Influence of Comorbidities on the Length of Stay of Covid-19 Patients in Kenyatta National Hospital – Infectious Disease Unit (KNH–IDU), Nairobi County, Kenya

Authors

  • Dr. Vivian Manyeki Degree of Master of Public Health – Epidemiology, Department of Community Health, Student, School of Public Health, AMREF International University
  • Sr. Dr. Margaret Nyongesa PhD Lecturer, School of Public Health, Department of Health System Management & Development, AMREF International University
  • Dorcas Maina, PhD Senior Lecturer, Department of Nursing, University of Nairobi

DOI:

https://doi.org/10.47672/ajhmn.2199

Keywords:

Comorbidities, Length Stay, Covid-19 Patients, Kenyatta National Hospital

Abstract

Purpose: To determine the influence of comorbidities on the LOS of COVID-19 patients in KNH-IDU between 1st June 2020 and 30th November 2020

Materials and Methods: This retrospective cohort study comprised of 558 COVID-19 patients of which 69% survived and 31% died. The overall median LOS was 7.5 days (IQR: 0-183) – 8 days (IQR: 1-171) for the survivors, and 6 days (IQR: 0-183) for the non survivors. Data was extracted from hospital records using a questionnaire and analyzed with STATA version 15. Chi-square tests determined associations, while regression analysis examined LOS determinants based on model coefficients and significance.

Findings: Significant differences were seen in age (p<0.01), with more survivors aged 20-40 years and non-survivors aged over 40 years. Non-survivors had higher referral rates (p<.001), ICU admissions (p<.001), and intubation needs (p<.001). Diabetes and hypertension were more common in non-survivors (p<.001). Non-survivors also had higher WBC counts (p<.001), higher neutrophil counts (p<.01), lower lymphocyte counts (p<.001), and lower platelet counts (p<.001).

Implications to Theory, Practices and Policy: Practically, the findings underscore the need for targeted clinical management strategies, particularly for younger patients and those with severe disease, to optimize LOS and improve survival rates.

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References

Abate, B. B. et al. (2020. Sex difference in coronavirus disease (COVID-19): A systematic review and meta-analysis, BMJ Open. doi: 10.1136/bmjopen-2020-040129.

Arnold, C. G., Libby, A., Vest, A., Hopkinson, A., & Monte, A. A. (2022). Immune mechanisms associated with sex-based differences in severe COVID-19 clinical outcomes. Biology of sex Differences, 13(1), 7.

Bowmans – The value of knowing, COVID-19: tracking government response in Kenya, Update: As at 10th November 2020. Available at: https://www.bowmanslaw.com/wp-content/uploads/2020/12/Bowmans-Kenya-Government-Response-Tracker.pdf.

Brill, S. E., Jarvis, H. C., Ozcan, E., Burns, T. L., Warraich, R. A., Amani, L. J., ... & Creer, D. D. (2020). COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease. BMC medicine, 18, 1-9.

Chen, J. et al. (2020), Clinical progression of patients with COVID-19 in Shanghai, China, Journal of Infection. doi: 10.1016/j.jinf.2020.03.004.

Fisher RA. The logic of inductive inference (with discussion). Journal of Royal Statistical Society. 1935;98:39–82.

Gebhard, C., Regitz-Zagrosek, V., Neuhauser, H. K., Morgan, R., & Klein, S. L. (2020). Impact of sex and gender on COVID-19 outcomes in Europe. Biology of sex differences, 11, 1-13.

Gupta, S. et al. (2020). Factors Associated with Death in Critically Ill Patients with Coronavirus Disease 2019 in the US, JAMA Internal Medicine. doi: 10.1001/jamainternmed.2020.3596.

Ingabire, P. M., Nantale, R., Sserwanja, Q., Nakireka, S., Musaba, M. W., Muyinda, A., ... & Mukunya, D. (2022). Factors associated with prolonged hospitalization of patients with corona virus disease (COVID-19) in Uganda: a retrospective cohort study. Tropical Medicine and Health, 50(1), 100.

Kenya National Bureau of Statistics, available at: https://knbs.or.ke/visualizations/?page_id=3126

Mulu, A., Bekele, A., Abdissa, A., Balcha, T. T., Habtamu, M., Mihret, A., ... & Bayih, A. G. (2021). The challenges of COVID-19 testing in Africa: the Ethiopian experience. Pan African Medical Journal, 38(1).

