Clinical Outcomes Among Hospitalized Youths With COVID-19 in Sub-Saharan Africa | Adolescent Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the clinical outcomes and associated factors among children and adolescents hospitalized with COVID-19 in sub-Saharan Africa?

Findings  In this cohort study of 469 children and adolescents hospitalized with COVID-19 in 6 sub-Saharan African countries, morbidity and mortality were substantially higher than reported among those in non-African settings and were independently associated with age younger than 1 year and select noncommunicable disease comorbidities.

Meaning  This study’s findings may have implications for clinical practice and health policy regarding pediatric COVID-19 in African countries; given their high risk of adverse outcomes, COVID-19 vaccination and therapeutic interventions are needed for African children and adolescents.

Abstract

Importance  Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.

Objective  To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.

Design, Setting, and Participants  This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.

Exposures  Age, sex, preexisting comorbidities, and region of residence.

Main Outcomes and Measures  An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.

Results  Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.

Conclusions and Relevance  In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 19, 2021.

Published Online: January 19, 2022. doi:10.1001/jamapediatrics.2021.6436

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Nachega JB et al. JAMA Pediatrics.

Corresponding Author: Jean B. Nachega, MD, PhD, MPH, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St, Crabtree Hall A531, Pittsburgh, PA 15261 (jbn16@pitt.edu).

Author Contributions: Drs Nachega and Machekano had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Nachega and Sam-Agudu are joint first authors.

Concept and design: Nachega, Sam-Agudu, Machekano, Rabie, Van der Zalm, Redfern, Gachuno, Ishoso, Zumla, Suleman, Tshilolo, L. Umar, Adejumo, Mofenson.

Acquisition, analysis, or interpretation of data: Nachega, Sam-Agudu, Machekano, Van der Zalm, Redfern, Dramowski, O'Connell, Tshiasuma Pipo, Tshilanda, Byamungu, Masekela, Jeena, Pillay, Gachuno, Kinuthia, Amoako, Agyare, Agbeno, Martyn-Dickens, Sylverken, Enimil, Jibril, Abdullahi, Amadi, U. Umar, Sigwadhi, Hermans, Otshudiema Otokoye, Mbala-Kingebeni, Zumla, Aanyu, Musoke, Noormahomed, Fowler, Kruger, Smith, Rosenthal, Mills, L. Umar, Mellors, Sewankambo, Siedner, Deckelbaum, Muyembe-Tamfun, Mofenson.

Drafting of the manuscript: Nachega, Sam-Agudu, Machekano, Redfern, Tshilanda, Masekela, Pillay, Gachuno, Ishoso, Sylverken, Jibril, U. Umar, Hermans, Zumla, Noormahomed, Tshilolo, Mills, Deckelbaum.

Critical revision of the manuscript for important intellectual content: Nachega, Sam-Agudu, Machekano, Rabie, Van der Zalm, Redfern, Dramowski, O'Connell, Tshiasuma Pipo, Byamungu, Masekela, Jeena, Gachuno, Kinuthia, Amoako, Agyare, Agbeno, Martyn-Dickens, Enimil, Abdullahi, Amadi, Sigwadhi, Hermans, Otshudiema Otokoye, Mbala-Kingebeni, Zumla, Aanyu, Musoke, Suleman, Fowler, Tshilolo, Kruger, Smith, Rosenthal, L. Umar, Mellors, Adejumo, Sewankambo, Siedner, Deckelbaum, Muyembe-Tamfun, Mofenson.

Statistical analysis: Nachega, Sam-Agudu, Machekano, Masekela, Gachuno, U. Umar, Sigwadhi, Smith, Mills, Sewankambo, Siedner.

Obtained funding: Nachega, Tshilanda, Masekela, Adejumo.

Administrative, technical, or material support: Nachega, Sam-Agudu, Rabie, Tshiasuma Pipo, Byamungu, Masekela, Jeena, Pillay, Gachuno, Kinuthia, Ishoso, Amoako, Agyare, Agbeno, Martyn-Dickens, Enimil, Jibril, Abdullahi, Amadi, U. Umar, Otshudiema Otokoye, Mbala-Kingebeni, Aanyu, Suleman, Noormahomed, Fowler, L. Umar.

