





































Clinical Medicine Insights
Received 16 Mar 2022 | Revised 18 Apr 2022 | Accepted 30 Apr 2022 | Published Online 13 May 2022

DOI: https://doi.org/10.52845/CMI/2022-3-2-2 
CMI 03 (02), 287−296 (2022) ISSN (O) 2694-4626 

RESEARCH ARTICLE

Clinical Outcome Of Corona Virus Disease-19 Patients In An Infectious 
Disease Center, Olodo, Ibadan, Oyo State, Nigeria

Oluwagbenga Alonge1,2, Fowotade Adeola3, Folasade Bamidele2, Toyosi Omotosho2, Moradeyo 
Aboluwoye2, Stephen Olulana2, Nayim Fashina4, Fisayo Famuyiwa5, Anifat Eegunjobi6, Ganiyu 
Arinola7

1Department of Surgery, 
College of Medicine, Univer-
sity of Ibadan, Ibadan, 
Nigeria
2lnfectious Disease Centre, 
Olodo, lbadan, Nigeria
3Department of Medical 
Microbiology, University of 
Ibadan, Nigeria
4Department of Medical 
Microbiology, University 
College Hospital, lbadan, 
Nigeria
5Department of Chemical 
Pathology, University 
College Hospital, lbadan, 
Nigeria
6Department of Chemical 
Pathology, LAUTECH, 
Ogbomosho, Nigeria
7Department of Immunol-
ogy, University of Ibadan, 
Ibadan, Nigeria.

Abstract
Introduction: Corona Virus Disease (COVID-19) is a severe respiratory 
infection caused by the newly emerged Severe Acute Respiratory 
Syndrome-Corona Virus-2 (SARS-CoV-2).  Globally, mortality from this 
disease is high and infection sequelae can result in long-term illness.  
COVID-19 is a new disease and the best way to manage patients remains 
uncertain, particularly in resource-limited settings. An evaluation of the 
clinical outcome of COVID-19 cases managed at the Infectious Disease 
Center (IDC), Olodo in Ibadan, Oyo State, Nigeria over a period of 
eighteen weeks was carried out. This center (IDC), Olodo was designated 
by the Oyo State COVID-19 Task Force to manage mild to severe cases of 
COVID-19 in Oyo state.
Materials and Methods: A treatment protocol designed by the Case 
Management Team of the Oyo State COVID-19 Task Force was adopted. 
The protocol included classifying patients based on clinical signs and 
symptoms and qPCR Cycle Threshold (CT) values, treating with a 
cocktail that included chloroquine or hydroxychloroquine, zinc, vitamins 
C and D and or antibiotic(s) as indicated. Physiotherapy and nutritional 
support for these patients were also considered as priority.  
Results: During the period of study, 3,119 individuals tested for SARS-
CoV-2 infection in Oyo State received a positive result and 310 (9.9%) 
were admitted to the IDC, Olodo, Ibadan.  The average duration of 
admission was 10.22  3.48 days, with 22(7.1%) patients requiring 
respiratory support by way of supplemental oxygen using re-breather 
bags and Continuous Positive Airway Pressure (CPAP)was used on one 
patient.  No mortality was recorded among the 310 patients managed 
according to the protocol at the IDC,Olodo, Ibadan during the study 
period.  
Conclusion: This clinical outcome suggests that the management 
protocol used in our center is effective and thus deserves evaluation for 
use in resource poor settings.
Keywords: COVID-19 pandemic, Management protocol, Oyo 
State.

MANUSCRIPT CENTRAL

used to avoid complications of hemodialysis manifested in uremic
state including anorexia, nausea, vomiting leading to malnutrition, fluid
and electrolyte imbalance leading to volume overload, hyperkalemia,
metabolic acidosis, and hyperphosphatemia, as well as abnormalities
related to hormonal or systemic dysfunction such as hypertension,
anemia, hyperlipidemia, and bone disease, Timely diagnosis of protein-
energy-wasting (PEW) is important for early initiation of nutritional
intervention and treatment. In addition, education plans should be
prepared to mediate the nutrient intakes and identify the patient’s
difficulties and provide practical help.
Keywords: Renal dialysis, Nutritional status, Hemodialysis, Malnutri-
tion

Copyright : © 2022 The Authors. Published by Publisher. This is an
open access article under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

CMI 03 (02), 287−296 287

https://doi.org/10.52845/CMI/2022-3-1-4
https://creativecommons.org/licenses/by-nc-nd/4.0/
http://medicineinsights.info/index.php/cmi/index


