SARS-CoV-2 reinfection: Two cases from Ethiopia

Reinfection with SARS-CoV-2 has infrequently been reported in the literature and never from Ethiopia or Africa. We describe two individuals with documented recurrent COVID-19 disease admitted to Eka Kotebe Hospital, Addis Ababa, Ethiopia

COVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case report

Patients with coronavirus disease 2019 (COVID-19) can present with pneumonia and acute respiratory distress syndrome but rarely with acute myocardial infarction, especially in the absence of known cardiovascular disease risk factors. We present the case of a previously healthy young Ethiopian man with COVID-19 and no known cardiovascular risk factors who was diagnosed with acute ST-elevation myocardial infarction and left ventricular thrombu

Prone ventilation in COVID-19 acute respiratory distress syndrome: Case report of two patients from Ethiopia

The COVID-19 pandemic is one of the largest health crises that the world has ever seen, infecting forty million people and killing more than 1 million to date. The disease has imposed a significant demand on health care resources due to the increased number and severely ill patients visiting facilities each day. Since there is no effective cure for COVID-19, supportive management with oxygen, steroids, anticoagulation, and prone positioning remains the major interventions. Prone ventilation is known to have a mortality benefit in intubated patients with acute respiratory distress syndrome (ARDS). However, studies on its role in intubated patients with COVID-19 ARDS (CARDS) are very scarce in resource-limited settings like Africa. We describe two patients with CARDS who were successfully treated with invasive mechanical ventilation, prone ventilation, and standard supportive care

Letter to the Editor - Resumption of pulmonary function testing (Spirometry) at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, during the COVID-19 pandemic

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Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Objectives: The objectives of the study were to evaluate the benefit of awake prone positioning in COVID-19 patients hospitalized at Eka Kotebe General Hospital, Addis Ababa, Ethiopia.Materials and Methods: Consecutive patients with COVID-19 who require supplemental oxygen to maintain oxygen saturation of ≥90% during the month of October 2020 were enrolled. Structured questionnaires were employed to collect data. Admission oxygen saturation was recorded for each patient before and after their first proning session. Analysis of descriptive and comparison statistics was done using SPSS version 25.Results: A total of 61 patients were included in the study. The mean age (+SD) for the cohort was 55.4 (+16.9) years. The average duration of proning was 5+2.5 h/session and 8+6 h/day. The average oxygen saturation before proning was 89% (SD 5.2) and 93% (SD 2.8) 1 h after proning (P < 0.001); supplemental oxygen requirements significantly decreased with prone ventilation, before proning: FiO2 0.33 (+0.14) versus 1 h after prone ventilation: FiO2 0.31 (+0.13) (P < 0.001). Oxygen improvement with prone ventilation was not associated with duration of illness or total prone position hours. When assessed at 28 days after admission, 55.7% (n = 34) had been discharged home, 1.6% (n = 1) had died, and 42.6 (n = 26) were still hospitalized.Conclusion: Awake prone positioning demonstrated improved oxygen saturation in our oxygen requiring COVID-19 patients. Even though further studies are needed to support causality and determine the effect of proning on disease severity and mortality, early institution of prone ventilation in appropriate oxygen requiring COVID-19 patients should be encouraged

A health systems approach to critical care delivery in low-resource settings: a narrative review

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to “ensure the timely and effective delivery of life-saving health care services to those in need”. In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or “building blocks”: (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings

A health systems approach to critical care delivery in low-resource settings: a narrative review

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict, adding pressure to the already strained health systems. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to “ensure the timely and effective delivery of life-saving health care services to those in need”. In this narrative review we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the WHO health systems framework to structure findings within six core components or “building blocks”: 1) service delivery; 2) health workforce; 3) health information systems; 4) access to essential medicines and equipment; 5) financing; and 6) leadership and governance. We provide recommendations using this framework, derived from literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low resource settings

Acute limb ischemia in COVID-19 patients despite therapeutic anticoagulation: Experience from Africa

