Characteristics of COVID-19 patients and risk factors of mortality in the early times of pandemic, Herat-Afghanistan

Year 2023, Volume: 21 Issue: 1, 28 - 42, 15.04.2023

Nasar Ahmad Shayan , Pınar Okyay , Ahmad Amirnajad

https://doi.org/10.20518/tjph.1088382

Abstract

Objective: Coronaviruses are a large family of viruses that cause different types of diseases. This study aims to evaluate the risk factors for mortality based on comorbidity and socio-demographic characteristics among COVID-19 patients.

Methods: This cross-sectional study conducted in Herat, Afghanistan, from February 24 to July 5, 2020, used data provided by the public health department, including socio-demographics, symptoms, comorbidities, hospitalization, contact history, and COVID-19 test type. The Chi-square test was used to observe differences between categorical variables. In bivariate analysis, all independent variables with a significant p-value were put into the model. Odds ratios and 95% confidence intervals were calculated, and a p-value less than 0.05 was considered statistically significant.

Results: The study analyzed 11,183 COVID-19 cases, with a 53.5% positivity rate. Recovery rates in the city and Herat province districts were 96.2% and 94.7%, respectively. Case-fatality rates varied with age, with 0.4% for those aged 1-29 and 33% for those aged 80-105. Mortality rates were highest for those with COPD and cancer, at 12.5% and 18.2%, respectively. In the logistic regression results, age, gender, and COPD were significant variables for COVID-19 mortality.

Conclusion: By providing more health service facilities to people in risk groups, especially in rural areas, the mortality rate of COVID-19 and other diseases can be decreased.

Keywords

COVID-19, Herat, Afghanistan, Mortality, Risk factor

Thanks

Acknowledgments: Departments of public health and surveillance system did provide us with the data for this study. Characteristics of COVID-19 patients and Risk Factors of Mortality in the early Times of Pandemic, Herat-Afghanistan

Herat-Afganistan’da pandeminin erken dönemlerinde COVID-19 hastalarının özellikleri ve mortalite risk faktörle

Abstract

Amaç: Coronavirüsler, farklı hastalık türlerine neden olan geniş bir virüs ailesidir. Bu çalışma, COVID-19 hastalarında komorbidite ve hastaların sosyo-demografik özelliklerine göre mortalite risk faktörlerini değerlendirmeyi amaçlamaktadır.

Yöntem: Bu kesitsel çalışma, 24 Şubat-5 Temmuz tarihleri arasında Afganistan’ın Herat ilinde yürütülmüştür. Çalışmanın verileri Herat İl Halk Sağlığı Müdürlüğü tarafından sağlanmış olup hastaların sosyo-demografik verileri, hastalığın belirti ve bulguları, eşlik eden hastalıklar, hastaların hastaneye yatış özellikleri, enfekte bir kişiyle temas öyküsü ve COVID-19’u teşhis etmek için kullanılan test türü incelenmiştir. Çalışmada, kategorik değişkenler arasındaki farklılıkları gözlemlemek için ki-kare testi kullanılmıştır. İki değişkenli analizde, anlamlı bir p değerine sahip tüm bağımsız değişkenler modele alınmıştır. Olasılık oranları ve %95 güven aralıkları hesaplanmış ve 0,05’ten küçük bir p değeri istatistiksel olarak anlamlı kabul edilmiştir.

Bulgular: Çalışmada, %53.5 pozitiflik oranıyla 11.183 COVID-19 vakası analiz edilmiştir. Herat il merkezi ve ilçelerinde iyileşme oranları sırasıyla %96.2 ve %94.7 bulunmuştur. Bu çalışma, Herat ili ilçelerinde %94.7 olan iyileşme oranının kent merkezinde yaşayan hastalarda %96.2 olduğunu göstermektedir. Yaşa göre değişkenlik gösteren vaka-ölüm oranları, 1-29 yaşları için %0.4 ve 80-105 yaşları için %33 bulunmuştur. Ölüm oranları sırasıyla %12.5 ve %18.2 ile KOAH ve kanser hastalarında en yüksekti. Lojistik regresyon analizi sonucunda yaş, cinsiyet ve KOAH COVID-19 ölüm oranı ile ilişkili bulunan değişkenler olarak bulunmuştur.

