Factors associated with mortality in patients diagnosed with COVID-19 in the Manzini Region, Eswatini, 2020-2021

Introduction: Coronavirus disease 2019 (COVID-19) emerged in late 2019 and rapidly evolved into a global public health crisis. After more than 118,000 cases in 114 countries and 4,291 mortalities were reported, the WHO declared COVID-19 a worldwide pandemic on 11 March 2020. This study aims to determine demographic and clinical factors associated with COVID-19 case fatality among patients diagnosed in the Manzini Region, Eswatini, between March 2020 and August 2021. Methods: This retrospective cross-sectional study was based on an analysis of secondary data for patients with a positive diagnosis of COVID-19 in the Manzini region who had an outcome of either recovery or death. It then excluded all suspected cases that were not confirmed by laboratory results. A COVID-19 mortality was defined as a death resulting from a clinically compatible illness in a confirmed COVID-19 case. Descriptive statistics were used to summarise demographic, clinical characteristics. The Pearson chi-square test was used to assess differences in categorical variables, and finally used logistic regression was used to investigate factors associated with COVID-19 mortality. Results: After excluding 189 medical records, 15,124 cases and 336 COVID-19 mortalities were analyzed. Most of the participants were Females (54.5%), and the mortality rate in patients with SARS due to COVID-19 was 2.2%. Multivariate logistic regression identified the Year 2021 as the strongest independent predictor of mortality, increasing the odds of death over 15 times compared to 2020 (AOR 15.26, 95% CI: 6.60–35.24). Advanced age was also strongly associated with fatality, with patients aged ≥60 years (AOR 9.27, 95% CI: 3.12–25.92) and 50–59 years (AOR 8.12, 95% CI: 2.81–23.49) showing markedly higher odds of death compared with younger adults. Risk increased significantly with disease severity, ranging from mild (AOR 5.89, 95% CI: 2.94–11.80) and moderate (AOR 12.67, 95% CI: 5.54–29.01) to severe disease (AOR 123.71, 95% CI: 53.44–286.38). Hypertension also remained a significant risk factor (AOR 3.57, 95% CI: 2.01–6.36). Notably, Diabetes Mellitus appeared to be a protective factor (AOR 0.35, 95% CI: 0.18–0.71). Conclusion: Age, severity, and hypertension were confirmed risks. Crucially, the protective factor of diabetes suggests effective local prioritization and early management of high-risk patients during the pandemic.