COVID-19 quintupled in-hospital deaths in pregnant women in Africa
COVID-19 infection and pregnancy independently raised the risk of intensive care unit (ICU) admission, the need for supplemental oxygen, and death among hospitalized women in sub-Saharan Africa, finds a study published today in Clinical Infectious Diseases.
A team led by researchers from the University of Pittsburgh studied the outcomes of 1,315 hospitalized women of childbearing age in six sub-Saharan African countries (Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda) from Mar 1, 2020, to Mar 31, 2021. The cohort included 510 pregnant COVID-19 patients, 403 infected nonpregnant women, and 402 noninfected pregnant women.
Among COVID-19 patients, pregnancy was tied to increased risk of ICU admission (adjusted risk ratio [aRR], 2.38; 95% confidence interval [CI], 1.42 to 4.01), oxygen supplementation (aRR, 1.86; 95% CI, 1.44 to 2.42), and in-hospital death (adjusted subhazard ratio [aSHR], 2.00; 95% CI, 1.08 to 3.70).
In pregnant patients, COVID-19 infection raised the risk of ICU admission (aRR, 2.0; 95% CI, 1.20 to 3.35), the need for supplemental oxygen (aRR, 1.57; 95% CI, 1.17 to 2.11), and death (aSHR, 5.03; 95% CI, 1.79 to 14.13).
HIV or a history of tuberculosis doubled the risk of ICU admission among infected pregnant and non-pregnant women.
"Our findings indicate that hospitalized pregnant women with COVID-19 in Sub-Saharan Africa have two to five times greater risk of needing intensive care and dying than uninfected, hospitalized pregnant women," lead author Jean Nachega, MD, PhD, MPH, of Pitt Public Health and Stellenbosch University in Cape Town, South Africa, said in a University of Pittsburgh news release.
In a summary, the authors said vaccine hesitancy fueled by misinformation is another barrier to preventing COVID-19 in women and infants. "It is critical to evaluate and implement evidence-based educational and counseling interventions that address misinformation and disinformation to reassure pregnant women and their families and increase their confidence in proven effectiveness and safety of COVID-19 vaccines," they wrote.
Jun 8 Clin Infect Dis study and author summary
Jun 8 University of Pittsburgh news release
Low COVID vaccine uptake noted in homeless, jail prisoners in Minnesota
By the end of 2021, 60.4% of the general population of Minnesota was fully vaccinated against COVID-19, including 70.9% of people recently incarcerated in state prisons, according to a new study in Health Affairs. But rates for the state's homeless population and those incarcerated in local jails were far less, at 33.7 % and 29.9 %, respectively.
Jails are typically short-term places of confinement at the city, district, or county level for those awaiting a trial or sentencing, while prisons are for people convicted of a crime.
The vaccination gap widened in the fall of 2021, the study found, when booster doses were introduced in the state population. Thirty-one percent of the general population got a booster dose by November of 2021, compared with 8.4% of the homeless, 6.6% of those in jail, and 24.5% of those imprisoned.
Overall, 99.5% of the general population aged 65 years and older were fully vaccinated. Non-Hispanic Asians were the most vaccinated ethnic group, at 70.3%, and females were more likely to be vaccinated than males (66.6% vs 60.2%).
Black Minnesotans had the lowest vaccination rates, in both the general population and among those homeless or incarcerated.
"These findings are worrisome, as people living in congregate settings, compared with the general population, are at higher risk for COVID-19 transmission because of challenges in practicing social distancing and taking other precautions," the authors said. "These data highlight the urgency of targeted outreach to populations in congregate settings amid the resurgence of SARS-CoV-2 variants."
One approach, the authors add, is to offer vaccination when people first enter jail.
Jun 7 Health Aff abstract