Mortality and Predictors of Mortality Among COVID-19 Patients in Kiambu County, Kenya

Round 1

Reviewer 1 Report

This article addresses mortality among COVID-19 patients and identifies predictors of mortality. The article fills the gaps in research on this topic in Africa. The authors describe nuances in predictors of mortality in each of the five waves of COVID-19 in Kenya. Researchers emphasize the benefits of oxygen therapy for the outcomes of COVID-19 patients.

The abstract describes the most important information included in the article. The article's authors correctly introduce the subject and describe the five waves of the COVID-19 pandemic since the first case of COVID-19 appeared in Kenya. Materials and methods comprehensively describe the course of the study. The results are presented descriptively, and figures and tables are related to the set goals. Statistical analysis raises no objections. The discussion compares the most important results obtained in the study with the results of other studies worldwide. Limitations of the study are indicated. Conclusions are correctly drawn based on the obtained results.

Minor comments:

The affiliations of the authors of the article do not include e-mail addresses and there is no corresponding author indicated.

No keywords.

Materials and Methods. Study participants. It is worth stating in this section how many people participated in the study. How many patient records were included in the study? How many patient records were excluded from the study?

Who was the study funder, grant number?

Discussion. It is worth emphasizing the strengths of the study.

Bibliography. The bibliography should be corrected according to the mdpi guidelines

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections in track changes in the re-submitted manuscript document.

Comment 1: The affiliations of the authors of the article do not include e-mail addresses and there is no corresponding author indicated.

The emails for the affiliated authors and details of the corresponding author have been provided in the manuscript submission form. Please find the details listed in the table below:

Comment 2: No keywords.

We have included this list of keywords in the revised manuscript as track changes.

Keywords: SARS-Cov-2, COVID-19, Mortality, Survival Analysis, Africa

Comment 3: Materials and Methods. Study participants. It is worth stating in this section how many people participated in the study. How many patient records were included in the study? How many patient records were excluded from the study?

This suggestion has been incorporated in the revised manuscript as below.

Study Participants

We included 1,985 records of patients who tested positive for SARS-CoV-2 through either reverse-transcription polymerase chain reaction or rapid antigen test and were diagnosed with moderate, severe, or critical COVID-19 symptoms. We excluded 57 records of patients who tested positive for SARS-CoV-2 but did not require admission to the hospital.

Comment 4: Who was the study funder, grant number?

Funding Statement: This work was supported by the Fogarty International Center and the Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number D43TW011519.

Comment 5: Discussion. It is worth emphasizing the strengths of the study.

A statement on the strengths of the study is written below and has been incorporated in the manuscript revision.

Strengths:

The study analyzed data from hospitalized patients across multiple waves of the COVID-19 pandemic, capturing how patient characteristics evolved with emerging variants and the predictors of mortality across the waves. Additionally, the inclusion of analysis of follow-up symptoms among these patients, provides valuable insight into disease progression, key triggers of clinical deterioration, and indicators of post-COVID sequelae, underscoring the need for sustained post-discharge surveillance and long-term planning.

Comment 6: Bibliography. The bibliography should be corrected according to the mdpi guidelines
The bibliography has been corrected as per the MDPI guidelines.

Reviewer 2 Report

Thank you for the opportunity to review your paper on SARS-CoV-2 disease in Kiambu County, Kenya.  My only substantive criticism is that I would like a stronger acknowledgement that social and health system factors, in addition to virus strain variation, would have influenced temporal changes in mortality.  I acknowledge that this is not open to analysis in your paper, and also that the issues are alluded to in the statement that you "could not explain the differences in mortality predictors by wave, therefore there is need for further research to gain better understanding of these variations".  I agree with the foregoing, as far as it goes.  But I don't think that a little speculation would be out of place in this context.  

Issues that could impact include changes in case mix through successive waves and the impact of societal beliefs about quality of care on the likelihood of hospital presentation through the different waves.  It is also certain that the infection impacted the health workforce in several ways.  There would have been some deaths among health workers.  Workload would have led to increasing exhaustion through successive waves.  Some health workers very likely became anxious and depressed as a consequence of seeing so much death.  I'd ask that you give a few sentences to these issues in the discussion.  

Author Response

Comment:

Thank you for the opportunity to review your paper on SARS-CoV-2 disease in Kiambu County, Kenya.  My only substantive criticism is that I would like a stronger acknowledgement that social and health system factors, in addition to virus strain variation, would have influenced temporal changes in mortality.  I acknowledge that this is not open to analysis in your paper, and also that the issues are alluded to in the statement that you "could not explain the differences in mortality predictors by wave, therefore there is need for further research to gain better understanding of these variations".  I agree with the foregoing, as far as it goes.  But I don't think that a little speculation would be out of place in this context.  

Response:

We have included the sentence below in the discussion section to address this comment.

“Furthermore, the health workforce was significantly impacted over the course of the pandemic, with increased workload and staff shortages resulting from infections among healthcare workers and mounting exhaustion, which may have contributed to reduced quality of care.”