factors.
- Understanding health system influences on mortality is vital for pandemic response.
Purpose of the Study:
- To evaluate health system factors associated with COVID-19-related deaths in eastern India.
- To identify delays in healthcare seeking and access contributing to mortality.
Main Methods:
- A retrospective hospital-based study was conducted on 272 COVID-19 deaths between April and November 2020.
- Data were collected via medical records and telephonic interviews to assess delays.
- Statistical analysis was performed using SPSS, focusing on travel time, testing, and care access.
Main Results:
- Information was obtained for 243 deaths (89.3%).
- Median travel time to the hospital was 120 minutes (60 km).
- Median time from symptom onset to initial healthcare attention was 10 minutes, but 4 days to testing and admission.
Conclusions:
- Health system factors significantly influence COVID-19 mortality and require targeted interventions.
- Enhancing health system resilience is critical for mitigating deaths in resource-limited countries like India.
Introduction:
Mortality from coronavirus disease 2019 (COVID-19) pandemic has left footprints across all ages and socio-economic strata. The deaths because of COVID-19 are usually multi-factorial. The study aimed to assess the health system factors related to COVID-19-related deaths.
Materials And Methods:
A hospital-based retrospective study was conducted at a tertiary care hospital of eastern India. A total of 272 COVID-19 deaths that occurred between April and November 2020 were investigated. Data were extracted from Medical Record Department, and telephonic interviews were conducted to assess the different delays related to death. Data were analysed using Statistical Package for Social Sciences. Travel time, travel distance, delay in testing, and delay in receiving quality care were presented as median with inter-quartile range.
Results:
Complete information could be collected from 243 COVID deaths of the 272 deaths (89.3%). The duration of hospital stay was 1-7 days for 42% of the deceased. The median travel time was 120 min, and the median distance travelled was 60 km. The median time to receive first attention of health care workers was 10 minutes. There was hardly any delay in reporting of test results, whereas the median time from symptoms to test and the median time from symptoms to admission were 4 days each.
Conclusion:
Health system factors related to death of COVID-19 need to be addressed to avoid the avoidable deaths during the pandemic situation. The resilience of the health system can be helpful in reducing death toll in a low-resource country like India.
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