Drivers of the Second Wave and clinical characteristics of COVID-19 cases in Uganda: A Retrospective Study of Confirmed SARS-CoV-2 cases, March-June, 2021

BackgroundThe COVID-19 continued to pose several public health, social, economic challenges and the drivers for the occurrence of different COVID-19 waves remains undocumented in Uganda. We conducted a cross-sectional population-based survey among recovered COVID-19 cases to establish the drivers of SAR-CoV-2 infections. We performed a retrospective study and interviewed 1120 recovered COVID-19 cases from 10 selected districts in Uganda. We further conducted 38 Key Informant Interviews of members of the COVID-19 District Taskforce and 19 in-depth interviews among COVID-19 survivors from March to June, 2021. Results Out of the 1120 recovered COVID-19 cases interviewed, 62% were aged 39 years and below and 51.5% females with 90.9% under home based care management. Cases were more prevalent in business (25.9%), students (17.2%), farmers (17.1%) and health workers (12.4%) and 79.9% developed COVID-19 symptoms mainly cough, flu, and fever. Being asymptomatic was found to be associated with not seeking healthcare (APR 2, P <0.001). The mortality rate was 3.7% mostly among the elderly (6.3%) and 31.3% aged 40 years and above had comorbidities of high blood pressure, diabetes and asthma. High blood pressure and diabetes were significantly associated with low survival rate (P <0.001) among the COVID-19 cases. ConclusionsOur study identified several drivers under the broad categories of demographic, patient, health facilities and services, social and economic factors that attributed to emergence and sustenance of COVID-19 second wave from March to June, 2021. Specifically, being female, young, asymptomatic, under Home Based Care Management, social gatherings, school going, not vaccinated were among the major drivers of the second wave. We strongly recommend that the Ministry of Health together with National Taskforce for COVID-19 Response to reconsider some aspects of Home-Based Care Management to only established institutions and organizations with potential and facilities to monitor cases in addition to training and monitoring all those involved in supporting the Home Based Care Management.