Clinical Characteristics and Outcome of Pediatric COVID-19 Patients in Ethiopia During the Early COVID-19 Pandemic: A Prospective Cohort Study

Abstract

Introduction

Most previous pediatric COVID-19 studies reported milder disease in children. However, there are limited pediatric data from low-income settings. We aimed to assess the characteristics and outcomes of pediatric COVID-19 in Ethiopia.

Setting

St. Paul’s COVID-19 treatment center; a tertiary COVID-19 center. Pediatric care was provided in a dedicated ward but with a common ICU.

Methods

St. Paul’s Hospital COVID-19 cohort (SPC-19) included inpatient COVID-19 RT-PCR confirmed cases from August 2020 to January 2021. Data were extracted from case report forms attached to patient charts and completed by the clinicians. Data were uploaded into the Redcap database and exported to SPSS 20 for analysis. Binary logistic regression and chi-square test were used in the analysis.

Results

Seventy-nine patients 0–19 years were included from the SPC-19 cohort over 6 months. Pediatric admissions accounted for 11% of cases in the cohort. The mean age (SD) was 6.9 (±6.36) years and 40 (50.6%) were female. The disease was asymptomatic or mild in 57 (72.2%), moderate in 15 (19%), and severe or critical in 7 (8.8%). The commonest presentations in symptomatic children were prostration (26.6%) followed by vomiting (12.7%), fever and cough (11.4% each), and dyspnea (10%). About 53 (67%) children had multimorbidity, and 14 (17.7%) children died. All deaths were in children with comorbidities with tuberculosis and malignancy being associated with 43% of deaths. Nearly 5% of children reported long-COVID symptoms highlighting the need for prolonged follow-up in those children.

Conclusion

Despite lower admissions and severity, high mortality and morbidity was documented in our pediatric cohort. The presence of comorbidity and inadequate care organization likely contributed to high mortality. COVID-19 centers of low-income settings should emphasize optimizing the care of children with COVID-19 and multimorbidity, and vaccination should be considered in those children to prevent high morbidity and mortality.

Keywords:

• child
• inpatient
• COVID-19
• cohort studies
• multimorbidity
• Ethiopia

Abbreviations

ARDS, acute respiratory distress syndrome; BP, blood pressure; COVID-19, corona virus disease caused by the SARS-CoV-2 virus-2019; CRF, case report form; CRP, C-reactive protein; HDU/ICU, high dependency unit/intensive care unit; LMICs, low- and middle-income countries; MIS-C, multi-system inflammatory syndrome of childhood related to COVID-19; MV, mechanical ventilation; NIV, non-invasive ventilation; RR, respiratory rate; RT-PCR, reverse transcriptase polymerase chain reaction; PCT, procalcitonin; PICU, pediatric intensive care unit; PR, pulse rate; SD, standard deviation; SPC-19, St. Paul’s Hospital COVID-19 prospective cohort; SPHMMC, St. Paul’s Hospital Millennium Medical College; SPO2, saturation of oxygen measured by pulse-oximetry; WHO, World Health Organization.

Data Sharing Statement

Data is available with a reasonable request from the corresponding author.

Ethics Approval and Informed Consent

The study was approved by SPHMMC IRB. Informed consent was taken from parents or legal guardians of each participants and the study was done per the approved protocol and based on the principles of the Helsinki declaration.

Acknowledgments

We thank SPHMMC for funding the research and all participating patients and research team who worked in those difficult times tirelessly both in the clinical care as well as this research.

Author Contributions

All authors made a significant contribution to the study including in the conception, study design, execution, acquisition of data, analysis and interpretation; revising and critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The study was funded by SPHMMC. The funding institution has no role in data collection or writing of the research.