Severe Sars-cov-2 Related Disease in Children Aged 0-19 Years in Ethiopia, a Longitudinal Cohort Study

Abstract Objective To assess the prevalence of severe SARS CoV 2 related disease in children aged 0–19 years and to evaluate the associations between malnutrition and other risk factors for severe disease. Methods A study involving 385 children aged 0–19 years from January 2020 to December 2021. The outcome variable was children with severe COVID-19 disease, defined as those hospitalized for acute COVID-19 disease or multisystem inflammatory syndrome in children (World Health Organization case definition) with hypoxemia, hypotension, respiratory distress, or death. Undernutrition was also considered. The study used both univariable and multivariable analyses to assess possible associations, with a significant association considered at a P value < 0.05. Results Median age with interquartile range was 6(1–13). At presentation, 35.7% were malnourished with Weight for Age < − 2 SD scores and the mean weight for age Z-score was − 1.82 (4.54[SD]). Overall, 65.5% (252/385) of children were with severe COVID-19 disease and 19 (4.8%) met the World Health Organization case definition for multisystem inflammatory syndrome in children. Thirty six out of 385 (9.4%) children died. Children with comorbidities (167/385 (77.0%]) had a 1.4-fold greater risk of severe disease than children without these conditions (adjusted relative risk [RR] 1.37 (95% CI 1.14 to 1.65). Children with undernutrition (90/345, 73.2%) had a 1.15-fold greater risk of severe disease than children who were not malnourished (132/345, 63.5%) (RR 1.15, 95% CI 1.00 to 1.34), however, there was no association shown in the final model after adjusting for confounding (RR 1.04, 95% CI 0.90 to 1.20). Conclusion The study reveals increased mortality and severe disease in severely ill children, emphasizing the need for vaccines and preventive measures in countries like Ethiopia with high mortality burdens.