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COVID-19, Disease Progression, Patients, Bangladesh,
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Manna RM, Hasan S, Hannan R et al. Determinants of Disease Progression in Bangladeshi COVID-19 Patients: A Cross-sectional Survey [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:475 (https://doi.org/10.12688/f1000research.143492.1)
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Research Article
Determinants of Disease Progression in Bangladeshi COVID-19 Patients: A Cross-sectional Survey
[version 1; peer review: awaiting peer review]
PUBLISHED 13 May 2024
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Abstract
Corresponding author:
Shahriar Hasan
Competing interests:
No competing interests were disclosed.
Grant information:
The author(s) declared that no grants were involved in supporting this work.
Copyright:
© 2024 Manna RM et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Manna RM, Hasan S, Hannan R et al. Determinants of Disease Progression in Bangladeshi COVID-19 Patients: A Cross-sectional Survey [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:475 (https://doi.org/10.12688/f1000research.143492.1)
First published: 13 May 2024, 13:475 (https://doi.org/10.12688/f1000research.143492.1)
Latest published: 13 May 2024, 13:475 (https://doi.org/10.12688/f1000research.143492.1)
Introduction
The coronavirus disease 2019 (COVID-19) epidemic, which emerged in China at the end of 2019 and was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread rapidly globally and drove approximately 7 million deaths worldwide till August 2023. Despite the disease being controlled worldwide, the World Health Organization (WHO) reports new cases in some countries. It’s evident that the clinical course of this disease ranges from asymptomatic to respiratory diseases and demise of patients.1 In most of the cases, patients usually face mild illness while a relatively moderate number of patients need hospitalization and artificial oxygen support.2 By subtyping and predicting the outcome of COVID-19 patients, we can determine the stages of disease progression. In this way, patients can get targeted treatment and receive the appropriate medical resources at different points in their treatment cycle.3
According to the WHO, individuals with pre-existing health issues are usually more susceptible to COVID-19 infection.4 Studies reported that the existence of comorbidities most of the deaths are associated, particularly the vulnerable group with compromised immune system.5,6 The conditions and comorbidities such as obesity, older age, hypertension, and diabetes that are potentially connected to poor state of health, were marked as risk factors for the courses of severe and life-threatening disease.7 It has seen that organ damage was associated with severity of disease which mainly affected the liver, the heart and the kidneys. Furthermore, other risk factors identified were coagulation and inflammation dysfunctionality.8 Over the past three years, the clinical characteristics and epidemiological determinants of infected patients with COVID-19 infection has been targeted by many research works,8 while the risk factors associated with the severity and mortality has not been investigated sufficiently. For example, Chang et. al found that 8 out of every 10 of COVID-19 patients had only mild symptoms; however, 10–20% cases, patients had to face severe illness.9 Another study conducted by Wolff et. al. determines risk factors for disease severity were identified in 28 records.10 This study also reported the smoking habit, being obese and longer waiting time to hospital admission are lifestyle factors that have been linked with an increased risk of disease severity. In addition, a growing number of literatures reported the most common demographic factors leading to disease severity was age, followed by being male, post-menopausal condition and increasing age in females.11–13
Bangladesh, one of the world’s most populous countries, has an extensive healthcare system with four cohorts, including non-governmental organizations or NGOs, the private sector, and international development organizations.9
Bangladesh has faced ‘super spreader’ viral infection of this kind for the first time in this modern era.12,13 Research on disease factors and severity on Bangladesh would encourage policy makers in determining effective health policies and frameworks. Although a number of studies have investigated the determinants of mild and severe COVID-19 disease, however, it has not been explored fully in Bangladesh. As a result, the study aimed to identify the determinants associated with the aggravation of COVID-19 patient symptoms from asymptomatic-mild to severe or complex.
Methods
Study design & settings
This was a nationwide study of COVID-19 patients who were diagnosed and confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) from November 2020 to January 2021. The list of available COVID-19 positive patients was obtained, after formal written approval, from Civil Surgeon’s (CS) offices in Bangladesh.
