{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:41:48Z","timestamp":1782805308998,"version":"3.54.5"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Few epidemiologic studies related to COVID-19 have emerged from countries in Africa, where demographic characteristics, epidemiology, and health system capacity differ from other parts of the world.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To describe the characteristics and outcomes of patients admitted to COVID-19 treatment centers, assess risk factors for in-hospital death, and explore how treatment center admissions were affected by COVID-19 waves in Zambia.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study assessed patients admitted to COVID-19 treatment centers in 5 Zambian cities between March 1, 2020, and February 28, 2022.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Risk factors for in-hospital mortality, including patient age and severity of COVID-19, at treatment center admission.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Patient information was collected, including inpatient disposition (discharged or died). Differences across and within COVID-19 waves were assessed. Mixed-effects logistic regression models were used to assess associations between risk factors and in-hospital mortality as well as between characteristics of admitted patients and timing of admission.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 3876 patients were admitted during 4 COVID-19 waves (mean [SD] age, 50.6 [19.5] years; 2103 male [54.3%]). Compared with the first 3 waves (pooled), the proportion of patients who were 60 years or older admitted during wave 4, when the Omicron variant was circulating, was significantly lower (250 of 1009 [24.8%] vs 1116 of 2837 [39.3%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Factors associated with in-hospital mortality included older age (\u226560 vs &amp;lt;30 years; adjusted odds ratio [aOR], 3.55; 95% CI, 2.34-5.52) and HIV infection (aOR, 1.39; 95% CI, 1.07-1.79). Within waves, patients who were admitted during weeks 5 to 9 had significantly higher odds of being 60 years or older (aOR, 2.09; 95% CI, 1.79-2.45) or having severe COVID-19 at admission (aOR, 2.49; 95% CI, 2.14-2.90) than those admitted during the first 4 weeks.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The characteristics of admitted patients during the Omicron wave and risk factors for in-hospital mortality in Zambia reflect data reported elsewhere. Within-wave analyses revealed a pattern in which it appeared that admission of higher-risk patients was prioritized during periods when there were surges in demand for health services during COVID-19 waves. These findings support the need to expand health system capacity and improve health system resiliency in Zambia and other countries with resource-limited health systems.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.46152","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T16:02:45Z","timestamp":1670947365000},"page":"e2246152","source":"Crossref","is-referenced-by-count":13,"title":["Clinical Characteristics and Outcomes of Patients Hospitalized With COVID-19 During the First 4 Waves in Zambia"],"prefix":"10.1001","volume":"5","author":[{"given":"Peter A.","family":"Minchella","sequence":"first","affiliation":[{"name":"Centers for Disease Control and Prevention\u2013Zambia, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan","family":"Chanda","sequence":"additional","affiliation":[{"name":"Zambian Ministry of Health, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas Z.","family":"Hines","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention\u2013Zambia, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sombo","family":"Fwoloshi","sequence":"additional","affiliation":[{"name":"Zambian Ministry of Health, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megumi","family":"Itoh","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention\u2013Zambia, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davies","family":"Kampamba","sequence":"additional","affiliation":[{"name":"Zambian Ministry of Health, Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Chirwa","sequence":"additional","affiliation":[{"name":"Zambian Ministry of Health, Lusaka, 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