Supervision: Nachega, Sam-Agudu, Dramowski, Tshilanda, Masekela, Jeena, Gachuno, Ishoso, Sylverken, Abdullahi, Amadi, Otshudiema Otokoye, Zumla, Aanyu, Musoke, Kruger, Rosenthal, Mills, L. Umar, Muyembe-Tamfun.

Conflict of Interest Disclosures: Dr Nachega reported receiving grants from the Fogarty International Center at the National Institutes of Health (NIH) during the conduct of the study. Dr Sam-Agudu reported receiving grants from the African Forum for Research and Education in Health (AFREhealth) during the conduct of the study. Dr Rabie reported receiving grants from AFREhealth during the conduct of the study. Dr Byamungu reported receiving grants from the Fogarty International Center at the NIH during the conduct of the study. Dr Amoako reported receiving personal fees from AFREhealth during the conduct of the study. Dr Agbeno reported receiving personal fees from AFREhealth during the conduct of the study. Dr Martyn-Dickens reported receiving grants from AFREhealth during the conduct of the study. Dr Enimil reported receiving personal fees from Komfo Anokye Teaching Hospital during the conduct of the study. Dr Jibril reported receiving personal fees from AFREhealth during the conduct of the study. Dr Abdullahi reported receiving personal fees from AFREhealth during the conduct of the study. Dr Amadi reported receiving grants from AFREhealth during the conduct of the study. Dr U. Umar reported receiving grants from AFREhealth during the conduct of the study. Dr Aanyu reported receiving grants from AFREhealth during the conduct of the study. Dr Musoke reported receiving grants from AFREhealth during the conduct of the study. Dr L. Umar reported receiving grants from AFREhealth during the conduct of the study and grants from the Fogarty International Center at the NIH (directed to AFREhealth via the Makerere University Infectious Disease Institute) outside the submitted work. Dr Mellors reported receiving grants from Gilead Sciences (via the University of Pittsburgh), Janssen Pharmaceuticals (via the University of Pittsburgh), the NIH (via the University of Pittsburgh), and the US Agency for International Development (via the University of Pittsburgh); personal fees from Accelevir Diagnostics, Gilead Sciences, Merck & Co, the University of Pittsburgh, and Yufan Biotechnologies; owning shares in Abound Bio, Cocrystal Pharma, and Infectious Disease Connect; and serving as president and chief executive officer of Abound Bio, a scientific advisory board member of Gilead Sciences, and an advisor for Infectious Disease Connect outside the submitted work. Dr Muyembe-Tamfum reported receiving grants from the National Institute of Biomedical Research, Democratic Republic of the Congo during the conduct of the study and outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grant 1R25TW011217-01 from the Fogarty International Center at the NIH (Drs Nachega, Sewankambo, Suleman, and Adejumo).

Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: A complete list of the members of the AFREhealth COVID-19 Research Collaboration on Children and Adolescents appears in Supplement 2.

Additional Contributions: Rodney Ehrlich, MBChB, PhD, of the University of Cape Town School of Public Health and Family Medicine; Andre P. Kengne, MD, PhD, of the Non-Communicable Diseases Research Unit, South African Medical Research Council; John L. Johnson, MD, of Case Western Reserve University; and Peter Kilmarx, MD, of the National Institutes of Health/Fogarty International Center provided critical review and helpful advice on this manuscript. Chibueze Adirieje, MPH, of the Central and West Africa Implementation Science Alliance and the International Research Center of Excellence, Institute of Human Virology Nigeria, provided assistance with data analysis of facilities survey descriptive data. None of the nonauthor contributors received compensation for their assistance. We remember our colleague. Birhanu Ayele PhD, of Stellenbosch University, who died in January 2021 after making foundational contributions to the data analysis for this study. We also thank all members of the AFREhealth COVID-19 Research Collaboration Working Group and appreciate the continued support of Ireneous N. Dasoberi, MPhil, Clara Sam-Woode, MPhil, and Georgina Yeboah, MBA, of the AFREhealth Executive Secretariat in Kumasi, Ghana.