Survey procedures
The target population was the participants aged more than or equal to 18 years. Individuals who were currently being treated for COVID-19, children (<18 years), pregnant women and critically ill were excluded from the study. A structured questionnaire was prepared for the collection of the data. We conducted a pilot survey on 30 post COVID-19 individuals selected randomly from the sampling frame to test the questionnaire. Following, we collected total 384 COVID-19 positive patients from the relevant districts. We found that the response rate was around 60% (due to call drop, call waiting, inactive number, network problem, and refusal to give an interview).
Measures
Outcome variable
The outcome variable “Covid 19 Infection” which was determined by prone to be affected and progression to severity. The disease progression to severity has four categories which were asymptomatic (participants who tested positive for COVID-19 but remained asymptomatic throughout the course of the disease and no hospital admission was required for this group, and they did not receive oxygen support), mild (these group of participants were characterized by the individuals who tested positive for COVID-19 and experienced mild symptoms, such as cough, fever, body ache, loss of smell or taste and they did not require hospital admission or oxygen support), the third category was moderate (the participants with COVID-19 who exhibited more severe symptoms, necessitating clinical consultation, and they had symptoms included shortness of breath (SOB), and some required oxygen support administered via nasal cannula or venturi mask), and the last category were severe (it was indicated the participants who tested positive for COVID-19 with strong and severe symptoms that led to hospital admission and they required mechanical ventilation or high-flow oxygen support during their hospitalization, sometimes they experienced severe health complications as a result of COVID-19, and some individuals in the severe category succumbed to the disease).
Independent variables
All the COVID-19 positive patients in the sample underwent interviews by a structured questionnaire consisting of socio-demographic, lifestyle and behavioral, clinical, and study or work-related factors. The sociodemographic section of the questionnaire obtained information regarding patients age, gender, occupation, family income, education, marital status, living status.
Statistical analysis
Descriptive statistics was applied to describe the characteristics of the study population. Pearson chi-square tests were used to assess the disease progressions of COVID-19 across selected variables. Separate logistic regression model was used to assess the associated factors of Covid 19 Infection for socio-demographic, lifestyle and behavioral, clinical, and study or work-related factors and without adjustment for other explanatory factors. Results were recorded as Odd Ratio (OR) with its 95% Confidence Interval (95% CI). All statistics were performed using the Stata software version 14.0 (Stata corporation, college station, Texas, USA).
Ethical approval
Participation in this study was entirely voluntary. Informed written consent was obtained from study participants following explanation of the study aims and objectives. The study was approved by the Ethics Board of North South University (NSU), Dhaka, Bangladesh (2020/OR-NSU/IRB-No.0801, on 14th August 2020). All procedures were performed in accordance with relevant guidelines and regulations.
Results
Participant’s background characteristics
Participant’s background characteristics has shown in Table 1. A total of 384 of respondents were involved in the survey. Among the respondents, the largest proportion included within the category of 18 to 35 years (56.8%), while respondents aged 36 to 55 years and those aged more than 55 years constitute 36.7% and 6.5%, respectively. In this study it was also found that 73.2% of the respondents were male, and 26.8% were females. Occupational backgrounds shows that commerce/business and office workers account for the highest percentage at 49.5%, followed by healthcare workers (14.8%), and other occupations (11.7%). Notably, 24.0% of respondents did not specify their occupation. Regarding the family income, the majority (80.0%) earned less than 10,000 BDT, and 19.8% of the respondent’s income was 10,000-25,000 BDT. The educational levels of the respondents had a diverse distribution, with 34.9% completed up to primary education, 28.1% at the secondary level, and 17.5% with a higher secondary and above education. The marital status indicates that 68.7% of respondents were single, while 31.3% were married. Finally, 72.4% of the respondents reported that they were living in urban area, while 27.6% lived in the rural area.
Table 1. Descriptive statistics of sociodemographic characteristics of the respondents (n=384).
Distribution of progression of disease among the COVID-19 patients
Figure 1 shows the prevalence of disease progression among COVID-19 patients. We found that 40.36% of patients were in asymptotic condition, 43.49% were in mild condition, 9.11% were moderate condition and 7.03% were in severe condition.
