Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : LC22 - LC26 Full Version

Predictors of Mortality due to COVID-19 Infection among Adults: A Cross-sectional Study


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53490.16019
Devi Kittu, Saranya Periyasamy, Zubaida Begum Kadar

1. Professor, Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India. 2. Final Year Postgraduate, Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India. 3. Final Year Postgraduate, Department of Community Medicine, Indira GandhiMedical College and Research Institute, Puducherry, India.

Correspondence Address :
Devi Kittu,
Associate Professor, Department of Community Medicine, Indira Gandhi Medical
College and Research Institute, Puducherry, India.
E-mail: devi.kittu@rediffmail.com

Abstract

Introduction: Coronavirus diseases-2019 (COVID-19) has emerged as a pandemic with significant mortality risk. The early predictors of mortality in COVID-19 patients are older age, male gender, co-morbidities like uncontrolled diabetes, hypertension, severe asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease (CKD), Coronary Artery Disease (CAD), Chronic Liver Disease and malignancy and raised pro-inflammatory markers in most of the studies from China, Western Europe and US.

Aim: To determine the various risk factors associated with outcomes of COVID-19 infection among laboratory confirmed COVID-19 patients.

Materials and Methods: This descriptive cross-sectional study was conducted among 420 laboratory confirmed COVID-19 patients, aged 18 years and above, who were admitted in a designated COVID-19 hospital in Puducherry, India. Pretested structured questionnaire was used to collect the data through telephonic interview. Descriptive statistics, frequency, mean and standard deviation was estimated for demographic characteristics as appropriate. Chi-square test was used to investigate demographic and health related predictors of COVID-19 outcomes.

Results: The mean age of the study participants was 41.38 (±17.552) years. Thirty five (8.3%) patients died during their treatment. The common presenting symptom was fever (142, 33.80%), followed by cold and cough (96, 22.85% each). Factors such as more than 60 years of age, female gender, resident of rural area, patients owning yellow ration card, unemployment, overcrowding, current smoking and alcoholics, attending social gathering, social distancing, hand washing, level of wearing mask were found to be significantly associated with fatal prognosis.

Conclusion: Risk factors such as older age, females, rural residence, unemployment, overcrowding, smoking and alcoholism, co-morbidities, social gathering, social distancing, hand washing and mask usage were found to be associated with COVID-19 deaths.

Keywords

Co-morbidities, Coronavirus disease-2019, Deaths, Pandemic, Risk factors

Coronavirus disease-2019 (COVID-19), has emerged as a new disease, which has emerged as a pandemic with significant mortality risk. Currently COVID-19 pandemic has affected 274,628,461 crore people and 5,358,978 deaths till 20th December 2021, globally (1). In India, 478,007(1.4%) deaths have been recorded, out of 34,752,164 confirmed cases. The case mortality rate is projected to range from 2% to 3% (2). Puducherry, a Union territory in Southern India with a population of around 1,247,953 reported 125,472 cases and 1,869 (1.4%) deaths due to COVID-19 (3),(4).

In several countries, the rapid spread of the disease has certainly become a burden to health systems as a significant proportion of elderly, immunosuppressed and those with underlying metabolic, cardiovascular or respiratory diseases continue to develop severe forms of COVID-19, and thereby are at an increased risk for adverse outcomes (5). In a meta-analysis, a total of 58 studies were analysed, where significant association was found between COVID-19 deaths and older age, males, obesity, hypertension, diabetes, cardiovascular disease, cancer and Intensive Care Unit (ICU) admitted patients (6). A study done by “The open SAFELY collaborative”, death was associated with older age and male gender, uncontrolled diabetes, severe asthma and other prior medical conditions (7). Another study by Li X et al., found older age, underlying hypertension had a highly significant association with the severity of COVID-19 on admission (8). Also, mortality risk was higher for patients with COPD, CKD, CAD, diabetes, hypertension, chronic liver disease and malignancy (9).

Studies from India also reported similar findings. A study in Madurai, Tamil Nadu observed that the mortality was associated with old age, male gender, breathlessness, with two or more symptoms, CKD, malignancy, diabetes, diabetes with hypertension, diabetes with heart disease, hypertension with heart disease, diabetes with both hypertension and heart disease and other chronic diseases (10). Similarly, another study found older age, male sex, cancer, diabetes, hypertension, chronic circulatory disorders, respiratory disorders, CKD and other endocrine disorders, smoking, alcohol consumption, co-morbidities, oxygen saturation <90% at admission, Acute Respiratory Distress Syndrome (ARDS), C-Reactive Protein (CRP) >100 mg/L, higher D dimer were significantly associated with mortality among COVID-19 patients (11),(12),(13). In another study done in Pune, Maharashtra reported that the case fatality rate among the admitted cases was 29.4% and co-morbidity was one of the significant risk factors for the progression of disease and death (14).

COVID-19 has its presence wide across the globe, generating new information and fresh evidence based knowledge continuously. But currently available literature indicates varying information across regions and countries, emphasising the need for generating evidence for a specific geography, population, and context. Also, current therapeutic strategies to deal with COVID-19 are only supportive, and prevention efforts aimed at reducing transmission in the community are considered as the most effective measures to combat COVID-19 deaths (15).

