Comparison of patient length of stay in care between home-based care and hospitalized COVID-19 patients PATIENTS in Northern and West-Nile Regions in Uganda

Abstract

COVID-19 is a disease caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) which was first reported in Wuhan China in December 2019 and was declared a global pandemic by the World Health Organization on 11th March 2020. The pandemic has placed an enormous burden on the health systems across the world due to the increasing demand for health care in hospitals and ICUs. In this retrospective cross section study, the length of stay in care for COVID- 19 patients who were hospitalized in two regional referral hospitals and those who underwent home based care in Northern and West Niles regions in Uganda was compared. Factors influencing the length of stay in care were also determined. A total of 400 patients (200 hospitalized patients and 200 under home based care) with key information were included in the study. All patients were laboratory confirmed COVID-19 cases with a positive real time PCR test result from a nasopharyngeal swab or an oropharyngeal swab. Generally, there were no major differences between the hospitalized patient characteristics and those who were under home based care. Those who died in less than 14 days were 61.1% (95%CI: 0.40 to 3.72) and the recoveries were 59.9% (95%CI: 0.40 to 3.72) under both types of care. The mean length of stay in care for hospitalized patients was 14.8 days while that of patients under home based care was 15.0 days. The difference in the mean length of stay in care among hospitalized patients and patients under home based was not statistically significant (t=0.28, p=0.38) and there was no association between type of care and length of stay in care (OR: 0.96: 95% CI 0.64 to 1.43: p=0.837). Symptom Status of patients and their occupation were found to be important factors influencing recovery. It was observed that symptomatic patients were associated with longer stay in care (OR: 1.96, p=0.01). Likewise, law enforcement officers had a higher likelihood of staying longer compared to people involved in health-related work (OR: 3.28, p=0.03). Covid-19 patient stay in care is not dependent on the approach used in case management. Therefore, it’s important to evaluate all approaches based on the prevailing conditions and patients reviewed case per case before deciding whether they are admitted to hospital and repurposed facilities or be managed under home based care and isolation.