1 INTRODUCTION

T he Severe Acute Respiratory Syndrome-
Corona Virus-2 (SARS-CoV-2) responsible 
for the coronavirus disease 19 (COVID-19)

pandemic is a new virus of the Coronaviridae family 
in the Nidovirales order. This group of virus, 
including the Severe Acute Respiratory Syndrome 
Coronavirus (SARS-CoV) and the Middle East 
Respiratory Syndrome (MERS) Coronavirus, has 
been shown to cause acute lung injury (ALI) and 
Acute Respiratory Distress Syndrome (ARDS) 
resulting in respiratory failure and death in some 
patients. The signs and symptoms of SARS-CoV-2 
viral infection may be similar to those of influenza 
and seasonal allergies and in the tropical setting may 
mimic common ailments including malaria (Yang et 
al., 2020 and Shereen et al., 2020).
Human to human transmission of coronavirus 
occurs via droplets or aerosol and the virus uses 
spike proteins to attach to the angiotensin-
converting enzyme 2 (ACE-2) on the surface of 
normal cells.  Conformational change in the spike 
protein facilitates viral envelope fusion with the cell 
membrane. Once within the cell, the virus initiates 
replication, ultimately producing more viruses that 
infect other cells (Shereen et al., 2020).  SARS-
CoV-2 viral infection activates antiviral immune 
responses that are often accompanied by marked 
and uncontrolled pro-inflammatory cytokines 
overdrive also referred to as cytokine storm (Yang 
et al., 2020). 
Severe SARS-CoV-2 infection has been found to 
cause lymphopenia which can arise because of 
ACE-2 receptor expression on lymphocytes 
permitting viral entry and consequent lymphocyte 
cell death. SARS-CoV-2 infection is also 
accompanied by increase serum lactic acidaemia, a 
condition that is also known to inhibit lymphocyte 
proliferation. Subsequently, there is associated 
lymphocyte, granulocyte and monocyte dysfunction, 
and a high neutrophil-to-lymphocyte ratio, in severe 
SARS-CoV-2 infection (Yang et al., 2020). Severe- 
and critically ill- COVID-19 cases exhibits severe 
pneumonia and metabolic disorders developing into 
acute respiratory distress syndrome, multiple organ 
dysfunctions, septic shock and death (Huang et al., 

2020). Some studies suggested that the 
immunopathogenesis after SARS-CoV-2 infection 
has been linked to the development of the disease 
into severe cases (Qin et al., 2020).
No known specific and effective drugs or vaccines 
have been developed to manage or prevent 
COVID-19 (Wu et al., 2020) thus many drugs have 
been evaluated in its management and further search 
contunues. National Institute of Health (NIH) and 
Food and Drug Administration (FDA) 
recommended, remdesivir and convalescent blood 
products as promising potentials for COVID-19 
treatment apart from the uses of chloroquine, 
hydroxychloroquine, favipiravir, ivermectin, and 
colchicines (Hossen et al., 2020). Usage of another 
antihelminthic drug (apart from ivermectin) was 
also proposed (Onifade and Arinola, 2020). 
Tocilizumab was deemed as adjunctive therapy for 
patients with cytokine release syndrome while 
baricitinib and ruxolitinib were reported to have 
additive immunosuppressive effect (Hossen et al., 
2020). Santos et al (2020) reported that therapeutics 
for COVID-19 includes camostatmesylate, 
remdesivir, favipiravir, tocilizumab, baricitinib, 
convalescent plasma, and humanized monoclonal 
antibodies. 
Oyo State, in the South Western region of Nigeria, 
has a population of about seven million people. The 
index case of coronavirus infection in the state was 
reported in Ibadan, the state capital on 21st March 
2020 and the patient was temporarily isolated and 
managed at the Agbami Chest Clinic in Jericho, 
Ibadan, Nigeria. Three other patients who tested 
positive for the viral infection were subsequently 
transferred to the Infectious Disease Center (IDC) at 
Olodo, Ibadan on 27th April 2020 when this 
designated center was commissioned. This fully 
furnished center was established by the Oyo State 
Government to provide clinical care for residents of 
the state who test positive for SARS-CoV-2 virus 
and were symptomatic enough to warrant 
institutional care as well as some asymptomatic 

Supplementary information The online version of 
this article (10.52845/CMI/2022-3-2-2) contains 
supplementary material, which is available to autho-
rized users.

