Clinical profile and predictors of outcomes of hospitalized patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 in Nigeria: A retrospective analysis of 13 high burden states

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Christopher Sabo Yilgwan
Adamu Onu
Joshua Ofoli
Longji Benle Dakum
Nathan Yakubu Shehu
Dimie Ogoina
Ijeoma Okoli
Deborah Osisanwo
Vivian Okafor
Adebola Olayinka
Ibrahim Mamadu
Adebimpe Adebiyi


COVID 19, SARS-CoV-2, Nigeria, Mortality


Background: The majority of global COVID deaths have occurred in developed countries. Not much is known about the clinical outcomes for the patients admitted with COVID in Nigeria. We thus described the clinical characteristics, outcomes, and predictors of outcomes of hospitalized Nigerian COVID-19 patients.

Methodology: We performed multilevel and mixed effects regression, Kaplan-Meir survival, and Cox proportionate hazards analyses to evaluate factors associated with death in patients admitted for COVID-19 in 13 high-burden states of Nigeria between 25th February 2020 and 30th August 2021.

Results: Of the 3462 patients (median age, 40 years (interquartile range 28 years 54 years), 2,990(60.6%) were male and, 213(6.15%) of them died while on admission. Male sex (adjusted odds ratio [aOR], 1.78 [95% confidence interval {CI}, 1.23–2.56]), age group 45-65 years (OR, 3.93 [95% CI, 1.29–12.02]), age group 66-75 years (aOR, 5.37 [95% CI, 1.68–17.14]), age group > 75 years (aOR, 6.81 [95% CI, 2.04–22.82]), chronic cardiac disease (aOR, 3.07 [95% CI, 1.20–7.86]), being diabetic (aOR, 2.16 [95% CI, 1.41–3.31]), and having chronic kidney disease (OR, 11.01 [95% CI, 2.74–44.24]),were strongly associated with increased odds of death. Having concurrent malaria (aOR, 0.45 [95% CI, 0.16–1.28]), use of Azithromycin for treatment (aOR, 0.33 [95% CI, 0.19–0.54]), and use of Chloroquine/Hydroxychloroquine for treatment (aOR, 0.07 [95% CI, 0.03–0.14]) were significantly associated with decreased odds of death.

Conclusions: The cumulative probability of death of male patients, diabetics, hypertensives, and patients with CKD was higher than that of female patients and those without those comorbidities while concurrent malaria and use of chloroquine/hydroxychloroquine in the treatment regimen were associated with a decreased risk of dying in patients treated in our isolation centres.

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1.Lai CC, Wang CY, Wang YH, Hsueh SC, Ko WC, Hsueh PR. Global epidemiology of coronavirus disease 2019 (COVID-19): disease incidence, daily cumulative index, mortality, and their association with country healthcare resources and economic status. International journal of antimicrobial agents. 2020;55:105946.

2.Schellekens P, SourrouilleDM. COVID-19 mortality in rich and poor countries: a tale of two pandemics?. World Bank Policy Research Working Paper. 2020 May 28(9260).

3.Ayodele KP, Jimoh H, Fagbamigbe AF, Onakpoya OH. The dynamics of COVID-19 outbreak in Nigeria: A sub-national analysis. Scientific African. 2021 Sep 1;13:e00914.

4.Worldometer.COVID-19 coronavirus pandemic; reported cases and deaths by country, territory or conveyance.[Accessed on 15 June 2021]. Available at:

5.Nutley T, Reynolds H. Improving the use of health data for health system strengthening. Global health action. 2013 Dec 1;6(1):20001.

6.Erdfelder E, Faul F, Buchner A. GPOWER: A general power analysis program. Behavior research methods, instruments, & computers. 1996;28:1-1.

7.Quaglio GL, Preiser W, Putoto G. COVID-19 in Africa. Public Health. 2020;185:60. doi: 10.1016/j.puhe.2020.05.030.

8.Nachega JB, Ishoso DK, Otokoye JO, Hermans MP, Machekano RN, Sam-Agudu NA, Nswe CB, Mbala-Kingebeni P, Madinga JN, Mukendi S, Kolié MC. Clinical characteristics and outcomes of patients hospitalized for COVID-19 in Africa: early insights from the Democratic Republic of the Congo. The American Journal of tropical medicine and Hygiene. 2020;103:2419.

9.Macedo A, Gonçalves N, Febra C. COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis. Ann Epidemiol. 2021;57:14-21.doi: 10.1016/j.annepidem.2021.02.012

10.Okonji EF, Okonji OC, Mukumbang FC, Van Wyk B. Understanding varying COVID-19 mortality rates reported in Africa compared to Europe, Americasand Asia. Trop Med Int Health. 2021 Jul;26:716-719. doi: 10.1111/tmi.13575.

11.Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M. Age, and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Societyof Hypertension. Hypertension. 2020;76:366-72.

12.Tehrani S, Killander A, Åstrand P, Jakobsson J, Gille-Johnson P. Risk factors for death in adult COVID-19 patients: frailty predicts fatal outcome in older patients. International Journal of Infectious Diseases. 2021;102:415-21.

13.Channappanavar R, Fett C, Mack M, Ten Eyck PP, MeyerholzDK, Perlman S. Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection. The Journal of Immunology. 2017;198:4046-53.

14.Popoola OT. Population growth and life expectancy in Nigeria: Issues and further considerations. Humanities and Social Science Research. 2018;1:30.DOI:10.30560/hssr.v1n1p30.

