Factors associated with Coronavirus Disease 2019 deaths, Sierra Leone, 2020-2022

Respiratory Diseases

The Coronavirus Disease 2019(COVID-19) constitutes a global public health threat and has claimed the lives of over 6 million people. Understanding predictors of COVID-19 deaths can help target interventions to reduce
deaths. Therefore, we described COVID-19 deaths and identified associated factors in Sierra Leone.
We conducted a retrospective secondary data analysis of COVID-19 deaths among patients reported from March 31, 2020, to March 31, 2022. We extracted information on demographic, clinical, and pre-existing medical conditions from the District Health Information System-2. We analyzed data by person and place to identify patterns of deaths. We calculated adjusted odds ratios(aOR) and 95% confidence intervals(CI) to identify risk factors for
Of 8,595 COVID-19 cases, 3.2%(276/8595) died. The median age of decedents was 60(1-98) years, with most death among aged 60+ years, 55%(153/276). Health care workers accounted for 3.6%(10/276) of the deaths. Over
half of the deaths, 60%(165/276), occurred in the capital, Freetown and 17%(45/276) of the deaths occurred at the decedent’s home. Of the decedents, symptoms were recorded for 167(61%) with fever 75%(126/167) as the most common symptom. There were 26%(72/276) decedents with pre-existing conditions. The most common pre-existing conditions were hypertension, 65%(47/72), and diabetes, 39%(28/72). Unconsciousness (aOR=16.6, 95% CI: 4.1-67.5), difficulty in breathing (aOR=3.2, 95% CI: 2.2-4.6), cardiac disease (aOR=2.9, 95% CI: 1.4-6.4), hypertension (aOR=2.9, 95% CI: 1.8-4.6), and diabetes(aOR=2.6, 95% CI: 1.5-4.7) were significant factors associated
with COVID-19 deaths. Symptomatic cases were 3.6 times more like to die than asymptomatic cases (aOR=3.6, 95% CI: 2.0-6.4).
Pre-existing conditions and clinical severity were associated with an increased risk of COVID-19 deaths. People with pre-existing conditions should be aware of the increased risk of death if they have COVID-19. We emphasized the need for health authorities to prioritize the elderly and those with pre-existing conditions for COVID-19 vaccination.

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