# Underlying conditions associated with adverse COVID-19 treatment outcomes in selected Kenyan hospitals, October 2020 to December 2021

## TL;DR

This study found that patients with chronic conditions like hypertension and diabetes were more likely to die from COVID-19 in Kenyan hospitals.

## Contribution

The study provides new evidence on how underlying health conditions affect severe outcomes of COVID-19 in sub-Saharan Africa.

## Key findings

- More than half of hospitalized patients had at least one underlying condition.
- Mortality was significantly higher among patients with heart disease and hypertension.
- Integrated care for non-communicable and infectious diseases is critical in pandemic preparedness.

## Abstract

Data are limited on the impact of chronic underlying conditions on COVID-19 treatment outcomes in sub-Saharan Africa.

Determine the effect of underlying conditions on COVID-19 severity and treatment outcomes in Kenya.

We conducted a retrospective cohort study using routine medical records from Kenya’s three large COVID-19 treatment centers. We examined two outcomes: mortality and clinical severity. Patients with lower respiratory tract illness without tachypnoea or difficulty in breathing were considered to have mild COVID-19. Underlying conditions were based on documentation in medical records. Logistic regression models assessed associations between underlying conditions and COVID-19 severity and mortality.

Among the 1,123 hospitalized COVID-19 patients included in the analysis, 59% (n = 664) had at least one underlying condition, 24.9% (n = 261) had severe disease, and 32.5% (n = 365) died. Hypertension (61.1%; n = 409), diabetes (38.9%; n = 258), and HIV (14.2%; n = 94) were the most common underlying conditions. Deaths were significantly higher among hospitalized COVID-19 patients with underlying conditions (35.4%) than those without (28.3%) (p = 0.01). The adjusted odds of severe COVID-19 were 50% higher among patients with hypertension (adjusted odds ratio [aOR] 1.50; 95% confidence interval [CI] 1.11–2.02). Mortality during COVID-19 hospitalization was nearly threefold higher among patients with heart disease (aOR 2.82; 95% CI 1.18–6.74) and 37% higher among patients with diabetes (aOR 1.37; 95% CI 1.00–1.88).

Patients with underlying conditions hospitalized for COVID-19 were more likely to die than those without. Hypertension was independently associated with disease severity, while heart disease and diabetes were independently associated with death during COVID-19 treatment.

Main findings: More than half of patients hospitalized with COVID-19 had underlying conditions, and mortality was significantly higher among those with chronic heart disease and hypertension.Added knowledge: The study highlights the potential impact of non-communicable diseases and chronic infectious diseases, such as HIV, on infectious disease pandemics in low and middle income countries.Global health impact for policy and action: Strengthening integrated care for non-communicable and infectious diseases is critical to mitigate the impact of future pandemics in low- and middle-income countries undergoing epidemiological transition.

Main findings: More than half of patients hospitalized with COVID-19 had underlying conditions, and mortality was significantly higher among those with chronic heart disease and hypertension.

Added knowledge: The study highlights the potential impact of non-communicable diseases and chronic infectious diseases, such as HIV, on infectious disease pandemics in low and middle income countries.

Global health impact for policy and action: Strengthening integrated care for non-communicable and infectious diseases is critical to mitigate the impact of future pandemics in low- and middle-income countries undergoing epidemiological transition.