Abstract:
Background
Data on coronavirus disease 2019 (COVID-19) clinical characteristics and severity from
resource-limited settings are limited. This study examined clinical characteristics and factors
associated with COVID-19 mortality and hospitalisation in rural settings of Indonesia, from 1
January to 31 July, 2021.
Methods
This retrospective cohort included individuals diagnosed with COVID-19 based on polymerase
chain reaction or rapid antigen diagnostic test, from five rural provinces in Indonesia.
We extracted demographic and clinical data, including hospitalisation and mortality from a
new piloted COVID-19 information system named Sistem Informasi Surveilans Epidemiologi
(SISUGI). We used mixed-effect logistic regression to examine factors associated with
COVID-19-related mortality and hospitalisation.
Results
Of 6,583 confirmed cases, 205 (3.1%) died and 1,727 (26.2%) were hospitalised. The
median age was 37 years (Interquartile range 26–51), with 825 (12.6%) under 20 years, and
3,371 (51.2%) females. Most cases were symptomatic (4,533; 68.9%); 319 (4.9%) had a
clinical diagnosis of pneumonia and 945 (14.3%) presented with at least one pre-existing
comorbidity. Age-specific mortality rates were 0.9% (2/215) for 0–4 years; 0% (0/112) for
5–9 years; 0% (1/498) for 10–19 years; 0.8% (11/1,385) for 20–29 years; 0.9% (12/1,382)
for 30–39 years; 2.1% (23/1,095) for 40–49 years; 5.4% (57/1,064) for 50–59 years; 10.8%
(62/576) for 60–69 years; 15.9% (37/232) for �70 years. Older age, pre-existing diabetes,
chronic kidney disease, liver diseases, malignancy, and pneumonia were associated with
higher risk of mortality and hospitalisation. Pre-existing hypertension, cardiac diseases,
COPD, and immunocompromised condition were associated with risk of hospitalisation but
not with mortality. There was no association between province-level density of healthcare
workers with mortality and hospitalisation.
