Covid-19 patient death rate ‘considerably higher in Africa than globally’

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The death rate among critically-ill Covid-19 patients may be “considerably higher” in Africa than any region in the world, research suggests.

The scientists behind the study, published in the journal The Lancet, said shortage of critical care resources – such as lack of oxygen, and potential life-saving interventions, such as dialysis – could be contributing to the high mortality in the region.

Professor Bruce Biccard, from Groote Schuur Hospital and the University of Cape Town, South Africa – who co-led the research, said: “Our study is the first to give a detailed and comprehensive picture of what is happening to people who are severely ill with Covid-19 in Africa, with data from multiple countries and hospitals.

“Sadly, it indicates that our ability to provide sufficient care is compromised by a shortage of critical care beds and limited resources within intensive care units.”

The researchers looked at data from 3,140 adults admitted to 64 hospitals in 10 countries – Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger, Nigeria, and South Africa – between May and December 2020.

They found death rates among adults after being admitted to critical care with suspected or confirmed Covid-19 infection appeared to be “considerably higher” in Africa (48%) than globally (32%).

The researchers said a lack of intensive care resources and underuse of those available could be a critical factor in the high mortality rate in Africa.

They found that half of patients died without being given oxygen, and while 68% of hospitals had access to dialysis to treat kidney failure, only 10% of severely-ill patients received it.

The scientists also estimate that the provision of dialysis is seven times less, and the provision of ECMO (to oxygenate blood) is 14 times lower than required to adequately treat Covid-19 patients.

People with pre-existing conditions – such as HIV/Aids, chronic kidney disease, chronic liver disease and diabetes – were found to have the greatest risk of poor outcomes.

But contrary to existing research from around the world, being male was not linked with increased mortality, the researchers said.

Professor Dean Gopalan, from the University of KwaZulu-Natal, South Africa – a co-lead on the study, said: “The finding that men did not have worse outcomes than women is unexpected.

“It might be that the African women in this study had a higher risk of death because of barriers to accessing care, or care and limitations or biases in care when critically ill.”

The researchers said that in a resource-limited settings, shortage of functioning equipment and specialised staff must be taken into consideration when providing care for critically-ill Covid-19 patients.

Professor Biccard said: “Poor access to potential life-saving interventions such as dialysis, proning (turning patients on their front to improve breathing), and blood oxygen monitoring could be factors in the deaths of these patients, and may also partly explain why one in eight patients had therapy withdrawn or limited.

“We hope these findings can help prioritise resources and guide the management of severely ill patients – and ultimately save lives – in resource-limited settings around the world.”

The findings come as many African nations are grappling with lack of adequate supplies of Covid-19 vaccines while others have thousands of expired doses which they have been unable to use.

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