Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Abstract
ENGLISH ABSTRACT: Objectives To describe the characteristics, clinical
management and outcomes of patients with COVID-19 at
district hospitals.
Design A descriptive observational cross-sectional study.
Setting District hospitals (4 in metro and 4 in rural
health services) in the Western Cape, South Africa. District
hospitals were small (<150 beds) and led by family
physicians.
Participants All patients who presented to the hospitals’
emergency centre and who tested positive for COVID-19
between March and June 2020.
Primary and secondary outcome measures Source
of referral, presenting symptoms, demographics,
comorbidities, clinical assessment and management,
laboratory turnaround time, clinical outcomes, factors
related to mortality, length of stay and location.
Results 1376 patients (73.9% metro, 26.1% rural). Mean
age 46.3 years (SD 16.3), 58.5% females. The majority
were self-referred (71%) and had comorbidities (67%):
hypertension (41%), type 2 diabetes (25%), HIV (14%)
and overweight/obesity (19%). Assessment of COVID-19
was mild (49%), moderate (18%) and severe (24%). Test
turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was
longer than length of stay (median 2.0 day (IQR 2.0–3.0)).
The most common treatment was oxygen (41%) and only
0.8% were intubated and ventilated. Overall mortality was
11%. Most were discharged home (60%) and only 9%
transferred to higher levels of care. Increasing age (OR
1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37
to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to
2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV
(OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease
(OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked
with mortality (p<0.05). Pulmonary diseases (tuberculosis
(TB), asthma, chronic obstructive pulmonary disease,
post-TB structural lung disease) were not associated with
increased mortality.
Conclusion District hospitals supported primary care
and shielded tertiary hospitals. Patients had high levels of
comorbidities and similar clinical pictures to that reported
elsewhere. Most patients were treated as people under
investigation. Mortality was comparable to similar settings
and risk factors identified.
Description
CITATION: Mash, R. J. et al. 2021. Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study. BMJ Open, 11:e047016, doi:10.1136/bmjopen-2020-047016.
The original publication is available at https://bmjopen.bmj.com
The original publication is available at https://bmjopen.bmj.com
Keywords
COVID-19 (Disease), Coronavirus disease-19, Patients -- Evaluation, Clinical findings, Monitoring, Patient
Citation
Mash, R. J. et al. 2021. Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study. BMJ Open, 11:e047016, doi:10.1136/bmjopen-2020-047016.