Article Test – practice

In our retrospective cross-sectional survey of COVID-19 patients at Likuni mission hospital. majority of our patients were females (67%). The
typical clinical presentations were fever, cough, chest pains, headache, shortness of breath, and general body weakness. Even though the COVID-19 pandemic had varying clinical picture across various regions, most of the symptoms were similar. The finding from this study, are also reflected in other studies done across the world.15 The similarity in clinical presentation has a huge significance to public health information, prevention and control of the disease. Whilst the clinical presentation was similar to studies done in other settings, there were huge differences in demographic characteristics such as age. Our population was predominantly younger, with a mean age of 35. This reflects the demographic variations that exist across various nation.

Most of developing countries, including Malawi, have predominantly younger population16. Nearly half of the population is below the age of 50, and majority of them are youth16. This demographic variation, explains why most of the people affected were in their 20’s. This is also the group that has high level of social mobility and interactions, leading to higher rate of positive contacts and increased rate of spread of the disease.

While clinical comorbidities such as diabetes, hypertension, dyslipidemias and chronic lung conditions have clearly been documented to affect the outcomes of patients, diagnosed with COVID-19, in this present study, it did not appear as a major factor. Contrary to the findings in studies done across Europe and Asia, where the prevalence of comorbidity amongst patients diagnosed with COVID-19 was as high as 50%15, our present study demonstrated very low percentage of patients who had comorbidities. Only 2% (n=4) had known diagnosed hypertension and asthma. This may reflect limitations in diagnostic capability across various developing countries. While WHO recommends screening for non-communicable diseases in routine practice, most developing countries lack diagnostic capacity and have
inadequate human resource to cater for integrated disease. It is an undisputable fact, that there is an epidemiological transition in Africa. Most countries are suffering from dual burden of NCDs and infectious diseases and Malawi is not an exception.17 The prevalence of non-communicable diseases has been increasing in Malawi, with hypertensive disorders being the predominant disease18.

Despite that being the case, many people still live with chronic conditions, but they are largely unaware of it due to poor health seeking behaviour and limited screening for comorbidities during routine care. This could partially explain the low levels of comorbidity among our patients. There is also a strong link between age and development of chronic conditions. Advanced age has been closely associated with increased risk of developing chronic conditions such as hypertension and atherosclerotic disorders18. The predominantly younger population could have led to low levels of comorbidity among our patients as compared to studies done in other regions, which the population is predominantly aged. This demographic variation plays a significant role in the differences in comorbidities seen across the world.

In our study we also observed that most of the patient presented with more than 3 symptoms but did not suffer a severe disease that needed hospitalization. Most of them self-reported to the hospital and were sent to self-isolation as they didn’t require advanced respiratory support. Only 10 out of 490 required hospitalizations, and all were above the age of 60. There was a closer association between advanced age and needing hospitalization and the results were statically significant. Unlike in studies done in other settings, nearly all our patients survived and were discharged from the hospital without need of follow up. This is contrary to the findings in other settings,
where all-cause mortality was particularly high probably owing to the advanced patient age and high prevalence of comorbid conditions15.

67% percent of our population lived in suburbs and depended on piece works for day to living. The population was predominantly of low socioeconomic status and lived in overcrowded areas. These areas had high COVID-19 transmission rates, but fortunately the case fatality rate was extremely low. Our findings also agree with studies done across the country, where densely populated areas had high transmission rates and most people barely lived below the poverty level. Also, studies done in other countries, demonstrated that people from low social economic status, were more likely to be affected from the disease15. Adherence to COVID- 19 preventive measures requires access to safe and clean water, and other preventive equipment such as mask. Most people in low socio-economic status don’t have access to these items. This led to challenges in adherence to COVI-19 preventive measures and increased spread of the disease. Our results clearly demonstrates that various disparities exist among patients diagnosed with COVID-19. The differences in socio-demographic
profiles between different regions of the world, has read to different patterns of the disease as it is clearly demonstrated in this study. While most of our patients were young and didn’t have any comorbidity, the situation was so different in other parts of the world. This, therefore calls for localized policies and guidelines across various regions to mitigate the spread of the disease.