CMI 03 (02), 287−296 MANUSCRIPT CENTRAL 288



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Dr. Bushra Mohsen Abdulla ET al.

patients whose home environments were not 
conducive for the approved self isolation policy of 
the Nigerian Center for Disease Control (NCDC). 
Oyo State has two NCDC-approved laboratories 
that conduct qPCR testing and release results of 
testing within 48 hours as mandated by the Oyo 
State Task Force on COVID-19.  At the time of 
reporting these clinical outcomes, Oyo State, 
Nigeria had conducted 15,733 tests of which 3,119 
were positive for the virus with 1,952 recoveries 
and 37 deaths. None of the deaths was recorded at 
the IDC, Olodo and this may be a pointer to the 
relative effectiveness of management protocol 
being practiced in this center and this may be 
worth reviewing particularly in other resource-
limited settings.

parallel flow was established for the staff as part of 
the Infection Prevention and Control protocols.  
Whilst on admission, patients were commenced on 
a cocktail of medications; oral chloroquine  or 
hydroxychloroquine for three days; oral zinc for 
three weeks; azithromycin for three days; Vitamin 
C for three weeks and Vitamin D was added to the 
protocol in patients with respiratory symptoms 
along with those whose oxygen saturation falls 
below 95% in room air. Chest physiotherapy was 
commenced and antibiotics listed in the 
antibiogram for community pneumonia in Nigeria 
was administered via the intravenous route for a 
minimum of 48 hours (and later changed to oral 
medications) if patients had clinical features of 
chest infection.
Subcutaneous enoxaparin (Clexane) 40 mg daily or 
twice daily and dexamethasone with doses ranging 
from 6mg daily to 10mg depending on the weight 
of the patient were added to the regime of 
medications in patients with lung infiltration on 
plain radiograph or on computerized tomography of 
the chest. All the patients were well hydrated and 
served high protein diet except when 
contraindicated. In addition, the physiotherapist 
carried out breathing exercises, conducted physical 
workout and aerobic exercises for patients twice 
weekly whilst indoor games were provided as the 
needs arose. Twenty two patients requiring 
supplemental oxygen were managed with re-
breather bags and CPAP mask but no patient 
required mechanical ventilation although the center 
currently has two mechanical ventilators and three 
CPAP machines.
Medical staff at the center had pre-exposure 
prophylaxis comprising oral chloroquine for three 
days or hydroxychloroquine for three days; zinc 
tablet for three weeks; azithromycin three days and 
vitamin C tablet for three weeks. The medical staffs 
were also required to work on a one-week-on and 
one-week-off shift duty and were accommodated in 
designated hotels without contact with their 
families during the time that they were on duty and 
two weeks after completing their shifts.

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Methodology

Over a period of 18 weeks, three hundred and ten 
(310) consecutive COVID-19 patients were 
managed as in-patients at the Infectious Disease 
Center, Olodo in Ibadan. On admission, their 
SARS-CoV-2 qPCR Cycle Threshold (CT) values 
were documented based on assays for the N-gene 
and ORFlab genes, baseline laboratory 
investigations were carried out including 
electrolytes and urea, liver function test and blood 
film (thick and thin films) for malaria parasite.  
Co-morbidities were also documented and patients 
with severe respiratory difficulties as defined by 
oxygen saturation (SpO2) of less than 90% were 
managed in the 10-bed Intensive Care Unit (ICU).  
For all other patients, disease severity 
classification was a determinant of CT values, 
clinical signs and symptoms, rather than symptoms 
alone. As the clinical conditions of the ICU 
patients improved, and the CT values increased, 
these patients were weaned from the ICU to a High 
Dependency Unit (HDU) and finally the general 
male and female wards, from where patients were 
discharged. During the study period, the protocol 
for discharge as laid by the NCDC was that the 
patients should have two negative qPCR results. 
This has since changed in line with best global 
practices and international consensus. A unilateral 
flow was maintained for patients and another Results



CMI 03 (02), 287−296 (2022) MANUSCRIPT CENTRAL 290

A total of three hundred and ten (310) patients 
with a median age of 36 years with ages ranging 
from 2 years to 95 years were managed at the 
center over an eighteen-week period. More than 
half of the patients (53.9%) were aged 21 to 40 
years with 1% of the cases aged >80 years. There 
were more males (66.1%) among the patients 
than females (33.9%) (Table 1). The dosage of 
vitamin D (1000 iu), vitamin C (1000 iu), Zn 
(20mg), azithromycin, hydroxychloroquine or 
chloroquine as given to COVID-19 patients and 
medical staff at the center is presented in Table 2.
In Table 3, 60.5% of the patients had symptoms 
especially among the 21-40years age group 
(50.3%). Only 35 (17.9%) patients presented 
with only one symptom whilst 20.5% had three 
symptoms. The five commonest symptoms in 

  descending order were; fever (18.4%), headache 
(18.1%), anosmia (10.9%), agenuia (10.1%) and 
cough (9.1%) in Table 4. One hundred and three 
(103) patients had co-morbidities as follows: only 
hypertension in 69(53.9%), only peptic ulcer 
disease in 23(18.0%) whilst 11(8.6%) had only 
diabetes mellitus.  Combinations of at least two of 
these conditions were present in 25 out of 103 
patients (Table 5). The mean length of stay at the 
isolation center was 10.22  3.48 days whilst the 
mean CT value on admission was 30.42  5.49. 
There was a significant negative association 
between the length of stay and the CT value on 
admission (Table 6). In addition, patients with co-
morbidities stayed on admission longer even if 
they were admitted with lower CT values (Table 
7).