Figure 1. COVID-19 disease progression among the respondents.
Association among demographic and lifestyle variables with the disease progressions of COVID-19
Table 2 shows the association between various socio-demographic and lifestyle factors with COVID-19 symptom severity. The respondents whose age was 18-35 years, showing mild symptoms at 39.73%, while those over 55 years, experienced moderate symptoms at 34.00% and severe symptoms at 49.38%. Gender disparities were also evident, with males reporting higher percentages of mild (65.64%), moderate (71.88%), and severe symptoms (52.00%) than females. On the other hand, the healthcare workers facing 18.46% mild symptoms but only 1.00% severe, while commerce/business and office workers exhibit 46.67% mild and 48.03% severe symptoms. Marital status significantly influences symptom severity, with 98.00% of married individuals experiencing severe symptoms compared to 2.00% of singles. Urban residents generally face more severe symptoms (78.97%) compared to rural dwellers (21.03%). Additionally, lifestyle factors like smoking (95.0%) and physical exercise (48.0%) present percentages of association with more severe symptoms.
Table 2. Association among socio-demographic and lifestyle variables with the disease progressions of COVID-19 (n=384).
Association among Clinical Factors (Comorbidity) with the disease progressions of COVID-19
Table 3 shows that among the comorbidity participants specially the participants having diabetics from earlier have faced covid-19 disease. About 98 percent participants have faced covid-19 disease with severe stage who had diabetics from earlier. The association between cancer and asthma with the disease progressions of COVID-19 has found significant. Diabetes prevalence has been found significant disease progression in all categories- from asymptomatic to severe conditions. Similar findings were found for CLD-Asthma/COPD. The prevalence is around 88-98% considering all respect. The association between cancer with the disease progressions of COVID-19 has found significant. It was found that among the patients who was reached to the severe stage of the disease, 60 percent of them have faced the disease cancer while this percentage is 93.97 for the patients who has reached to mild stage.
Table 3. Association among Clinical Factors (Comorbidity) with the disease progressions of COVID-19 (n=384).
Association among study or Work-Related Factors with the disease progressions of COVID-19
It is portrayed that workplace condition, public transport use, long exposure in public facilities, sedentary work is significantly associated with Covid-19 disease progression. Among the patients with using public transport have faced 68.07 percent in asymptomatic condition while 38.02 percent people with exposed to public facilities for long time faced covid-19 with severe condition (Table 4).
Table 4. Association among Study or Work-Related Factors with the disease progressions of COVID-19 (n=384).
Determinants of COVID-19 disease progression
Logistic regression estimates shows that age, gender, smoking status, diabetics, working conditions significantly affect Covid 19 disease progression among people (Table 5). It was found that female has 70% lower risk of Covid 19 asymptomatic condition than the male (OR=0.30, p≤0.05). It was also found that people with not habituate with smoking have lower risk of affecting in Covid 19 (OR=.065, p≤0.05). It was also found that people with not having diabetics have 89 percent lower risk of affecting in Covid 19 (OR=0.11, p≤0.05). It was also found that people aged more than 55 has 9 times higher chance of having Covid-19 in comparison to people aged 18-35; (OR=9.33, p≤0.05). It has also found that people with income 10000 to 25000 had 63% of lower chance of having covid-infection in comparison to people with income less than 10000 (OR=0.34, p≤0.05).
Table 5. Logistic regression estimates of disease progressions of COVID-19.
Discussion
Our study has disclosed the determinants of disease progression in Bangladeshi COVID-19 patients. This study found that about 40.36% of patients were in asymptotic condition that is they were COVID-19 positive but have no symptoms as well as hospital admission has not required, 43.49% were in mild condition that is they were COVID-19 positive with mild symptoms such as cough, fever, body ache, smell, taste; but hospital admission and oxygen support has not required, 9% were moderate condition with having characteristics of COVID-19 positive with strong symptoms clinical consultation and oxygen support via nasal or venturi mask has been required, while 7% were in severe condition with belonging to the characteristics of COVID-19 positive with strong symptoms, hospital admission and mechanical or high flow oxygen has been required as well as they have faced health complications. That is a major portion of the respondents faced the disease with the mild condition. This finding is similar with recent studies have found that that 8 out of every 10 of COVID-19 patients had only mild symptoms; however, 10–20% cases, patients had to face severe illness.13–15 They also identified that most of the patients of Covid-19 faced the problem at a mild level. The findings suggest that there was a need of efficient and proper management during COVID 19 period.