References
1.
Castagnoli  R , Votto  M , Licari  A ,  et al.  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review.   JAMA Pediatr. 2020;174(9):882-889. https://www.ncbi.nlm.nih.gov/pubmed/32320004. doi:10.1001/jamapediatrics.2020.1467 PubMedGoogle ScholarCrossref
2.
Mantovani  A , Rinaldi  E , Zusi  C , Beatrice  G , Saccomani  MD , Dalbeni  A .  Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis.   Pediatr Res. 2021;89(4):733-737. doi:10.1038/s41390-020-1015-2Google ScholarCrossref
3.
Mehta  NS , Mytton  OT , Mullins  EWS ,  et al.  SARS-CoV-2 (COVID-19): what do we know about children? a systematic review.   Clin Infect Dis. 2020;71(9):2469-2479. doi:10.1093/cid/ciaa556 PubMedGoogle ScholarCrossref
4.
Havers  FP , Whitaker  M , Self  JL ,  et al; COVID-NET Surveillance Team.  Hospitalization of adolescents aged 12-17 years with laboratory-confirmed COVID-19—COVID-NET, 14 states, March 1, 2020–April 24, 2021.   MMWR Morb Mortal Wkly Rep. 2021;70(23):851-857. doi:10.15585/mmwr.mm7023e1 PubMedGoogle ScholarCrossref
5.
Kim  L , Whitaker  M , O’Halloran  A ,  et al; COVID-NET Surveillance Team.  Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19—COVID-NET, 14 states, March 1–July 25, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(32):1081-1088. doi:10.15585/mmwr.mm6932e3 PubMedGoogle ScholarCrossref
6.
Li  B , Zhang  S , Zhang  R , Chen  X , Wang  Y , Zhu  C .  Epidemiological and clinical characteristics of COVID-19 in children: a systematic review and meta-analysis.   Front Pediatr. 2020;8:591132. doi:10.3389/fped.2020.591132Google Scholar
7.
Patel  NA .  Pediatric COVID-19: systematic review of the literature.   Am J Otolaryngol. 2020;41(5):102573. doi:10.1016/j.amjoto.2020.102573 PubMedGoogle Scholar
8.
Liguoro  I , Pilotto  C , Bonanni  M ,  et al.  SARS-COV-2 infection in children and newborns: a systematic review.   Eur J Pediatr. 2020;179(7):1029-1046. doi:10.1007/s00431-020-03684-7 PubMedGoogle ScholarCrossref
9.
Gotzinger  F , Santiago-Garcia  B , Noguera-Julian  A ,  et al; ptbnet COVID-19 Study Group.  COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study.   Lancet Child Adolesc Health. 2020;4(9):653-661. doi:10.1016/S2352-4642(20)30177-2 PubMedGoogle ScholarCrossref
10.
World Health Organization. WHO coronavirus (COVID-19) dashboard. World Health Organization. Accessed January 13, 2022. https://covid19.who.int/
11.
UNICEF. Children in Africa: key statistics on child survival and population. UNICEF; January 2019. Accessed August 5, 2021. https://data.unicef.org/resources/children-in-africa-child-survival-brochure/
12.
Parker  A , Louw  EH , Lalla  U ,  et al.  Multisystem inflammatory syndrome in adult COVID-19 wards at Tygerberg Hospital, Cape Town, South Africa.   S Afr Med J. 2020;110(9):15244.Google Scholar
13.
Rostami  A , Sepidarkish  M , Leeflang  MMG ,  et al.  SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis.   Clin Microbiol Infect. 2021;27(3):331-340. doi:10.1016/j.cmi.2020.10.020Google ScholarCrossref
14.
Sam-Agudu  NA , Rabie  H , Pipo  MT ,  et al; Investigators in the AFREhealth COVID-19 Research Collaboration on Children and Adolescents.  The critical need for pooled data on coronavirus disease 2019 in African children: an AFREhealth call for action through multicountry research collaboration.   Clin Infect Dis. 2021;73(10):1913-1919. doi:10.1093/cid/ciab142 PubMedGoogle ScholarCrossref
15.
Kitano  T , Kitano  M , Krueger  C ,  et al.  The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: a systematic review of fatality and ICU admission in children worldwide.   PLoS One. 2021;16(1):e0246326. doi:10.1371/journal.pone.0246326 PubMedGoogle Scholar
16.
Lishman  J , Kohler  C , de Vos  C ,  et al.  Acute appendicitis in multisystem inflammatory syndrome in children with COVID-19.   Pediatr Infect Dis J. 2020;39(12):e472-e473. doi:10.1097/INF.0000000000002900 PubMedGoogle ScholarCrossref
17.