National Emergency Response Committee on Coronavirus, Brief 251 - November 30, 2020. Available at https://www.health.go.ke/wp-content/uploads/2020/12/NERC-brief-on-COVID-19-Nov-30th-2020.pdf

Ombajo, L. A., Mutono, N., Sudi, P., Mutua, M., Sood, M., Loo, A. M., ... & Thumbi, S. M. (2020). Epidemiological and clinical characteristics of COVID-19 patients in kenya. medRxiv.

Owino, B. (2020). Kenya’s Covid-19 budget: Funding for health and welfare, Published on 2 July 2020. Available at: https://devinit.org/resources/kenyas-covid-19-budget-funding-for-health-and-welfare/ . Visited on: 15/5/21.

Peckham, H. et al. (2020). Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission, Nature Communications. doi: 10.1038/s41467-020-19741-6.

Rees, E. M. et al. (2020). COVID-19 length of hospital stay: A systematic review and data synthesis, medRxiv. doi: 10.1101/2020.04.30.20084780.

Richardson, S., Hirsch, J. S., Narasimhan, M., et al. (2020). Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA, 323(20), 2052–2059.

Rodriguez-Morales, A. J. et al. (2020). Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis, Travel Medicine and Infectious Disease. doi: 10.1016/j.tmaid.2020.101623.

Rotter, T., Kinsman, L., James, E. L., Machotta, A., Gothe, H., Willis, J., ... & Kugler, J. (2010). Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane database of systematic reviews, (3).

Sanyaolu, A. et al. (2020). Comorbidity and its Impact on Patients with COVID-19, SN Comprehensive Clinical Medicine. doi: 10.1007/s42399-020-00363-4.

Schorr, E. (2012). Theoretical framework for determining hospital length of stay (LOS), BMC Proceedings. doi: 10.1186/1753-6561-6-s4-p32.

Setareh, M., Alavi, N. M., & Atoof, F. (2021). Severity of illness affecting the length of stay and outcomes in patients admitted to intensive care units, Iran, 2019. Journal of Education and Health Promotion, 10(1).

Stokes, E. K. et al. (2020). Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020, MMWR. Morbidity and Mortality Weekly Report. doi: 10.15585/mmwr.mm6924e2.

Swann, O. V. et al. (2020). Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: Prospective multicentre observational cohort study, The BMJ. doi: 10.1136/bmj.m3249.

Taherdoost, H. (2017). Determining sample size; how to calculate survey sample size. International Journal of Economics and Management Systems, 2.

Wang, X. et al. (2020). Clinical characteristics of non-critically ill patients with novel coronavirus infection (COVID-19) in a Fangcang Hospital, Clinical Microbiology and Infection. doi: 10.1016/j.cmi.2020.03.032.

World Bank. (2022). Rural population (% of total population) - Sub-Saharan Africa | Data. World Bank Group. 2022. https://data.worldbank.org/indicator/ https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS. Accessed 12/06/24

World Health Organization; (2021). COVID-19 Clinical management: living guidance, World Health Organization.

Wu, S. et al. (2020). Understanding factors influencing the length of hospital stay among non-severe COVID-19 patients: A retrospective cohort study in a Fangcang shelter hospital, PLoS ONE. doi: 10.1371/journal.pone.0240959.

Wu, Z. and McGoogan, J. M. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China, JAMA. doi: 10.1001/jama.2020.2648.

Zhang, J. J., Lee, K. S., Ang, L. W., Leo, Y. S., & Young, B. E. (2020). Risk factors for severe disease and efficacy of treatment in patients infected with COVID-19: a systematic review, meta-analysis, and meta-regression analysis. Clinical Infectious Diseases, 71(16), 2199-2206.

Zheng, J. et al. (2020). Incidence, clinical course and risk factor for recurrent pcr positivity in discharged covid-19 patients in guangzhou, china: A prospective cohort study, PLoS Neglected Tropical Diseases. doi: 10.1371/journal.pntd.0008648.

Zhou, F., Yu, T., Du, R., et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054–1062.

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Published

2024-07-12

How to Cite

Manyeki, D. V., Nyongesa, S. D. M., & Maina, D. (2024). Influence of Comorbidities on the Length of Stay of Covid-19 Patients in Kenyatta National Hospital – Infectious Disease Unit (KNH–IDU), Nairobi County, Kenya. American Journal of Health, Medicine and Nursing Practice, 10(4), 12–34. https://doi.org/10.47672/ajhmn.2199

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