Institute for Disease Modeling, Bellevue, WA, USA.
IRSS-Clinical Research Unit of Nanoro, Burkina Faso.
Int J Infect Dis. 2020 Dec;101:194-200. doi: 10.1016/j.ijid.2020.09.1432. Epub 2020 Sep 26.
Absolute numbers of COVID-19 cases and deaths reported to date in the sub-Saharan Africa (SSA) region have been significantly lower than those across the Americas, Asia and Europe. As a result, there has been limited information about the demographic and clinical characteristics of deceased cases in the region, as well as the impacts of different case management strategies.
Data from deceased cases reported across SSA through 10 May 2020 and from hospitalized cases in Burkina Faso through 15 April 2020 were analyzed. Demographic, epidemiological and clinical information on deceased cases in SSA was derived through a line-list of publicly available information and, for cases in Burkina Faso, from aggregate records at the Centre Hospitalier Universitaire de Tengandogo in Ouagadougou. A synthetic case population was probabilistically derived using distributions of age, sex and underlying conditions from populations of West African countries to assess individual risk factors and treatment effect sizes. Logistic regression analysis was conducted to evaluate the adjusted odds of survival for patients receiving oxygen therapy or convalescent plasma, based on therapeutic effectiveness observed for other respiratory illnesses.
Across SSA, deceased cases for which demographic data were available were predominantly male (63/103, 61.2%) and aged >50 years (59/75, 78.7%). In Burkina Faso, specifically, the majority of deceased cases either did not seek care at all or were hospitalized for a single day (59.4%, 19/32). Hypertension and diabetes were often reported as underlying conditions. After adjustment for sex, age and underlying conditions in the synthetic case population, the odds of mortality for cases not receiving oxygen therapy were significantly higher than for those receiving oxygen, such as due to disruptions to standard care (OR 2.07; 95% CI 1.56-2.75). Cases receiving convalescent plasma had 50% reduced odds of mortality than those who did not (95% CI 0.24-0.93).
Investment in sustainable production and maintenance of supplies for oxygen therapy, along with messaging around early and appropriate use for healthcare providers, caregivers and patients could reduce COVID-19 deaths in SSA. Further investigation into convalescent plasma is warranted until data on its effectiveness specifically in treating COVID-19 becomes available. The success of supportive or curative clinical interventions will depend on earlier treatment seeking, such that community engagement and risk communication will be critical components of the response.
截至目前，撒哈拉以南非洲（SSA）地区报告的 COVID-19 病例和死亡人数明显低于美洲、亚洲和欧洲。因此，有关该地区死亡病例的人口统计学和临床特征以及不同病例管理策略的影响的信息有限。
通过 2020 年 5 月 10 日在 SSA 报告的死亡病例和 2020 年 4 月 15 日在布基纳法索住院的病例的数据进行了分析。通过公开提供的信息清单从 SSA 的死亡病例中得出人口统计学、流行病学和临床信息，对于布基纳法索的病例，则从瓦加杜古 Centre Hospitalier Universitaire de Tengandogo 的综合记录中得出。使用来自西非国家人群的年龄、性别和潜在疾病分布，概率推导出综合病例人群，以评估个体危险因素和治疗效果大小。基于其他呼吸道疾病观察到的治疗效果，通过逻辑回归分析评估接受氧气治疗或恢复期血浆治疗的患者的生存调整后优势比。
在 SSA，提供人口统计学数据的死亡病例主要是男性（63/103，61.2%）和年龄>50 岁（59/75，78.7%）。具体来说，布基纳法索大多数死亡病例要么根本没有寻求治疗，要么仅住院一天（59.4%，19/32）。高血压和糖尿病通常被报告为潜在疾病。在综合病例人群中按性别、年龄和潜在疾病进行调整后，未接受氧气治疗的病例的死亡优势比接受氧气治疗的病例明显更高，例如由于标准治疗中断（OR 2.07；95%CI 1.56-2.75）。接受恢复期血浆的病例的死亡可能性比未接受的病例降低了 50%（95%CI 0.24-0.93）。
投资于可持续生产和维持氧气治疗供应，以及围绕医疗保健提供者、护理人员和患者早期和适当使用的信息宣传，可能会降低 SSA 的 COVID-19 死亡人数。在获得关于其在治疗 COVID-19 方面的具体疗效的数据之前，需要进一步研究恢复期血浆。支持性或治疗性临床干预的成功将取决于更早的治疗寻求，因此社区参与和风险沟通将是应对的关键组成部分。
