Epidemiological profile and risk factors associated with COVID-19 deaths in Douala city – Cameroon, 2020

  • Vaccine preventable diseases
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Background:
COVID-19 is an emerging, deadly viral zoonosis caused by SARS-CoV-2. In March 2020, Cameroon was one of the most affected countries in Africa, with a case fatality rate of 2.2% (25/1136), and nearly half of the reported deaths were in Douala. We analyzed the risk factors for pandemic-related deaths in this city in 2020.

Methods:
We conducted a case-control study over a 2-month period in the health districts of Douala. Risk factors were assessed by matching one case with two controls by age and sex. A case was as any suspected COVID-19 death in the community or in a hospital, confirmed by RT-PCR after postmortem sampling, or any infected person who died of COVID-19. We collected sociodemographic data, clinical characteristics, and risk factors like comorbidities using a questionnaire administered to the victims' relatives. We used logistic regression to search for risk factors.

Results:
A total of 1,493 COVID-19 cases were confirmed, of which 162 suspected deaths were notified, 64 cases were confirmed by RT-PCR and 56 were investigated. The remaining 8 cases did not obtain consent. The sex ratio M/F was 4.1, the mean age was 57.3 years (14-82). The most represented group was [50-70 years]. The attack rate was 4.62/10 000 (case fatality 4.3%). Risk factors associated with death from COVID-19 were male (OR=2.64, CI95%:1.23-5.66), age ≥60 years (OR=5.60, CI95%:2.63-11.93), and hospital attendance >3 days after onset of symptoms (OR=2.88, CI95%:2.49-36.37). Comorbidities associated with death were hypertension (OR=51.2, CI95%:11.5-228); diabetes (OR=25.32, CI95%:7.15-89.68); and asthma (OR:18.89, CI95%:2.26-155.32). Self-medication with non-steroidal anti-inflammatory drugs was associated with death (OR=6.83, CI95%:1.36-71.12).

Conclusions:
Fatality of COVID-19 in Douala remains high compared with that nationally. Risk factors associated with deaths are related to age ≥60, hypertension, diabetes, and delayed management. The response strategy should be primarily directed toward these vulnerable populations.

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