Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study

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dc.contributor.authorMash, Robert Jamesen_ZA
dc.contributor.authorPresence-Vollenhoven, Mellisaen_ZA
dc.contributor.authorAdeniji, Adeloyeen_ZA
dc.contributor.authorChristoffels, Renaldoen_ZA
dc.contributor.authorDoubell, Karlienen_ZA
dc.contributor.authorEksteen, Lawsonen_ZA
dc.contributor.authorHendrikse, Ameeen_ZA
dc.contributor.authorHutton, Laurenen_ZA
dc.contributor.authorJenkins, Louisen_ZA
dc.contributor.authorKapp, Paulen_ZA
dc.contributor.authorLombard, Annieen_ZA
dc.contributor.authorMarais, Heleenen_ZA
dc.contributor.authorRossouw, Liezelen_ZA
dc.contributor.authorStuve, Katrinen_ZA
dc.contributor.authorUgoagwu, Abien_ZA
dc.contributor.authorWilliams, Beverleyen_ZA
dc.date.accessioned2021-02-04T06:18:56Z
dc.date.available2021-02-04T06:18:56Z
dc.date.issued2021
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at https://bmjopen.bmj.com
dc.description.abstractENGLISH 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.en_ZA
dc.description.urihttps://bmjopen.bmj.com/content/bmjopen/11/1/e047016.full.pdf
dc.description.versionPublisher's version
dc.format.extent10 pagesen_ZA
dc.identifier.citationMash, 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.
dc.identifier.issn2044-6055 (online)
dc.identifier.otherdoi:10.1136/bmjopen-2020-047016
dc.identifier.urihttp://hdl.handle.net/10019.1/109507
dc.language.isoen_ZAen_ZA
dc.publisherBMJ Publishing Groupen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectCOVID-19 (Disease)en_ZA
dc.subjectCoronavirus disease-19en_ZA
dc.subjectPatients -- Evaluationen_ZA
dc.subjectClinical findingsen_ZA
dc.subjectMonitoring, Patienten_ZA
dc.titleEvaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational studyen_ZA
dc.typeArticleen_ZA
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