Socio-Demographic and Clinical Characteristics and Outcomes of COVID-19 Patients in Kaduna State

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INTRODUCTION
Coronavirus Disease 2019 (COVID-19) or Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) is a severely fatal disease first identified in Wuhan China in 2019 [1].It has since spread globally and was declared pandemic in March, 2020 by the World Health Organization [2].Several factors have been identified globally to be the predicting factors of worst clinical outcomes and mortality.Severe COVID-19 infection has been reported across advanced age, male sex and low socioeconomic status.A survey on the impacts of sex and gender on the outcome of COVID-19 in Europe revealed higher mortality among infected men and with concomitant severe outcome among aged men [3].A meta-analysis by Augusta et al. [4] found that men have a higher chance of dying from COVID-19 infection than their female counterpart in respective settings (either hospitalized or not).It was suggested to be as a result of the presence of toll-like receptor 7 on the X chromosome which serves as a defense against viral infections [4].A survey by Hussain et al. [5] revealed gender disparity among COVID-19 infected individuals with worst clinical outcomes and increased mortality among men.Some of the factors proposed were sex hormones, intrinsic variation in the innate and adaptive immunity and genetic differences in the expression of immune regulatory genes between men and women [5].
A study conducted by Jamil et al. in Northeast India [6] and El Aidaoui et al. in Casablanca Morocco [7], revealed advancing age, male gender and presence of comorbidities among others as some predictors of poor outcomes of COVID-19 infection.Furthermore, a survey on the outcomes of COVID-19 in patients with thoracic malignancies in New York by gender and ethnicity, found a higher mortality among men and Hispanics, however with similar clinical severity between ethnic groups [8].Another survey on the gender-based difference of COVID-19 in Taiwan found increased mortality, prolonged hospital stays and increased severity of presentation in men [9].
Several surveys attributed the presence of comorbidities notably hypertension, diabetes and cardiac disease as factors associated with worst clinical presentation, prolonged admissions and increased mortality among COVID-19 patients [10,11].Therefore, there was a need to determine the socio-demographics and clinical characteristics and outcomes of COVID-19 infection in Kaduna state with the highest number of COVID-19 cases in northern Nigeria.This will enable policy makers and other stakeholders to pay more attention to the identified factors leading to worst clinical outcomes in order to provide a lasting solution.

Survey
The survey was a retrospective cross-sectional review of clinical records of all COVID-19 patients admitted from 27/03/2020 to 31/12/2021 in the four isolation centers.Patients with incomplete records and those managed at home were excluded from the study.A structured questionnaire was used to collect data on age, sex, date of onset, date of presentation, severity of symptoms, and final clinical outcome (Recovery or Death).The questionnaire also contained classification of the COVID 19 cases as mild, moderate and severe.A patient that was asymptomatic at presentation was classified as mild while a patient was classified as moderate if they presented with fever, cough, respiratory rate <30 breaths per minute, SPO2 >90% for adults and >92% for children and a patient with grunting respiration, respiratory rate >30 breaths per minute, spO2 <90% for adults and <92% for children requiring oxygenation was classified as severe [12].

Data analysis
Data analysis was done using IBM SPSS version 26 and Stata 12. Data was summarized using frequencies and percentages for categorical variables, mean and standard deviation for continuous variables, and bivariate analysis to explore determinants of poor outcomes.
Religion, marital status and occupations were not explored in other studies as predictors of clinical severity.The duration of symptoms in this study was found to be prolonged with advancing age and more among elderly men than women.Furthermore, the study found that age, religion, marital status, presence of comorbidities and occupation contribute to mortality among COVID-19 patients.This corroborates with findings of Jamil et al. in Northeast India [6], El Aidaoui et al. [7], Alkundi et al. [16] and Mohan et al. [17] on the effect of age and presence of comorbidities as determinants of worst outcome of COVID-19.
Though other sociodemographic factors were not explored in several other studies.Sex was not found to affect mortality; this contradicts several studies by Hussain et al. [5] and Kuo et al. [9] that revealed an increased mortality rate among men.Even though the studies could not specifically identify the reasons for the observed differences in the clinical outcomes across gender, several speculations were suggested like sex hormones, xchromosomal factors, and inherent innate and adaptive immunity as protective factors for women.In conclusion, the findings of this study showed significant effects of age, marital status, occupation, presence of comorbidities and religion on the severity of clinical presentation and clinical outcome of COVID-19 infection.However, gender was only found to affect the severity of presentation but not overall mortality, while Tribe and Level of education were not found to affect any of the clinical outcomes or mortality.There is a need for policymakers and other relevant stakeholders to come up with policies targeting critical factors such as advancing age, presence of comorbidities and so on among the infected individuals in order to curtail the pandemic.

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Hamdala Alternative Isolation Center (HAIC), General Hospital Kafanchan and Zaria Hotel.The State had a total of 262 beds in the four Isolation centers.The response of the state to the COVID-19 pandemic was via nine pillars setup by the state Emergency Operation Centre (EOC).These pillars include Case Management, Risk communication, Logistics and Supplies, Epidemiology and Surveillance, Laboratory Services, Point of Entry (POE), Infection Prevention and Control, Coordination and Research.

Table 1 .
Sociodemographic Characteristics of COVID-19 Patients admitted in Kaduna State Isolation Centers.

Table 2 .
Clinical Characteristics of COVID-19 Patients admitted in Kaduna State Isolation Centers.

Table 3 .
Relationship between Sociodemographic Profiles and Severity of Clinical Presentation of COVID-19 Patients in Kaduna State.

Table 4 .
Relationship between Sociodemographic Profiles and Outcome of COVID-19 Patients in Kaduna State.The survey on the sociodemographic characteristics and clinical characteristics and outcomes of COVID-19 patients in Kaduna state, revealed majority of the patients admitted in Kaduna state were mild to moderate cases.This corroborates the findings of Jamil et al. in Northeast India [6], Albadawy et al. in Egypt [14], Osibogun et al. in Lagos [13], Oyefabi et al. in Kaduna [15] that most COVID-19 infections were mild to moderate in presentation.However, advancing age, religion, sex, marital status and occupation were found to be associated with severe clinical presentation in this study.This agrees with the findings of Whisenant et al. in New York City