TY - JOUR
T1 - Assessment of Clinical Outcomes among Children and Adolescents Hospitalized with COVID-19 in 6 Sub-Saharan African Countries
AU - African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents
AU - Nachega, Jean B.
AU - Sam-Agudu, Nadia A.
AU - MacHekano, Rhoderick N.
AU - Rabie, Helena
AU - Van Der Zalm, Marieke M.
AU - Redfern, Andrew
AU - Dramowski, Angela
AU - O'Connell, Natasha
AU - Pipo, Michel Tshiasuma
AU - Tshilanda, Marc B.
AU - Byamungu, Liliane Nsuli
AU - Masekela, Refiloe
AU - Jeena, Prakash Mohan
AU - Pillay, Ashendri
AU - Gachuno, Onesmus W.
AU - Kinuthia, John
AU - Ishoso, Daniel Katuashi
AU - Amoako, Emmanuella
AU - Agyare, Elizabeth
AU - Agbeno, Evans K.
AU - Martyn-Dickens, Charles
AU - Sylverken, Justice
AU - Enimil, Anthony
AU - Jibril, Aishatu Mohammed
AU - Abdullahi, Asara M.
AU - Amadi, Oma
AU - Umar, Umar Mohammed
AU - Sigwadhi, Lovemore Nyasha
AU - Hermans, Michel P.
AU - Otokoye, John Otshudiema
AU - Mbala-Kingebeni, Placide
AU - Muyembe-Tamfum, Jean Jacques
AU - Zumla, Alimuddin
AU - Sewankambo, Nelson K.
AU - Aanyu, Hellen Tukamuhebwa
AU - Musoke, Philippa
AU - Suleman, Fatima
AU - Adejumo, Prisca
AU - Noormahomed, Emilia V.
AU - Deckelbaum, Richard J.
AU - Fowler, Mary Glenn
AU - Tshilolo, Léon
AU - Smith, Gerald
AU - Mills, Edward J.
AU - Umar, Lawal W.
AU - Siedner, Mark J.
AU - Kruger, Mariana
AU - Rosenthal, Philip J.
AU - Mellors, John W.
AU - Mofenson, Lynne M.
N1 - Publisher Copyright:
© 2022 Nachega JB et al.
PY - 2022/3
Y1 - 2022/3
N2 - Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. Exposures: Age, sex, preexisting comorbidities, and region of residence. Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
AB - Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. Exposures: Age, sex, preexisting comorbidities, and region of residence. Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
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U2 - 10.1001/jamapediatrics.2021.6436
DO - 10.1001/jamapediatrics.2021.6436
M3 - Article
C2 - 35044430
AN - SCOPUS:85123353720
SN - 2168-6203
VL - 176
SP - E216436
JO - JAMA pediatrics
JF - JAMA pediatrics
IS - 3
ER -