In-hospital trends of non-communicable disease mortality during the COVID-19 pandemic at a regional referral hospital in southwestern Uganda

Background Non-communicable diseases (NCDs) represent a growing health burden in sub-Saharan Africa. In Uganda, 33% of deaths were attributed to NCDs in 2016 and to-date many health facilities are ill-equipped to properly manage NCDs. The COVID-19 pandemic presented significant challenges for the healthcare system in Uganda, though changes in hospital admissions and outcomes for adults with NCDs and without COVID-19 infection remain unknown. Methods Between March 1, 2019, and August 31, 2021, we conducted a chart review of Ugandan adults who carried a history of or were admitted for an NCD. Based on mortality trends, we broke admissions into three periods: Pre-Pandemic (March 1, 2019, to May 31, 2020), Early Pandemic (June 1, 2020, to March 31, 2021), and Late Pandemic (April 1, 2021, to August 31, 2021), and calculated admission and mortality rate for the most common NCD diagnoses during these periods. A multivariable logistic regression model was fitted for a primary outcome of in-hospital mortality. Results Of 3,777 total individuals, 1,655 were admitted Pre-Pandemic, 1,423 in the Early Pandemic, and 699 in the Late Pandemic. We found a five-fold increase in mortality in the Early Pandemic period compared to the Pre-Pandemic and Late Pandemic periods (15.4 vs 2.9 vs 2.4, p < 0.001). Factors associated with an increased odds for in-hospital mortality included admission with hypotension (OR 2.4; 95%CI 1.6, 3.6; p < 0.001) or hypertensive urgency (OR 1.6; 95%CI 1.1, 2.4; p = 0.03), each unit increase in Sequential Organ Failure Assessment score (OR 1.4; 95%CI 1.3, 1.5; p < 0.001), and each unit increase in Charlson Comorbidity Index (OR 1.2; 95%CI 1.0, 1.3; p = 0.045). Conclusions NCD-associated in-hospital mortality was high in the early COVID-19 pandemic period. Disruptions in longitudinal NCD care (e.g., due to strict movement restrictions) that occurred due to the pandemic may have been contributory. Future work should focus on understanding NCD morbidity and mortality for hospitalized individuals in resource limited settings, as well as working to develop more resilient systems for longitudinal NCD care to ensure adequate care even during disasters and pandemics.