van der Zalm  MM , Lishman  J , Verhagen  LM ,  et al.  Clinical experience with severe acute respiratory syndrome coronavirus 2–related illness in children: hospital experience in Cape Town, South Africa.   Clin Infect Dis. 2021;72(12):e938-e944. doi:10.1093/cid/ciaa1666Google ScholarCrossref
18.
Webb  K , Abraham  DR , Faleye  A , McCulloch  M , Rabie  H , Scott  C ; Cape Town MISC-Team.  Multisystem inflammatory syndrome in children in South Africa.   Lancet Child Adolesc Health. 2020;4(10):e38. doi:10.1016/S2352-4642(20)30272-8 PubMedGoogle Scholar
19.
Coker  M , Folayan  MO , Michelow  IC , Oladokun  RE , Torbunde  N , Sam-Agudu  NA .  Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa.   Pediatr Res. 2021;89(5):1078-1086. doi:10.1038/s41390-020-01174-yGoogle ScholarCrossref
20.
Global Burden of Disease Collaborative Network. GBD results tool: IHME data. Institute for Health Metrics and Evaluation; 2017. Accessed October 30, 2021. http://ghdx.healthdata.org/gbd-results-tool
21.
Craig  J , Hauck  S . Estimates of critical care capacity in 54 African countries. Center for Disease Dynamics, Economics and Policy. May 14, 2020. Accessed October 31, 2021. https://cddep.org/publications/critical-care-capacity-africa/
22.
African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators.  Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study.   Lancet. 2021;397(10288):1885-1894. doi:10.1016/S0140-6736(21)00441-4 PubMedGoogle ScholarCrossref
23.
World Health Organization. Six in seven COVID-19 infections go undetected in Africa. World Health Organization. October 14, 2021. Accessed October 24, 2021. https://www.afro.who.int/news/six-seven-covid-19-infections-go-undetected-africa
24.
Ouma  PO , Maina  J , Thuranira  PN ,  et al.  Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis.   Lancet Glob Health. 2018;6(3):e342-e350. doi:10.1016/S2214-109X(17)30488-6 PubMedGoogle ScholarCrossref
25.
Ayebale  ET , Kassebaum  NJ , Roche  AM , Biccard  BM .  Africa’s critical care capacity before COVID-19.   S Afr J Anaesthesiol Analg. 2020;26(3):162-164. doi:10.36303/SAJAA.2020.26.3.2431Google Scholar
26.
Mwananyanda  L , Gill  CJ , MacLeod  W ,  et al.  Covid-19 deaths in Africa: prospective systematic postmortem surveillance study.   BMJ. 2021;372:n334. doi:10.1136/bmj.n334 PubMedGoogle Scholar
27.
Nwosu  K , Fokam  J , Wanda  F ,  et al.  SARS-CoV-2 antibody seroprevalence and associated risk factors in an urban district in Cameroon.   Nat Commun. 2021;12(1):5851. doi:10.1038/s41467-021-25946-0 PubMedGoogle ScholarCrossref
28.
Ngere  I , Dawa  J , Hunsperger  E ,  et al.  High seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya.   Int J Infect Dis. 2021;112:25-34. doi:10.1016/j.ijid.2021.08.062 PubMedGoogle ScholarCrossref
29.
Vandenbroucke  JP , von Elm  E , Altman  DG ,  et al; STROBE Initiative.  Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.   PLoS Med. 2007;4(10):e297. doi:10.1371/journal.pmed.0040297 PubMedGoogle Scholar
30.
World Health Organization. Global COVID-19 clinical platform: case report form for suspected cases of multisystem inflammatory syndrome (MIS) in children and adolescents temporally related to COVID-19. World Health Organization. May 18, 2020. Accessed October 30, 2021. https://apps.who.int/iris/handle/10665/332121
31.
World Health Organization. COVID-19 clinical management: living guidance. World Health Organization. January 25, 2021. Accessed October 23, 2021. https://resourcecentre.savethechildren.net/pdf/who-2019-ncov-clinical-2021.1-eng_1.pdf
32.
World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19: scientific brief. World Health Organization. May 15, 2020. Accessed November 1, 2021. https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19
33.
Fine  JP , Gray  RJ .  A proportional hazards model for the subdistribution of a competing risk.   J Am Stat Assoc. 1999;94(446):496-509. doi:10.1080/01621459.1999.10474144 Google ScholarCrossref
34.