15.Population Reference Bureau (PRB),The 2019 World Population Data Sheet, Population Reference Bureau (PRB), Washington, DC, USA, 2019,

16.Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJ, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. Geneva: World Health Organization. 2001 Jan;9(10).Al-Lami RA, Urban RJ, Volpi E, Algburi AM, Baillargeon J. Sex hormones and novel coronavirus infectious disease (COVID-19). In: Mayo Clinic Proceedings2020;95:1710-1714.

17.Shah P, Owens J, Franklin J, Mehta A, Heymann W, Sewell W, Hill J, Barfield K, Doshi R. Demographics, comorbidities and outcomes in hospitalized COVID-19 patients in rural southwest Georgia. Annals of Medicine. 2020;52:354-60.

18.Akinbolagbe YO, Otrofanowei E, Akase IE, Akintan PE, Ima-EdomwonyiUE, Olopade BO, et al. Predictors and outcomes of COVID-19patients with hypoxemia in Lagos, Nigeria. JPan Afr Thorac Soc2022; 3:42-50.

19.Alasia D, Maduka O. Profile and Outcome of Hospitalized Patients with Severe COVID-19 in a Tertiary Hospital in Southern Nigeria. EC Pulmonology and Respiratory Medicine 10.6 (2021):13-26.

20.Burke H, Freeman A, Cellura DC, Stuart BL, Brendish NJ, Poole S, Borca F, Phan HT, Sheard N, Williams S, Spalluto CM. Inflammatory phenotyping predicts clinical outcome in COVID-19. Respiratory research.2020;21:1-9.

21.Siddiqui SH, Sarfraz A, Rizvi A, Shaheen F, Yousafzai MT, Ali SA. Global variation of COVID-19 mortality rates in the initial phase. Osong public health and research perspectives. 2021;12:64.

22.Panda AK, Tripathy R, Das BK.Plasmodium falciparum infection may protect a population from severe acute respiratory syndrome coronavirus 2 infection. The Journal of Infectious Diseases. 2020;222:1570-1.

23.Iesa MA, Osman ME, Hassan MA, Dirar AI, AbuzeidN, Mancuso JJ, Pandey R, Mohammed AA, Borad MJ, Babiker HM, Konozy EH. SARS-CoV-2 and Plasmodium falciparum common immunodominant regions may explain low COVID-19 incidence in the malaria-endemic belt. New microbes and new infections. 2020; 38:100817.

24.Ssebambulidde K, Segawa I, Abuga KM, Nakate V, Kayiira A, Ellis J, Tugume L, Kiragga AN, Meya DB. Parasites and their protection against COVID-19-Ecology or Immunology? MedRxiv. 2020 Jan 1.DOI:10.1101/2020.05.11.20098053

25.Lapidus S, Liu F, Casanovas-Massana A, Dai Y, Huck JD, Lucas C, Klein J, Filler RB, Strine MS, Sy M, Deme AB. Plasmodium infection induces cross-reactive antibodies to carbohydrate epitopes on the SARS-CoV-2 Spike protein. medRxiv. 2021.05.10.21256855. doi: 10.1101/2021.05.10.21256855.

26.Anyanwu MU. The association between malaria prevalence and COVID-19 mortality. BMC Infectious Diseases. 2021;21:1-6.

27.Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, Cai J, Yang R, Han J, Huang Y, He S. Effects of angiotensin II receptor blockers and ACE(angiotensin-converting enzyme) inhibitors on virus infection, inflammatory status, and clinical outcomes in patients with COVID-19 and hypertension: a single-center retrospective study. Hypertension. 2020;76:51-8.

28.Kenyon C, Rosanas A. Could malaria explain the global distribution of the angiotensin converting enzyme I/D polymorphism? A systematic review and ecological study. F1000Research. 2020;9:1205.

29.Acharya D, Liu G, Gack MU. Dysregulation of type I interferon responses in COVID-19. Nature Reviews Immunology. 2020;20:397-8.

30.World Health Organization. (2020). Clinical management of severe acute respiratory infection (SARI)when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization. License: CC BY-NC-SA 3.0 IGO.

31.Mccabe G, Sahni DS, Ramsaha S. A systematic review on the therapeutic relevance of hydroxychloroquine/chloroquine in the management of COVID-19. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine. 2021;46:380.

32.Chowdhury MS, Rathod J, Gernsheimer J. A rapid systematic reviewof clinical trials utilizing chloroquine and hydroxychloroquine as a treatment for COVID‐19. Academic Emergency Medicine. 2020;27:493-504.

33.Diaz‐Arocutipa C, Brañez‐Condorena A, Hernandez AV. QTc prolongation in COVID‐19 patients treated with hydroxychloroquine, chloroquine, azithromycin, or lopinavir/ritonavir: A systematic review and meta‐analysis. Pharmacoepidemiology and Drug Safety. 2021;30:694-706.

34.Karalis V, Ismailos G, KaratzaE. Chloroquine dosage regimens in patients with COVID-19: Safety risks and optimization using simulations. Safety Science. 2020; 129:104842.

35.Medema G, Been F, Heijnen L, Petterson S. Implementation of environmental surveillance for SARS-CoV-2 virus to support public health decisions: Opportunities and challenges. Curr Opin Environ Sci Health. 2020; 17:49-71. doi: 10.1016/j.coesh.2020.09.006

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