Background: Hypercoagulability is a common complication seen in COVID-19 infection. However, arterial thrombosis such as acute limb ischemia (ALI) is far less common. Data on the incidence and nature of arterial thromboembolic complications in patients with COVID-19 is limited, originating from a few case reports and case series. Data in the African continent are very scarce. Method: This is a case series of 10 patients with COVID-19 who developed ALI while on treatment at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. All patients with ALI and COVID-19 admitted between February 1, 2021, and December 31, 2021, were retrospectively identified and reviewed. COVID-19 was confirmed by RT-PCR and ALI was confirmed by Doppler ultrasound and/or computed tomography angiography in the presence of clinical suspicion. Results: A total of 3098 patients were hospitalized with confirmed COVID-19 during the study period. In a series of 10 patients, 8 (80%) males with a median age of 53.5 years were included. All except one (10%) had one or more risk factors for ALI and one had a ‘possible’ case of vaccine-induced thrombotic thrombocytopenia (VITT) associated with ALI. All were admitted with severe COVID-19 and most (80%) developed ALI during hospitalization (median of seven days from admission). The median duration between COVID-19 and ALI symptom onset was 14.5 days (IQR, 11–15). The majority (60%) were taking therapeutic anticoagulation at the time of ALI onset which is the standard of care for patients with severe disease. Five (50%) were successfully revascularized (median time of 3.5 days) and the rest underwent amputation. All survived and were discharged improved. Conclusion: ALI can occur in the context of COVID-19 even while a patient is on therapeutic dose anticoagulation and in the absence of traditional risk factors. It is wise to be vigilant of this complication for timely intervention and better treatment outcomes

Post-COVID-19 pulmonary complications among recovered COVID-19 patients: a cross-sectional study from Addis Ababa, Ethiopia

Abstract Background The COVID-19 pandemic has been linked to chronic pulmonary complications all over the world. Respiratory complications such as chronic cough, dyspnea, increased respiratory rate, and oxygen support demand are prevalent in recovered COVID-19 patients. These problems are long-term and have a negative impact on one’s quality of life. Patients must be evaluated for potential complications, and risk factors must be found. Some reports around the world explain the factors that contribute to the development of these complications. However, to the best of our understanding, no reports of post-COVID-19 complications have been reported from Ethiopia. Methods Facility based cross-sectional study was done among 405 participants selected by simple random sampling technique. Structured questionnaire which includes participants’ demographic, clinical and 3rd month visit characteristics was collected by Open Data Kit and exported to SPSS version 25.0 for analysis. Percentage with frequency and median with Interquartile range was used in descriptive statistics. The association between variables was analyzed with bivariate and multi variable logistic regression. A statistical significance was declared at p-value < 0.05, with 95% confidence interval. Results The median (Interquartile range) age of participants was 57.0 (43.0, 65.0) years, 63.2% were males. The prevalence of post-COVID-19 pulmonary complication in recovered COVID-19 patients was 14.1% (95% CI: 10.8%, 17.8%). After adjusting for possible confounders on multivariate analysis, older age [AOR = 0.227, 95% CI (0.08–0.66)] and consolidation [AOR = 0.497, 95% CI (0.258–0.957)] were shown to have significant association with post COVID-19 pulmonary complications. Conclusion The prevalence of post COVID-19 pulmonary complication was observed to be lower than other reports globally. Older age and the presence of consolidation on lung imaging were associated with those complications. Clinicians are recommended to consider assessing the lasting effects of the pandemic, beyond immediate care, and should also investigate the COVID-19 history in patients presenting with respiratory issues

Clinical Characteristics and Treatment Outcomes of COVID-19 Patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia

Data from much of Africa are still scarce on the clinical characteristics, outcomes of treatment, and factors associated with disease severity and mortality of COVID-19. A cross-sectional study was conducted at Eka Kotebe General Hospital, Ethiopia\u27s first COVID-19 treatment center. All consecutive symptomatic SARS CoV-2 RT-PCR positive individuals, aged 18 and older, admitted to the hospital between March 13 and September 16, 2020, were included. Of the total 463 cases, 319 (68.9%) were male. The median age was 45 years (interquartile range 32-62). The most common three symptoms were cough (69%), shortness of breath (SOB; 44%), and fatigue (37%). Hypertension was the most prevalent comorbidity, followed by diabetes mellitus. The age groups 40 to 59 and ≥ 60 were more likely to have severe disease compared with those \u3c 40 years of age (adjusted odds ratio [aOR] = 3.45, 95% confidence interval [CI]: 1.88-6.31 and aOR = 3.46, 95% CI: 1.91-6.90, respectively). Other factors associated with disease severity included the presence of any malignancy (aOR = 4.64, 95% CI: 1.32-16.33) and SOB (aOR = 3.83, 95% CI: 2.35-6.25). The age group ≥ 60 was significantly associated with greater in-hospital mortality compared with those \u3c 40 years. In addition, the presence of any malignancy, SOB, and vomiting were associated with higher odds of mortality. In Ethiopia, most COVID-19 patients were male and presented with cough, SOB, and fatigue. Older age, any malignancy, and SOB were associated with disease severity; these factors, in addition to vomiting, also predicted mortality