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

{ 'indexed': { 'date-parts': [[2022, 10, 20]], 'date-time': '2022-10-20T05:13:48Z', 'timestamp': 1666242828326}, 'reference-count': 33, 'publisher': 'Public Library of Science (PLoS)', 'issue': '10', 'license': [ { 'start': { 'date-parts': [[2022, 10, 19]], 'date-time': '2022-10-19T00:00:00Z', 'timestamp': 1666137600000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/publicdomain/zero/1.0/'}], 'funder': [ { 'DOI': '10.13039/100000200', 'name': 'United States Agency for International Development', 'doi-asserted-by': 'publisher', 'award': ['72OFDA20GR0221']}], 'content-domain': {'domain': ['www.plosglobalpublichealth.org'], 'crossmark-restriction': False}, 'abstract': '<jats:p>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.</jats:p>', 'DOI': '10.1371/journal.pgph.0000924', 'type': 'journal-article', 'created': { 'date-parts': [[2022, 10, 19]], 'date-time': '2022-10-19T17:26:37Z', 'timestamp': 1666200397000}, 'page': 'e0000924', 'update-policy': 'http://dx.doi.org/10.1371/journal.pgph.corrections_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': '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', 'prefix': '10.1371', 'volume': '2', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-2363-7998', 'authenticated-orcid': True, 'given': 'Shannon', 'family': 'Doocy', 'sequence': 'first', 'affiliation': []}, {'given': 'Iris', 'family': 'Bollemeijer', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-4191-5931', 'authenticated-orcid': True, 'given': 'Eva', 'family': 'Leidman', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-3010-9790', 'authenticated-orcid': True, 'given': 'Abdou', 'family': 'Sebushishe', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0001-8911-0684', 'authenticated-orcid': True, 'given': 'Eta Ngole', 'family': 'Mbong', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-6859-1973', 'authenticated-orcid': True, 'given': 'Kathleen', 'family': 'Page', 'sequence': 'additional', 'affiliation': []}], 'member': '340', 'published-online': {'date-parts': [[2022, 10, 19]]}, 'reference': [ { 'key': 'pgph.0000924.ref001', 'first-page': '2021', 'volume': '21', 'author': 'World Health Organization', 'journal-title': 'COVID-19 Dashboard. 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