DURBAN - A STUDY conducted by African Covid-19 Critical Care Outcomes Study (Acccos) investigators in 10 African countries, including South Africa, found a higher death rate among critically ill Covid-19 patients than in any other region in the world.
The SA-led study funded by a grant from the Critical Care Society of Southern Africa and published in The Lancet medical journal, was based on 3 140 adult participants admitted to 64 hospitals in 10 countries between May and December 2020.
These include 13 hospitals in South Africa while the rest were from Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger and Nigeria.
Death rates among adults in the 30 days after being admitted to critical care with suspected or confirmed Covid-19 infection appear considerably higher in Africa with an average of 48% while the global average is 31%.
According to the Africa-based researchers, a critical factor in these excess deaths may be a lack of intensive care resources and underuse of those available.
For example, the researchers found that half of the patients died without being given oxygen, and while 68% of hospitals had access to renal dialysis, only 10% (330 out of 3 073) of severely ill patients received it.
According to the study, there has been no reported clinical outcomes data from Africa, or patient management data in low-resource settings.
The study aimed to address this evidence gap and identify which human and hospital resources, underlying conditions, and critical care interventions might be associated with mortality or survival in adults (aged 18 or older) admitted to intensive care or high-care units in Africa.
All participants received standard care and were followed up for at least 30 days unless they died or were discharged.
After 30 days, the study found that 48% of the critically ill patients had died, 16% survived but remained in hospital, 84% had been discharged while the outcome of 63 patients was unknown.
The majority of patients, 61%, were men with an average age of 56 with a few underlying chronic conditions.
The most common conditions included high blood pressure, diabetes, HIV/Aids, chronic kidney disease and coronary artery disease.
“People with pre-existing conditions had the highest risk of poor outcomes. Having chronic kidney disease or HIV/Aids almost doubled the risk of death, while chronic liver disease more than tripled the risk of dying.”
The study found that diabetes was also associated with poor survival.
However, contrary to previous studies, being male was not linked with increased mortality.
As the study’s co-lead Professor Dean Gopalan from the University of KwaZulu-Natal said the finding that men did not have worse outcomes than women was unexpected.
“It might be that the African women in this study had a higher risk of death because of barriers to accessing care, or limitations or biases in receiving care when critically ill,” he said.
The study found that compared with survivors, patients who died were also more likely to have a higher degree of organ dysfunction.
The Sequential Organ Failure Assessment(SOFA) score revealed that more respiratory and cardiovascular support on admission to intensive care was required yet the resources to provide this care were limited.
“The quick SOFA score could be a simple tool to use at critical admission in low-resourced settings to help clinicians identity patients with poor prognosis at an early stage and to avoid delays in starting necessary organ support,” said Gopalan.
Professor Bruce Biccard from Groote Schuur Hospital and the University of Cape Town, said this was the first study to give a detailed and comprehensive picture of what is happening to people who are severely ill with Covid-19 in Africa.
“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,” he said.
Poor access to potential life-saving interventions such as dialysis, proning (turning patients on their front to improve breathing), and blood oxygen monitoring could be factors in the deaths of these patients, he said.
Biccard said this 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,” he said.
THE MERCURY