Clinical Outcomes of Treatment Strategies Used in the Management of Covid-19 Patients in Kenya: Potentially Effective Therapy Options

Abstract

Background: The recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) identified as coronavirus-19 shown to be of great health concern globally and declared a pandemic by the World Health Organization (WHO). The SARS-CoV infection may be asymptomatic or present clinically with non-specific or specific symptoms ranging from mild to critically ill disease. COVID-19 may be associated with different risk factors in a patient such as diabetes, hypertension, cardiovascular disease, and chronic respiratory disease, which possibly increase complications and mortality. With no available registered drugs or vaccines in the first year of the pandemic, managing the disease was mainly supportive regarding the symptoms observed with an option to repurpose available approved drugs or drugs from in vitro observation used during the SARS-CoV and MERS-CoV pandemics; isolation of infected individuals, and quarantine of whether symptomatic or not, frequent use of disinfectants and hand washing, were used as preventives measures. In sum, the clinical control approaches lie on one hand on drugs which include antiviral, anti-pro-inflammatory cytokine, anti-infectious, and monoclonal antibodies; on the other hand, supportive care including oxygen and mechanical ventilation. Objectives: To document the clinical outcomes, adherence to the standard of care, and the influence of co-morbidities on the clinical outcomes of the treatment regimens in the management of COVID-19 in Kenya since the first case was reported Methods: This was a retrospective cross-sectional study done at Kenyatta National Hospital and Mater Misericordiae hospital in Nairobi County and at Coast General Teaching Hospital in Mombasa County, respectively. The study involved 408 COVID-19 positive patient records files, admitted into the healthcare facilities of interest in Kenya since the first case was reported on 13th March 2020 until 31st December 2021. The collected variables included sociodemographic information, clinical data, pharmacological interventions, and clinical outcomes. Data analysis was done using SPSS version 25. Descriptive statistics such as frequency, mean, and standard deviation, were used to summarize the results. Inferential statistic such as Chi-square, univariable and multivariable logistic regression analysis was used to assess the factors associated with patients discharge. All hypotheses were tested at a 95% confidence interval whereby a p-value of <0.05 was considered statistically significant. Crude odds ratio (cOR) and adjusted odds ratio (aOR) were computed in the logistic regression analyses.

Results: Overall, 76.5% of the patients were discharged, patients in private hospitals had a significantly higher odds (aOR = 10.166, p < 0.001) of being discharged compared to patients in public hospitals, for each unit increase in disease severity, the odds of discharge decrease (aOR = 0.214, p < 0.001). Patients with comorbidities had lower odds of discharge (aOR = 0.281, p < 0.001) compared to those without comorbidities. The use of Tocilizumab (aOR = 0.169, p = 0.04), Baricitinib (aOR = 0.979, p = 0.98), Remdesivir (aOR = 0.518, p = 0.19), supplementary drugs (aOR = 3.979, p = 0.16) were not strongly associated with discharge. The regimen group variable was not a strong predictor of discharge (aOR = 0.297, p = 0.07). Adherence to national guideline was not a significant predictor for discharge (aOR = 1.011, p = 0.98). Conclusion: Around three-quarters of patients had a favorable treatment outcome. Patients treated in private hospitals were more likely to be discharged compared to patients in public hospitals. Patients treated with mild and moderate disease severity had better treatment compared to those with severe and critical disease. The overall treatment strategies used in Kenya were not strongly associated with a favorable outcome (discharge). The presence of a comorbidity was shown to adversely affect the treatment outcome. Recommendations: Research is needed to evaluate the efficacy of each drug used in the management of COVID-19 in Kenya. The treatment strategies used so far have not been shown to influence discharge, so there is a need to make improvements by incorporating new molecules into the guidelines, and also make drugs available, accessible, and affordable. Routine training for health care professionals on any updates of the guidelines every time there is new input