According to our data, association between the disease progressions of COVID-19 with age, residence, marital status, smoking habit, diabetics, physical exercise, working conditions are significant. It was found that among the participants with comorbidities specially the participants with diabetes from earlier faced COVID-19 disease. We also found that people without diabetes had approximately 90% lower risk of affecting in COVID-19. It may be due to the cause that the immune capability of diabetic patient become slightly lower than the people who had not diabetes. A number of previous studies reported that those with COVID-19 who also had diabetes were at a higher risk of worse prognosis and fatality.16–18 Another study revealed the fact that diabetes mellitus is one of the most frequent underlying medical conditions which lead to severity of any other disease.2 The findings are similar to the other concurrent study findings.
Logistic regression estimates show that age, gender, smoking status, diabetics, working conditions significantly affect Covid-19 disease progression among people. It was found that female has 70% of lower risk of Covid-19 than the male which may due to the cause that male is using to move higher outside home than the female because of office, mosques etc. In line with this, it should be mentioned that a previous studies found that the most common demographic factor leading to disease severity is age, followed by being male.19–21 Another study has found that age and comorbidities were contributing factors for increasing mortality or progression of the disease.17 A study expressed that being senior citizen and having coronary vascular disease were appeared to increase the risk of COVID-19 death.18 That is the socio-demographic variables specially the age and gender are the major demographic determinants of disease progression which was acknowledged by so many researchers and also found by this study.
It was also found that people with not habituate with smoking have lower risk of affecting in Covid-19. A previous study found that smoking habit, being obese and longer waiting time to hospital admission are lifestyle factors that have been linked with an increased risk of disease severity.22 That is smoking status is one of the lifestyle determinants which can lead to severity of disease. All of these findings conclude that people facing highly crowded working condition, facing diabetics and habituate with smoking should become more aware to avoid the covid-19 disease.
Limitations
This study has several limitations. First, due to COVID-19 situations, number of sample size was limited. Data from the hotspot areas or geographically dispersed area cannot be considered for time limits. Second, disease progression into severity was measured through response not from hospital records or clinical database. Third, the study did not a large area therefor, the results do not present the whole situation.
Conclusion
The study assessed the determinants of COVID-19 disease progression through a cross sectional study by targeting the population of Bangladesh aged more than or equal to 18 years who were COVID-19 positive. The study found that 7.03% of severe conditions and 9.11% moderate conditions, while 40.36% of asymptomatic patients. We found heterogenic association between the disease progressions with age, sex, residence, marital status, smoking habits, diabetes, physical exercise, working conditions, sedentary lifestyle The significant of the research cannot be undermined as it would help the decision makers and policy planners to undertake countermeasures for the expected third wave of COVID-19 or any other possible pandemic. This study enforces the idea of using vulnerability ratings for each and every risk factor disease progression factors. Findings suggest extra care should be taken for the patients having diabetes, heart, lung related diseases. Similar focus needs to be taken in the hospital for the proper care and management of the comorbid patients mentioned in the study.
Ethical approval and consent
Participation in this study was entirely voluntary. Informed written consent was obtained from study participants following explanation of the study aims and objectives. The study was approved by the Ethics Board of North South University (NSU), Dhaka, Bangladesh (2020/OR-NSU/IRB-No.0801, on 14th August 2020). All procedures were performed in accordance with relevant guidelines and regulations.
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how to cite this article
Manna RM, Hasan S, Hannan R et al. Determinants of Disease Progression in Bangladeshi COVID-19 Patients: A Cross-sectional Survey [version 1; peer review: awaiting peer review]. F1000Research 2024, 13:475 (https://doi.org/10.12688/f1000research.143492.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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