With this background, this study was conducted to determine the various risk factors associated with mortality due to COVID-19 infection among laboratory confirmed COVID-19 patients in a designated COVID hospital in Puducherry, India.

Material and Methods

This was a descriptive cross-sectional study, involving 420 laboratory confirmed COVID-19 patients admitted in the Indira Gandhi Medical College and Research Institute, Puducherry, India. The study period was three months from September 2020 to November 2020. Institute Scientific Research Committee as well as Institute Ethical Committee (N0.8/275/IEC-30/PP/2020) approval was obtained before data collection.

Inclusion criteria: Laboratory confirmed COVID-19 infected patients who were admitted in the study hospital, with age more than 18 years, and who were willing to participate in the study.

Exclusion criteria: Severe COVID-19 infected patients who were admitted in ICU or under Non Invasive Ventilation (NIV) with oxygen support were excluded from the study.

Sample size calculation: The sample size was calculated using the formula: n=z2pq/d2 using a proportion of COVID-19 infection among the suspect cases in the study hospital, in the month of August 2020 (number of persons tested positive for COVID-19 among the suspects) was 44.7%, at 95% confidence interval with a sample error of 5% which comes to 379. Adding 10% non response rate to this, the sample size calculated was 416 which was rounded off to 420 (16).

Study Procedure

Total number of COVID-19 patients who were positive in the month of September 2020 was 3163. Out of this 3163, 1025 patients were admitted. Using simple random sampling methods the required sample of 420 was drawn from the sampling frame. Identification details (contact numbers) of all 420 patients were obtained from the COVID-19 control room.

A predesigned and pretested structured interviewer administered questionnaire (socio-demographic variables, co-morbidities, COVID-19 appropriate behaviour and other risk factors) was used to collect the data. The demographic variables like colour of ration card was based on the annual income of the families, overcrowding (based on number of persons per room) and socio-economic condition (based on updated BG Prasad Socio-economic Classification). Hypertension was defined based on systolic and diastolic blood pressure and Body Mass Index (BMI) was classified based on cut-off values for normal Asian Indian adults (17),(20),(21). Data collection was done by the investigator through telephonic interview, after obtaining oral informed consent.

Statistical Analysis

Data entry and analysis was done using Microsoft Excel 2010 and Statistical Package for the Social Science (SPSS) for windows version 23, Chicago, IL) software respectively. Descriptive statistics, frequency, mean and standard deviation was estimated for demographic characteristics as appropriate. Chi-square test was used to find the association between attributes. The p-value <0.05 was considered as significant.

Results

Total number of samples tested during the study period was 7347. Out of this sample, 3163 samples were found to be COVID-19 positive. Hence, the total positivity rate was 43.05%.

Out of the selected 420 participants, 35 died for which the details were collected from their respective family members. The death rate was 8.3%. The mean age of the participants was 41.38±17.552 years.

Frequency distribution of socio-demographic, co-morbidities and COVID-19 appropriate behaviour study practises of study particip-ants was shown in (Table/Fig 1). Out of the 420 participants, majority 340 (80.95%) were less than 60 years of age. Males were 252 (60%) in number. Almost two third 311 (74.05%) were residents of urban areas. Nearly half of the participants 189 (45%) possessed red colour ration card. Overcrowding was present in 71 (16.90%) houses of the participants. Two-third of participants 328 (78.10%) belonged to low socio-economic conditions (class IV and class V). Majority of the patients 277 (65.95%) were employed. More than one fourth of the participants 118 (28.10%) had associated co-morbidities, among them 59 (50%) were diabetic. A 277 (65.95%) of them had no prior exposure to COVID-19 infection. Overall, 349 (83.10%) of them did not participate in social gathering before contacting the infection. Patients who always followed social distancing was 222 (52.85%). Almost half 193 (45.95%) of the patients washed their hands always. Majority 306 (72.86%) of COVID patients used their masks always. A 297 (70.71%) wear their masks at the level of the nose (Table/Fig 1).

(Table/Fig 2) shows the common presenting symptoms. Out of 565 responses, 142 (33.80%) reported fever, 96 (22.85%) had cough and an equal proportion suffered cold.

Association of factors related to death due to COVID-19 was tested by Chi-square test (Table/Fig 3). Among the socio-demographic variables studied, death were more among older patients (≥60 years) (χ2=23.723; p≤0.05), females compared to males (χ2=3.928; p=0.047), houses which were overcrowded (χ2=76.627; p<0.05). Similarly, death was associated with 80% of the patients who were unemployed (p<0.05). Out of the total 35 deaths, the proportion of patients who were current smokers and current alcoholics was found to be significantly associated with deaths (p<0.05). Presence of any co-morbidities was also found to be significantly associated with deaths. Among the co-morbidities, patients who were diabetic were found to be statistically significant with fatal COVID-19 prognosis (p<0.05). Among the COVID-19 appropriate behaviours practised, patients who participated in social gathering, practised social distancing intermittently, intermittent hand washing practices were found to be significantly associated with COVID-19 deaths (p<0.05). Also, patients who used mask intermittently were significantly associated with COVID-19 mortality (p<0.05). In addition, wearing mask at level of mouth was found to be significantly associated with death due to COVID-19 infection (p<0.05) (Table/Fig 3).