Sonuç: Bu çalışma, özellikle kırsal alanlarda daha fazla sağlık hizmeti sağlayarak COVID-19 ve diğer hastalıkların ölüm oranının azaltılabileceğini göstermektedir.

Keywords

COVID-19, Herat, Afganistan, Mortalite, Risk faktörü

References

• Chan JF-W, Yuan S, Kok K-H, To KK-W, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet. 2020 Feb 15;395(10223):514–23.
• Wu Y, Ho W, Huang Y, Jin D-Y, Li S, Liu S-L, et al. SARS-CoV-2 is an appropriate name for the new coronavirus. The Lancet. 2020 Mar 21;395(10228):949– 50.
• Zhu H, Wei L, Niu P. The novel coronavirus outbreak in Wuhan, China. Glob Health Res Policy [Internet]. 2020 Mar 2 [cited 2021 Jan 22];5. Available from: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC7050114/
• Worldmeter. Coronavirus Update (Live): 97,859,772 Cases and 2,093,577 Deaths from COVID-19 Virus Pandemic - Worldometer [Internet]. 2021 [cited 2021 Jan 22]. Available from: https:// www.worldometers.info/coronavirus/
• Gao Y. COVID-19: Risk factors for critical illness. EClinicalMedicine [Internet]. 2020 Aug 1 [cited 2021 Jan 30];25. Available from: https:// www.thelancet.com/journals/eclinm/ article/PIIS2589-5370(20)30251-0/ abstract
• Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care. 2021 Jan 11;25(1):25.
• WHO. Coronavirus [Internet]. 2021 [cited 2021 Feb 5]. Available from: https://www.who.int/westernpacific/ health-topics/coronavirus
• World Health Organization. Coronavirus [Internet]. [cited 2020 Sep 16]. Available from: https://www.who. int/westernpacific/health-topics/ coronavirus
• Afghanistan Analysis Network. Covid-19 in Afghanistan (6): A closer look at the MoPH’s official figures [Internet]. Afghanistan Analysts Network - English. 2020 [cited 2021 Jan 2]. Available from: https://www. afghanistan-analysts.org/en/reports/ economy-development-environment/ covid-19-in-afghanistan-6-a-closer-look-at-the-mophs-official-figures/
• PAHO/WHO. Case definitions for COVID-19 surveillance – 16 December 2020 - PAHO/WHO | Pan American Health Organization [Internet]. [cited 2021 Feb 5]. Available from: https://www. paho.org/en/topics/coronavirus-infections/coronavirus-disease-covid-19-pandemic/case-definitions-covid-19#:~:text=Clinical%20 criteria%3A,%2C%20 diarrhea%2C%20altered%20 mental%20status
• Aryana news. Registration of the first Corona virus event in Afghanistan [Internet]. Ariana News Agency . 2020 [cited 2020 Sep 16]. Available from: https://ariananews.co/ news/%d8%ab%d8%a8%d8%aa- %d8%a7%d9%82%d8%b9%d9%87- %d8%b1%d9%88%d9%86%d8%a7- %db%8c%d8%b1%d9%88%d8%b3- %d8%a7%d9%81%d8%ba%d8%a 7%d9%86%d8%b3%d8%aa%d8%- a7%d9%86.html/
• Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. Journal of Clinical Virology. 2020 Jun 1;127:104378.
• UKRI C the science explained-. Sex, gender and COVID-19 [Internet]. 2020 [cited 2021 Feb 5]. Available from: https://coronavirusexplained.ukri. org/en/article/cad0007/
• Shah P, Owens J, Franklin J, Mehta A, Heymann W, Sewell W, et al. Demographics, comorbidities and outcomes in hospitalized Covid-19 patients in rural southwest Georgia. Annals of Medicine. 2020 Oct 2;52(7):354–60.
• Abid K, Bari YA, Younas M, Tahir Javaid S, Imran A. Progress of COVID-19 Epidemic in Pakistan. Asia Pac J Public Health [Internet]. 2020 May 19 [cited 2021 Feb 5]; Available from: https:// www.ncbi.nlm.nih.gov/pmc/articles/ PMC7240311/
