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. 2022 Oct 19;2(10):e0000924.
doi: 10.1371/journal.pgph.0000924. eCollection 2022.

Clinical progression and outcomes of patients hospitalized with COVID-19 in humanitarian settings: A prospective cohort study in South Sudan and Eastern Democratic Republic of the Congo

Shannon Doocy  1 , Iris Bollemeijer  2 , Eva Leidman  1   3 , Abdou Sebushishe  4 , Eta Ngole Mbong  5 , Kathleen Page  6
Affiliations

Clinical progression and outcomes of patients hospitalized with COVID-19 in humanitarian settings: A prospective cohort study in South Sudan and Eastern Democratic Republic of the Congo

Shannon Doocy et al. PLOS Glob Public Health. .

Abstract

Little information is available on COVID-19 in Africa and virtually none is from humanitarian and more resource-constrained settings. This study characterizes hospitalized patients in the African humanitarian contexts of Juba, South Sudan and North and South Kivu in Eastern Democratic Republic of the Congo. This observational cohort was conducted between December 2020 and June 2021. Patients presenting for care at five facilities or referred from home-based care by mobile medical teams were eligible for enrollment and followed until death or recovery. Disease progression was characterized for hospitalized patients using survival analysis and mixed effects regression model to estimate survival odds for patient characteristics and treatments received. 144 COVID-19 cases enrolled as hospitalized patients were followed to recovery/death. The observed mortality proportion among hospitalized patients was 16.7% (CI: 11.2-23.3%); mortality was three times higher in South Sudan, where patients presented later after symptom onset and in worse conditions. Age and diabetes history were the only patient characteristics associated with decreased survival; clinical status indicators associated with decreased survival included fever, low oxygen level, elevated respiratory and pulse rates. The only therapy associated with survival was non-invasive oxygen; invasive oxygen therapies and other specialized treatments were rarely received. Improving availability of oxygen monitoring and proven COVID-19 therapies in humanitarian and resource-poor settings is critical for health equity. Customizing training to reflect availability of specific medications, therapies and operational constraints is particularly important given the range of challenges faced by providers in these settings.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig 1
Fig 1. Study participant flow diagram.
Fig 2
Fig 2. Survival probability by country and oxygen level at admission.
See this image and copyright information in PMC

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Grants and funding

This study was funded by the United States Agency for International Development in the form of a grant (72OFDA20GR0221) awarded to SD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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