Flowchart for admissions of COVID-19 patients.

BackgroundWe investigated the clinical profile, complications, and outcomes of inpatients with COVID-19 at Parirenyatwa Hospital, Harare, across the first two waves of SARS-CoV-2 infection, and factors associated with mortality.MethodsWe conducted a prospective cohort study on all patients admitted to the COVID-19 unit. Data were extracted from medical records and negative binomial regression with robust standard errors was used to assess the association between sociodemographic and clinical characteristics and mortality. Cox Regression was used for sensitivity analysis.ResultsOf 563 people admitted with COVID-19 between 2 July 2020 and 19 March 2021, 214 (38.0%) died, 340 were discharged and 9 transferred. The median age was 56 (IQR 44–68) years and 53.8% were male. Overall, 38.8% experienced a complication, the most common being acute kidney injury (17.9%) and hyperglycaemia (13.1%). The most common comorbidity was hypertension (41.3%) followed by diabetes (28.6%), HIV (12.1%), cardiovascular disease (10.9%) and chronic kidney disease (7.8%). Among participants who stayed in the ward for more than 1 night, mortality was higher in patients with comorbidity compared to those without any comorbidity (38.7% vs 25.5%, risk ratio (RR) = 1.52 (95% CI 1.11, 2.07), p = 0.008). After adjusting for oxygen saturation, comorbidities, sex and pregnancy, mortality was higher in the second wave than in the first (adjusted RR 1.23, 95% CI 1.00–1.51, p = 0.05). In the second wave 57/161 (35.4%) deaths were attributed to lack of resources, mainly human resources.ConclusionThe mortality rate was high and clinical COVID-19 care needs to pay careful attention to patient monitoring for complications and management of comorbidities. This will require addressing the critical health workforce shortage issues. Prevention of COVID-19 including vaccination particularly among individuals with comorbidities remains a high priority.</div

Interventions and complications of COVID-19 patients, by outcome.

Interventions and complications of COVID-19 patients, by outcome.</p

Characteristics of patients at admission, by wave.

Characteristics of patients at admission, by wave.</p

Factors associated with mortality in participants who stayed in the ward for more than 1 night, using univariate and multivariate negative binomial regression models.

Factors associated with mortality in participants who stayed in the ward for more than 1 night, using univariate and multivariate negative binomial regression models.</p

Flowchart for people with DR-TB whose records were included in the study, 2014–2021, Zimbabwe.

Flowchart for people with DR-TB whose records were included in the study, 2014–2021, Zimbabwe.</p

Mortality attributable to lack of resources by month (November 2020 to March 2021, n = 409).

Mortality attributable to lack of resources by month (November 2020 to March 2021, n = 409).</p

Factors associated with mortality in participants who stayed in the ward for more than 1 night, using multivariate Cox regression models.

Factors associated with mortality in participants who stayed in the ward for more than 1 night, using multivariate Cox regression models.</p

COVID-19 and incidental COVID-19 admissions over time, and national COVID-19 case reports.

COVID-19 and incidental COVID-19 admissions over time, and national COVID-19 case reports.</p

Characteristics of health workers screened through the comprehensive health check program; July 2020—July 2022, in the ICAROZ study.

Characteristics of health workers screened through the comprehensive health check program; July 2020—July 2022, in the ICAROZ study.</p

Map of Zimbabwe showing the geographical spread of the service provision.

The map was created using shape files from Humanitarian Data Exchange; Zimbabwe National Statistics Agency, and plotted in R using the sf and tmap packages. https://data.humdata.org/dataset/cod-ab-zwe.</p