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A Multi-centre, Cross-sectional Study on Coronavirus Disease 2019 in Bangladesh: Clinical Epidemiology and Short-term Outcomes in Recovered Individuals

A. Mannan
Department of Genetic Engineering & Biotechnology, Faculty of Biological Sciences, University of Chittagong

H. M. H. Mehedi
Department of Medicine, 250 bedded General Hospital

N. U. H. A. Chy
Health Economics Research Group, Department of Economics, University of Chittagong, Chattogram

Md. O. Qayum
Curator, Institute of Epidemiology, Disease Control & Research (IEDCR), Dhaka

F. Akter
Department of Endocrinology, Chittagong Medical College, Chattogram

M. A. Rob
Department of Medicine, 250 bedded General Hospital

P. Biswas
Department of Pathology, Mymensingh Medical College, Mymensingh

S. Hossain
Corona Unit, Dhaka Mohanagar General Hospital

M. Ibn Ayub
Department of Genetic Engineering & Biotechnology, University of Dhaka, Ramna, Dhaka, Bangladesh

Abstract/ Executive Summary:

Coronavirus disease 2019 (COVID-19) rapidly became a global pandemic. This study aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) -associated epidemiology and clinical outcomes in Bangladesh in order to understand the future course of the COVID-19 pandemic and develop approaches to prevention. A cross-sectional study based on retrospective interviews was conducted on 1021 individuals with RT-PCR-confirmed COVID-19 admitted in six different hospitals in Bangladesh and who recovered 4 weeks before the interview date. Of the 1021 patients, 111 (10.9%) were asymptomatic and the other 910 (89.1%) were symptomatic. Higher prevalence of COVID-19 was found in the male population (75%), in cohorts with B-positive blood group (36.3%) and in the 31–40 years age group. Common symptoms observed in our study participants were fever (72.4%), cough (55.9%), loss of taste (40.7%) and body ache (40%); whereas among the biochemical parameters, neutrophil count (46.4%), D-dimer (46.1%) and ferritin (37.9%) levels were elevated. Among the recovered individuals, short-term outcomes including pains and aches (31.8%), weakened attention span (24.4%) and anxiety or depression (23.1%) were also significantly prevalent in the symptomatic cases with comorbidities. Our study showed that in Bangladesh, adult males aged between 31 and 40 years were more vulnerable to developing COVID-19.

Keywords: Asymptomatic, Bangladesh, Comorbidities, Coronavirus disease 2019, Epidemiology, Post-coronavirus disease 2019

Location: Over all Bangladesh

Start Date:

End Date:

Program Area: Risk Management in Agriculture

Commodity: Virus

Objectives:

To find out a multi-centre, cross-sectional study on coronavirus disease 2019 in Bangladesh: clinical epidemiology and short-term outcomes in recovered individuals

Methodology:

A cross-sectional retrospective study was conducted among COVID-19-positive patients confirmed by RT-PCR using both nasopharyngeal and oropharyngeal swabs as clinical specimens. These COVID-19-diagnosed patients were admitted in six different hospitals in Bangladesh. Post-COVID-19 clinical characteristics was recorded upon each individual’s discharge from the hospital and after confirming that these individuals were indeed COVID-19 free by conducting two consecutive RT-PCR assays 24 hours apart. Recovered patients (according to negative RT-PCR result) at least 4 weeks before the interview were considered for this study. We also categorized all positive patients into two categories (symptomatic and asymptomatic) according to the presence of any one of the established symptoms described by WHO [9] and CDC (https://www.cdc.gov/coronavirus/2019-ncov/symptomstesting/symptoms.html). The RT-PCR test was performed using the Novel Coronavirus (2019-nCoV) Nucleic Acid Diagnostic Kit (PCR-Fluorescence Probing) by Sansure Biotech Inc. (Changsha, China) in Institute of Epidemiology Disease Control and Research (IEDCR) approved laboratories in Bangladesh. Study sites and sample size The study was conducted in six hospitals with specialized units (following government instructions) for isolating and treating individuals with COVID-19 from two different divisions of Bangladesh namely Dhaka (Dhaka Mohanogor General Hospital and Narayanganj Sadar Hospital) and Chattogram (Chittagong General Hospital, Chittagong Medical College Hospital, Chattogram Field Hospital and Chandpur Sadar Hospital). The study period started on 1 April 2020 and ended on 30 June 2020. Data collection and case enrolment The physicians collected data relevant to the study retrospectively by interviewing 1021 COVID-19 patients over the telephone and all data were recorded into a preset Google form approved by the institutional review board of the 250-bed Chattogram General Hospital. After diligent verification, the google forms were submitted and stored in our secured database. Medical prescriptions and hospital records were also accessed and matched with patient data obtained through the interview. Questionnaires included patient’s sociodemographic information, clinical manifestations, biochemical parameters, behavioural practice, comorbidities, medications, vital signs, laboratory tests, electrocardiogram results, inpatient medications, treatments and outcomes (including length of stay, discharge, re-admission and mortality). Exclusion criteria Deceased patients and those who were not interested in participating or did not give consent to data collection and usage for research purposes were not included. Ethical consideration The protocol was approved by the Institutional Review Board of the 250-bed General Hospital, Chattogram, Bangladesh (IRB#00981). Statistical analysis Descriptive statistical analyses were performed expressing categorical variables with numbers and proportions. They were compared using χ2 test and Fisher’s exact test. Values of p less than or equal to 0.05 (two-sided) were considered statistically significant. Multivariate logistic regressions were performed to identify the predictors of long-term post-COVID complications. All statistical analyses were performed using Stata/MP 14.0 (StataCorp, College Station, TX, USA) and GraphPad Prism (GraphPad, San Diego, CA, USA). The study considered COVID patients showing no symptoms of infection as asymptomatic and those showing at least one of the typical symptoms as symptomatic. Similarly, patients with at least one type of comorbidity were considered comorbid and those with no comorbidity were considered non-comorbid patients.

Source of Information: New Microbe and New Infect 2021; 40: 100838

Article Link (Online Journal):

Funding Source:

Total Budget (Tk.) :

Achievement/Findings:

Despite some limitations, this is the most comprehensive study conducted in Bangladesh that assessed COVID-19 patients for both pre-recovery and post-recovery complications to date. Our data have reconfirmed some significant global observations with regards to the epidemiological and clinical aspects of the disease. Above all, the study has helped in addressing some concerns regarding COVID-19 susceptibility and progression in Bangladesh. This study found that individuals with comorbidities had more severe clinical implications acquired during their COVID-19 spells. The results obtained from this study could contribute to devising effective strategies for the provision of comprehensive health care to COVID-19 patients with comorbidities. We assume that the outcomes of this study will work as a baseline for future studies in the same context.

Knowledge Management: Journal