Factors associated with COVID-19 inpatient mortality cases within 24 hours in South Africa

Abstract

Background. African countries with limited healthcare capacity are particularly vulnerable to the novel coronavirus (COVID‑19). The pandemic has left health systems short on resources to safely manage patients and protect healthcare workers. South Africa (SA) is still battling the epidemic of HIV/AIDS and tuberculosis (TB), which had their programme/services interrupted due to the effects of the pandemic. Lessons learnt from the HIV/AIDS and TB programme have shown that South Africans delay seeking health services when a new disease presents itself. Objective. To investigate the risk factors for COVID‑19 inpatients’ mortality within 24 hours of hospital admission in public health facilities in Limpopo Province, SA. Methods. The study used retrospective secondary data obtained from the 1 067 clinical records of patients admitted between March 2020 and June 2021 by the Limpopo Department of Health (LDoH). A multivariable logistic regression model, both adjusted and unadjusted, was used to assess the risk factors associated with COVID‑19 mortality within 24 hours of admission. Results. This study, which was conducted in Limpopo public hospitals, discovered that 411 COVID‑19 patients (40%) died within 24 hours of admission. The majority of the patients were aged ≥60 years, mostly of female gender, and had comorbidities. In terms of vital signs, most had body temperatures <38°C. Our study findings revealed that COVID‑19 patients who present with fever and shortness of breath were 1.8 and 2.5 times more likely to die within 24 hours of admission to the hospital, respectively, than patients without fever and with normal respiratory rate. Hypertension was independently associated with mortality in COVID‑19 patients within 24 hours of admission, with a high odds ratio (OR) for hypertensive patients (OR 1.451; 95% confidence interval 1.013 - 2.078) compared with non-hypertensive patients. Conclusion. Assessing demographic and clinical risk factors for COVID‑19 mortality within 24 hours of admission aids in understanding and prioritising patients with severe COVID‑19 and hypertension. Finally, this will provide guidelines for planning and optimising the use of LDoH healthcare resources, and also aid in public awareness endeavours.