The rate of deaths among critical care Covid 19 patients in Kenya and other African countries is much higher than in the rest of the world.
A new study shows while the global deaths average of critical care Covid 19 patients is 31 per cent, in Africa it is hitting up to 48 per cent.
The study which was open to all African countries however, attracted 10 countries and 64 hospitals. It reports up to 23 excess deaths in Africa compared to the global average.
The deaths are attributed mainly to a shortage of critical care resources. “In our study, only one in two patients referred for critical care was admitted.”
The study included: Kenya, Egypt, Ethiopia, Ghana, Libya, Malawi, Mozambique, Niger, Nigeria, and South Africa. Three hospitals from Kenya participated in the study.
In Kenya participating doctors includedZipporah Ngumi and Anne Mugera of Kenyatta National Hospital, Andrew Ndonga of Mater Misericordiae Hospital and Caesar Bitta of Jaramogi Oginga Odinga Teaching Hospital.
Three surprises, emerges from the new study: First, while previous data has shown more male deaths than females from Covid 19, this study among critical care patients showed no gender differences.
“It is possible that women have an increased mortality risk generally because of the barriers to accessing care and limitations or biases in care when critically ill,” says the study published in The Lancet on Friday, 22nd May 2021.
HIV/AIDS Risk Factor
Secondly, the study shows HIV-positive patients were at higher risk of death compared to other comorbidities.
“Our data suggest that HIV/AIDS is an important risk factor for Covid19 death.” HIV, diabetes, chronic liver disease, or kidney disease in that order presented the highest risk of death among critically ill Covid 19 patients.
Thirdly, the study found patients put on steroid therapy had higher chances of survival. Dexamethasone, a cheap and widely-available steroid against arthritis is being used for treating hospitalized Covid 19 patients in Kenya.
The study though found no shortage of nurses or doctors in critical care in the participating hospitals but blames years of neglect of the health systems in Africa for the high death rates.
During the eight-month study period,6779 patients were referred to critical care but only just about a half 3752 patients were admitted mainly due to a lack of resources.
The research agrees with other observations and data showing overall deaths from Covid 19 in Africa have been lower than in other parts of the world. “However, the critical care in-hospital deaths were higher for African countries than for other, non-African countries.”
This is why: First, the scarcity of critical care resources in African countries might contribute to the high critical care deaths said the study.
Second, there are inadequate critical care beds, with only one in two patients referred to critical care being admitted.
Third, the countries included in the study were highly under-resourced in critical care facilities such as dialysis, proning of patients, oxygen monitoring and supply, or even for blood tests.
Patient access to interventions was between seven-times lower, for dialysis and proning, and 14-times lower for oxygen support than what is required.
Dialysis was available in 39 of 57 sites and was offered to only 10 per cent of the patients despite these either being tertiary or teaching hospitals. Hence the team wondered what may be happening in lower-level hospitals.
The study concludes that increased deaths in Africa are associated with insufficient critical care resources, as well as the comorbidities of HIV/AIDS, diabetes, chronic liver disease, and kidney disease, and severity of organ dysfunction at admission.
By Gatonye Gathura
The study is available here: https://doi.org/10.1016/S0140-6736(21)00441-4