Characteristics of Hospitalized COVID-19 Patients at Admission and Factors Associated with Clinical Severity in Low- and Middle-Income Countries: An Observational Study.

Despite the numerous articles published on the clinical characteristics and outcomes of COVID-19 with regard to high-income countries, little is known about patients in low- and middle-income countries (LMIC) in this context. The objective of this observational, prospective, hospital-based multicentric study was to describe clinical features and outcomes of laboratory-confirmed COVID-19 patients hospitalized in each of the participating centers in Bangladesh, Guinea, Ivory Coast, Lebanon, Madagascar, and Mali during the first year of the pandemic (March 5, 2020 to May 4, 2021). The study outcome was the clinical severity of COVID-19, defined as hospitalization in intensive care unit or death. Multivariate logistic regression models were performed to identify independent variables associated with disease severity. Overall, 1,096 patients were included. The median age was 49.0 years, ranging from 38.0 in Mali to 63.0 years in Guinea. The overall clinical severity of COVID-19 was 12.3%, ranging from 6.4% in Mali to 18.8% in Guinea. In both groups of patients <60 and ≥60 years old, cardiovascular diseases (adjusted odds ratio [aOR]: 1.99; 95% CI: 1.13-3.50, P = 0.02; aOR: 2.47; 95% CI: 1.33-4.57, P = 0.004) were independently associated with clinical severity, whereas in patients <60 years, diabetes (aOR: 2.13; 95% CI: 1.11-4.10, P = 0.02) was also associated with clinical severity. Our findings suggest that COVID-19-related severity and death in LMICs are mainly driven by older age. However, the presence of chronic diseases can also increase the risk of severity especially in younger patients.

[Evolution of gender-based violence during the emergence of COVID-19 pandemic in Greater Abidjan (March 2020-May 2021)]. / Évolution des violences basées sur le genre lors de l'émergence de la pandémie de COVID-19 dans le Grand Abidjan (Mars 2020-Mai 2021).

In Côte d'Ivoire, a country of 28 million inhabitants in West Africa, a survey conducted by the Ministry of the Family in 2018 showed the extent of gender-based violence (GBV) in the Greater Abidjan area (5 million inhabitants), the country's economic capital. The social workers employed for this work were mobilized during the Covid-19 pandemic to raise awareness and help the population fight against SARS-CoV-2. The results collected by these workers during the first period (January 2019 - February 2020) and the second period (March 2020 - April 2021) are the subject of this article.From the first period to the second, the number of rapes increased from 41 to 77, sexual assaults from 4 to 7, physical assaults from 139 to 171, and forced marriages from 4 to 7. In total, the social workers helped 303 victims during the pre-pandemic period and 402 during the pandemic. This evolution varies from municipality to municipality in the Greater Abidjan area, and is not related to the number of inhabitants per municipality and without any link with the frequency of Covid-19 in each municipality. Despite possible biases, this study highlights a major health problem, GBV, and demonstrates the probable negative effects of the pandemic.