• Nikpouraghdam M, Jalali Farahani A, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. J Clin Virol. 2020 Jun;127:104378.
• UNFPA Afghanistan. Young people make their voices heard through the Afghan Youth Parliament [Internet]. UNFPA Afghanistan. 2018 [cited 2020 Oct 2]. Available from: https://afghanistan. unfpa.org/en/news/young-people make-their-voices-heard-through afghan-youth-parliament
• Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020 Jun 25;1–8.
• Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020 11;382(24):2372–4.
• Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766–73.
• Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020 May;94:91–5.
• Guan W-J, Liang W-H, Zhao Y, Liang H-R, Chen Z-S, Li Y-M, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5).
• Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 May 26;323(20):2052–9.
• Zeb S, Shahid R, Umar M, Aziz Q, Akram MO, Khurram M, et al. Analysis of COVID-19 Mortality in Allied Hospitals of Rawalpindi Medical University Pakistan. Biomedica. 2020 Jul 2;36:246–50.
• Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, et al. COVID-19 and Cardiovascular Disease. Circulation. 2020 May 19;141(20):1648–55.
• Ahrenfeldt LJ, Möller S, Thinggaard M, Christensen K, Lindahl-Jacobsen R. Sex Differences in Comorbidity and Frailty in Europe. Int J Public Health. 2019 Sep;64(7):1025–36.
• Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J [Internet]. 2020 May 14 [cited 2021 Feb 5];55(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC7098485/
• Posso M, Comas M, Román M, Domingo L, Louro J, González C, et al. Comorbidities and Mortality in Patients With COVID-19 Aged 60 Years and Older in a University Hospital in Spain. Arch Bronconeumol. 2020 Nov;56(11):756–8.
• Nichol KL, Baken L, Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med. 1999 Mar 2;130(5):397–403.
• Robilotti EV, Babady NE, Mead PA, Rolling T, Perez-Johnston R, Bernardes M, et al. Determinants of COVID-19 disease severity in patients with cancer. Nat Med. 2020;26(8):1218–23.
• The only cancer treatment center in Kabul is not equipped with the necessary facilities [Internet]. [cited 2020 Sep 28]. Available from: https://www.pajhwok. com/dr/2019/03/11/%D9%8A%D A%AF%D8%A7%D9%86%D9%87- D9%85%D8%B1%DA%A9%D8%B2- D8%AF%D8%A7%D9%88%D9%89- D8%B1%D8%B7%D8%A7%D9%86- %D8%AF%D8%B1- %DA%A9%D8%A7%D8 - %A8%D9%84-%D8%A8%D8%A7- %D8%A7%D9%85%DA%A9%D8 %A7%D9%86%D8%A7%D8%AA D9%84%D8%A7%D8%B2%D9%85- D9%85%D8%AC%D9%87%D8%B2- D9%86%D8%B4%D8%AF%D9%87- %D8%A7%D8%B3%D8%AA
• Noor FM, Islam MM. Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis. J Community Health. 2020 Dec;45(6):1270–82.
• Chidambaram V, Tun NL, Haque WZ, Majella MG, Sivakumar RK, Kumar A, et al. Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis. PLOS ONE. 2020 Nov 18;15(11):e0241541.
• Albitar O, Ballouze R, Ooi JP, Sheikh Ghadzi SM. Risk factors for mortality among COVID-19 patients. Diabetes Research and Clinical Practice. 2020 Aug 1;166:108293.
• Harrison SL, Fazio-Eynullayeva E, Lane DA, Underhill P, Lip GYH. Comorbidities associated with mortality in 31,461 adults with COVID-19 in the United States: A federated electronic medical record analysis. PLOS Medicine. 2020 Sep 10;17(9):e1003321.
• Mehraeen E, Karimi A, Barzegary A, Vahedi F, Afsahi AM, Dadras O, et al. Predictors of mortality in patients with COVID-19–a systematic review. Eur J Integr Med. 2020 Dec;40:101226.