Rubin  DB .  Inference and missing data.   Biometrika. 1976;63(3):581-592. doi:10.1093/biomet/63.3.581 Google ScholarCrossref
35.
Rubin  DB .  Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons; 1987. doi:10.1002/9780470316696
36.
Murthy  S , Leligdowicz  A , Adhikari  NKJ .  Intensive care unit capacity in low-income countries: a systematic review.   PLoS One. 2015;10(1):e0116949. doi:10.1371/journal.pone.0116949 PubMedGoogle Scholar
37.
Siaw-Frimpong  M , Touray  S , Sefa  N .  Capacity of intensive care units in Ghana.   J Crit Care. 2021;61:76-81. doi:10.1016/j.jcrc.2020.10.009 PubMedGoogle ScholarCrossref
38.
Kiragu  AW , Dunlop  SJ , Wachira  BW , Saruni  SI , Mwachiro  M , Slusher  T .  Pediatric trauma care in low- and middle-income countries: a brief review of the current state and recommendations for management and a way forward.   J Pediatr Intensive Care. 2017;6(1):52-59. PubMedGoogle Scholar
39.
Nachega  JB , Ishoso  DK , Otokoye  JO ,  et al.  Clinical characteristics and outcomes of patients hospitalized for COVID-19 in Africa: early insights from the Democratic Republic of the Congo.   Am J Trop Med Hyg. 2020;103(6):2419-2428. doi:10.4269/ajtmh.20-1240 PubMedGoogle ScholarCrossref
40.
Mabena  FC , Baillie  VL , Hale  MJ ,  et al. Clinical characteristics and histopathology of coronavirus disease 2019–related deaths in African children. Pediatr Infect Dis J. 2021;40(9):e323-e332.
41.
Oliveira  EA , Colosimo  EA , Simões E Silva  AC ,  et al.  Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.   Lancet Child Adolesc Health. 2021;5(8):559-568. doi:10.1016/S2352-4642(21)00134-6 PubMedGoogle ScholarCrossref
42.
Bennett  TD , Moffitt  RA , Hajagos  JG ,  et al; National COVID Cohort Collaborative (N3C) Consortium.  Clinical characterization and prediction of clinical severity of SARS-CoV-2 infection among US adults using data from the US National COVID Cohort Collaborative.   JAMA Netw Open. 2021;4(7):e2116901. doi:10.1001/jamanetworkopen.2021.16901 PubMedGoogle Scholar
43.
Graff  K , Smith  C , Silveira  L ,  et al.  Risk factors for severe COVID-19 in children.   Pediatr Infect Dis J. 2021;40(4):e137-e145. doi:10.1097/INF.0000000000003043 PubMedGoogle ScholarCrossref
44.
Shekerdemian  LS , Mahmood  NR , Wolfe  KK ,  et al; International COVID-19 PICU Collaborative.  Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units.   JAMA Pediatr. 2020;174(9):868-873. doi:10.1001/jamapediatrics.2020.1948 PubMedGoogle ScholarCrossref
45.
Kompaniyets  L , Agathis  NT , Nelson  JM ,  et al.  Underlying medical conditions associated with severe COVID-19 illness among children.   JAMA Netw Open. 2021;4(6):e2111182. doi:10.1001/jamanetworkopen.2021.11182 PubMedGoogle Scholar
46.
Sigel  K , Swartz  T , Golden  E ,  et al.  Coronavirus 2019 and people living with human immunodeficiency virus: outcomes for hospitalized patients in New York City.   Clin Infect Dis. 2020;71(11):2933-2938. doi:10.1093/cid/ciaa880 PubMedGoogle ScholarCrossref
47.
Bhaskaran  K , Rentsch  CT , MacKenna  B ,  et al.  HIV infection and COVID-19 death: a population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform.   Lancet HIV. 2021;8(1):e24-e32. doi:10.1016/S2352-3018(20)30305-2 PubMedGoogle ScholarCrossref
48.
Western Cape Department of Health; National Institute for Communicable Diseases, South Africa.  Risk factors for coronavirus disease 2019 (COVID-19) death in a population cohort study from the Western Cape Province, South Africa.   Clin Infect Dis. 2021;73(7):e2005-e2015. doi:10.1093/cid/ciaa1198Google ScholarCrossref
49.
World Health Organization. Clinical features and prognostic factors of COVID-19 in people living with HIV hospitalized with suspected or confirmed SARS-CoV-2 infection. World Health Organization. July 15, 2021. Accessed October 30, 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-Clinical-HIV-2021.1
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close