Predictors of COVID-19 mortality at 30 days of hospitalisation in Goma, Democratic Republic of Congo

Introduction: The COVID-19 pandemic has affected all provinces of the Democratic Republic of Congo, particularly the city of Goma (North Kivu). The effective crude fatality ratio in the DRC was 1.93%, while in Goma it was 7.4%. This study determined the apparent crude fatality ratio in the COVID-19 treatment centre and identified the predictors of COVID-19-related deaths within 30 days of hospitalisation in the city of Goma. Methods: A historical cohort study was conducted on patients hospitalised for COVID-19 in Goma’s COVID-19 Treatment Centres with self-medication as the exposure factor. The minimum calculated sample size was 356 individuals. SARS-CoV-2 infection was confirmed by RT-PCR, and the WHO definition was used for confirmed deaths. Cox regression identified independent predictors of COVID-19 death in Goma. We included 400 medical records of hospitalised COVID-19 patients. Results: The apparent crude fatality ratio was significantly higher in hospitalised patients exposed to self-medication at 50% (95% CI:32.06%-67.94%) compared to 20% (95% CI:16.19%-24.55%, p=value <0.001) among non-exposed. Cox regression identified the following death predictors: diabetes mellitus (aHR=2.92, 95% CI:1.40-3.43, p < 0.001); self-medication (aHR=1.90, 95%CI:1.01-3.59, p=0.048); being unemployed (aHR = 6.65, 95% CI:1.37-32.26, p=0.019); age ≥ 60 years (aHR=2.92, 95% CI: 1.17-7.27, p=0.021); complications including respiratory failure (aHR=39.56, 95% CI: 6.25-250.21, p < 0.001); heart failure (aHR=24.86, 95% CI: 3.65-169.37, p=0.001); thromboembolic diseases (aHR=25.75, 95% CI: 1.51- 439.18, p=0.025); stroke (aHR = 48.77, 95% CI: 6.11-389.66, p < 0.001); systemic inflammatory response syndrome (aHR=63.18, 95% CI: 10.03-397.87, p < 0.001); and drug reaction (aHR=99.49, 95% CI:10.81-915.60, p < 0.001). Conclusions: Advanced age beyond 60 years, self-medication, a history of diabetes mellitus, unemployment, and the occurrence of complications are predictors of death related to COVID-19 within 30 days of hospitalisation. Development of policies to protect vulnerable people (aged ≥60 years, those with chronic diseases and the poor) and a communication program to change behaviour towards self-medication could reduce COVID-19 fatality in Goma.