Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos,Nigeria:a retrospective cohort study

Background:The current pandemic of coronavirus disease(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients.The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.Methods:In this retrospective cohort study all confirmed COVID-19 adult patients(≥18 years of age)in Lagos between February 27 to July 62,020 were included.Demographic,clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos.Outcomes included dying,being discharged after recovery or being evacuated/transferred.Descriptive statistics considered proportions,means and medians.The Chi-square and Fisher’s exact tests were used in determining associations between variables.Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders.P-value≤0.05 was considered statistically significant.Results:A total of 2075 adults with COVID-19 were included in this study.The prevalence of hypertension,the most common comorbidity,was 17.8%followed by diabetes(7.2%)and asthma(2.0%).Overall mortality was 4.2%while mortality among the hypertensives was 13.7%.Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50%from 91%for those with hypertension alone and from 98%for all other patients(P<0.001).After adjustment for confounders(age and sex),severe COVID-19and death were higher for hypertensives{severe/critical illness:HR=2.41,P=0.001,95%CI=1.4–4.0,death:HR=2.30,P=0.001,95%CI=1.2–4.6,for those with hypertension only}{severe/critical illness:HR=3.76,P=0.001,95%CI=2.1–6.4,death:crude HR=6.63,P=0.001,95%CI=3.4–1.6,for those with additional comorbidities}.Hypertension posed an increased risk of severe morbidity(approx.4-fold)and death(approx.7-fold)from COVID-19 in the presence of multiple comorbidities.Conclusion:The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication.This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.

Correction to:Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos,Nigeria:a retrospective cohort study

Correction to:Global Health Research and Policy(2021)6:26 https://doi.org/10.1186/s41256-021-00210-6 Following publication of the original article[1],it is reported the second paragraph of the introduction includes some errors,as is indicated below.

Patients direct costs to undergo TB diagnosis

Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.Methods:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis.Surveys of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and Yemen.Adults>18 years with cough>2 weeks were enrolled prospectively.Direct costs were quantified using structured questionnaires.Patients with costs>75^(th) quartile were considered to have high expenditure(cases)and compared with patients with costs<75^(th) quartile to identify factors associated with high expenditure.Results:The most significant expenses were due to clinic fees and transport.Most participants attended the centres with companions.High expenditure was associated with attending with company,residing in rural areas/other towns and illiteracy.Conclusions:The costs incurred by patients are substantial and share common patterns across countries.Removing user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs.In locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.