Discussion

Most of the studies done on COVID-19 mortality focussed on clinical characteristics, laboratory parameters and inflammatory markers. These are applicable in critical care management and resource planning. But understanding the demographic, clinical characteristics and preventive measures of deceased COVID-19 patients could outline public health interventions focusing on preventing mortality. Hence, this study was undertaken to study the preventable risk factors of mortality of COVID 19 positive patients with special emphasis on COVID-19 appropriate behaviour.

Comparison of present study findings with other published studies on COVID-19 deaths were presented in (Table/Fig 4) (10),(12),(13),(22),(23),(24). The mean age of the study participants was 41.38±17.55 years. In other studies the mean age ranged from 40.1±13.1 to 62.5±13.7 (10),(12),(13),(22),(23),(24). In the current study, the overall death rate was 8.3%, and recovery rate was 91.7% among the study participants. Other studies observed similar findings, where the death rate ranged from 2%-10% (10),(12),(22),(23),(24). But a higher death rate (47.34%) was observed in a study conducted in Jaipur by Jain SK et al., (13). This may be due to fact that case fatality rate varies globally and across different regions, due to different stages of pandemic experienced in different parts of the world.

The two most common symptoms presented in this study was fever (33.80%) followed by cough (22.85%) and cold (22.85%). This findings from current study was similar to other studies (12),(13),(24),(25). A case series by Gupta N et al., also found that fever was the most common symptom (26). Other studies observed breathlessness and fever as the chief complaint during hospital admission (10),(22). Chauhan NK et al., reported fever and sore throat as the principle complaints by the COVID patients (23).

In this study, 51.43% of COVID-19 deaths was observed in the older age group (>60 years), which was similar to the findings of other studies (10),(12),(22),(23). The study also observed that 57.14% of deaths occurred in females. This finding was in contrast to other studies where majority of the deaths occurred in males (10),(12),(13),(22),(23). This difference may be because of the small sample size, and the death rate was also low in the present study. In the present study, overcrowding was found to be one of the risk factors of COVID death. These findings are similar to the study done by Ahmad K et al., which showed that with each 5% increase in percent households with poor housing conditions, there were a 50% higher risk of COVID-19 incidence and a 42% higher risk of COVID-19 mortality (27).

In the current study, 51.43% of the patients who died due to COVID-19 were smokers which are similar to the findings of by Chauhan NK et al., (23). In this study, among the COVID-19 positive patients, 74.29% reported associated co-morbidities. Similar findings were reported by other studies where co-morbidities like diabetes mellitus and hypertension were commonly associated with deaths (10),(12),(13),(22).(23),(24).

This study reported 60% mortality rate among patients who attended social gathering in the recent past. Mohan A et al., found that 82.8% of deceased patients participated in social gathering (24). In the present study, practising social distancing only intermittently was found to be associated with mortality. Also, intermittent hand washing practices was found to be associated with fatal prognosis. Similar finding was observed by Szczuka Z et al., where higher number of total cases and deaths from COVID-19 were related to lower levels of hand washing adherence (28). In this study, patients who never wore a mask and intermittent users were highly observed among those who died. Similarly, incorrect practice of wearing mask (at mouth level and at the level of chin) was also found to be associated with death. An experiment across 200 countries showed 45.7% fewer COVID-19 related mortality in countries where wearing mask was mandatory (29). A recent survey noted that only 44% of Indians were wearing it properly in compliance with the guidelines (30). Hence, it is important to ensure appropriate use of face mask for it to be effective.

The major advantage of this study was the involvement of multiple and rare factors of this study like demography, personal habits, co-morbidities and COVID-19 appropriate behaviour were studied. This can be used in future to adopt preventive strategies.

Limitation(s)

The study was conducted in a single centre with a limited sample size hence generalising it to the whole population is questionable. A multivariate analysis to identify risk factors by adjusting the confounders could not be performed, due to the low mortality rate (8.3% deaths).

Conclusion

The most common presenting symptom of COVID-19 infection was fever followed by cough and cold. Risk factors such as old age, females, rural residents, unemployment, overcrowding, smoking and alcoholism, co-morbidities, diabetes mellitus, social gathering, social distancing, hand washing, mask usage and level at which mask is worn was found to be significantly associated with COVID-19 deaths. Hence, preventable risk factors with special emphasis on COVID-19 appropriate behaviour need to be reinforced to general public through proper health education. In addition, special attention should be given to the COVID-19 patients with co-morbidities during admission for better prognosis.

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DOI and Others

DOI: 10.7860/JCDR/2022/53490.16019

Date of Submission: Nov 29, 2021
Date of Peer Review: Dec 21, 2021
Date of Acceptance: Jan 03, 2021
Date of Publishing: Feb 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 01, 2021
• Manual Googling: Jan 01, 2022
• iThenticate Software: Jan 12, 2022 (11%)

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