article · American Journal of Tropical Medicine and Hygiene
A retrospective study examined 766 patients hospitalised with confirmed SARS-CoV-2 infection across seven hospitals in Kinshasa, Democratic Republic of the Congo, between March and July 2020. The cohort had a median age of 46 years, and roughly two-thirds were male. A quarter of all patients presented with severe or critical illness requiring intensive care. Overall, roughly 81 percent of admitted individuals recovered and left hospital within 30 days, whilst total in-hospital mortality reached 13.2 percent, rising to nearly half among intensive care admissions. Compared to individuals aged 20 to 39 years, mortality risk was markedly elevated in those under 20 years, between 40 and 59 years, and 60 years or older. Chronic kidney disease and obesity also served as independent risk factors for death. Evaluating treatment regimens showed that chloroquine combined with azithromycin conferred no statistically significant benefit regarding clinical recovery or survival.
Early pandemic data from African healthcare settings were scarce. These findings highlight which hospitalised groups faced the greatest threat of fatal outcomes in Kinshasa, including the unexpected finding of high mortality among patients under 20 years of age. Recognising these risk markers and the lack of clinical benefit from chloroquine therapies helps clinicians prioritise critical care resources and refine local triage protocols.
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Little is known about the clinical features and outcomes of SARS-CoV-2 infection in Africa. We conducted a retrospective cohort study of patients hospitalized for COVID-19 between March 10, 2020 and July 31, 2020 at seven hospitals in Kinshasa, Democratic Republic of the Congo (DRC). Outcomes included clinical improvement within 30 days (primary) and in-hospital mortality (secondary). Of 766 confirmed COVID-19 cases, 500 (65.6%) were male, with a median (interquartile range [IQR]) age of 46 (34-58) years. One hundred ninety-one (25%) patients had severe/critical disease requiring admission in the intensive care unit (ICU). Six hundred twenty patients (80.9%) improved and were discharged within 30 days of admission. Overall in-hospital mortality was 13.2% (95% CI: 10.9-15.8), and almost 50% among those in the ICU. Independent risk factors for death were age < 20 years (adjusted hazard ratio [aHR] = 6.62, 95% CI: 1.85-23.64), 40-59 years (aHR = 4.45, 95% CI: 1.83-10.79), and ≥ 60 years (aHR = 13.63, 95% CI: 5.70-32.60) compared with those aged 20-39 years, with obesity (aHR = 2.30, 95% CI: 1.24-4.27), and with chronic kidney disease (aHR = 5.33, 95% CI: 1.85-15.35). In marginal structural model analysis, there was no statistically significant difference in odds of clinical improvement (adjusted odds ratio [aOR] = 1.53, 95% CI: 0.88-2.67, <i>P</i> = 0.132) nor risk of death (aOR = 0.65, 95% CI: 0.35-1.20) when comparing the use of chloroquine/azithromycin versus other treatments. In this DRC study, the high mortality among patients aged < 20 years and with severe/critical disease is of great concern, and requires further research for confirmation and targeted interventions.
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DOI: 10.4269/ajtmh.20-1240
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