Table 1: Socio-Demographic presentation of COVID-19 patients at IDC, Olodo, Ibadan, Nigeria.

Table 2: Medication Used Among COVID-19 patients and Pre-Exposure Prophylaxis for Un-Infected 
Medical Staff at IDC, Ibadan, Nigeria.



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Dr. Bushra Mohsen Abdulla ET al.

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Table: 3 Relationship between Symptoms and Age of  COVID-19 Patients at the IDC, Olodo, Ibadan, 
Nigeria.

Table 4: Percentages of Symptoms Number and Types Among COVID-19 Patients at the IDC, 
Olodo, Ibadan, Nigeria

Table 5: Frequencies and Percentages of Co-morbidity Types Among COVID-19 Patients at the IDC, 
Olodo, Ibadan, Nigeria.

Table 6: Correlation of Length of stay and CT Value Among COVID-19 Patients in IDC, Olodo, 
Ibadan, Nigeria.



Discussion

Inflammation, renal dysfunction, respiratory burst, 
immune dysregulation and accumulation of immune 
complexes are common in Nigerian COVID-19 
patients (Arinola, 2021; Arinola et al., 2021a-d; 
Arinola et al., 2020; Akinwumi et al., 2021; Arinola 
et al., 2022). The present study shows that 
COVID-19 patients in IDC, Olodo were mostly 
males, mainly between the 21-40years age range, 
spent between 2-21days on admission with few co-
morbid conditions. Also, there was no mortality 
recorded during the eighteen week period spanning 
27th April 2020 and 24th August 2020. These 
corroborates our earlier reports (Arinola et al., 2020) 
which emphasised the impact of age, occupation and 
gender on incidence or case fatality of COVID-19 
and that low mortality of COVID-19 patients in the 
IDC may be related to effective management, non-
fatal nature of SAR-COV-2 among IDC patients or 
mild to severe form of COVID-19 disease when 
admitted (Arinola et al., 2020). 

The treatment options for COVID-19 are largely 
supportive as there is no universally agreed protocol 
of care.  Therapeutics targeting the spike protein 
attachment to human cells and replication of SARS-
CoV-2 has generated a lot of interest and this is the 
mechanism of action of remdesivir either used singly 
or in combination with chloroquine. Monoclonal 
antibodies targeting the spike protein receptor 
binding domain (RBD) are undergoing trials as well 
as other therapeutics (Yang et al., 2020 and Shereen 
et al., 2020). It is important to note that, with the 
exception of the repurposed drugs, most of these 
experimental therapies will be out of reach of 
Nigerian patients even when they receive approval. 
Therefore, careful evaluation of repurposed drugs, 
including chloroquine or hydroxychloroquine and 
vitamins and zinc 

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Table 6: Correlation of Length of stay and CT Value Among COVID-19 Patients in IDC, Olodo, 
Ibadan, Nigeria.

supplementation used at the Oyo State IDC is 
important.  Unfortunately, few clinical trials are 
currently underway in Nigeria and most facilities 
are yet to share observational data such as we 
present in this report. The repurposing of 
chloroquine and hydroxychloroquine for treatment 
of SARS-CoV-2 infection was premised on the 
anti-inflammatory properties of these antimalarial 
which may be beneficial to the patients if there is 
underlying malaria parasitaemia and also to reduce 
pre-empted occurrence of inflammatory cytokine 
storm which is associated with SARS-Cov-2 
infection (Yang et al., 2020).
Various reports in the early phase of the pandemic 
showed that a number of existing drugs could 
inhibit SARS-CoV-2 replication in vitro, including 
chloroquine and hydroxychloroquine (two 
established anti-malarial drugs which share similar 
chemical structures and mechanisms of action), as 
well as azithromycin and ivermectin spawned 
interest in repurposing these drugs at various 
treatment centers including the IDC, Olodo, 
Ibadan.  Whilst initial clinical trial data has not 
revealed a role for these compounds in preventing 
or treating COVID-19, other trials remain in 
progress and very few trials are being conducted 
in Africa where the pandemic’s trajectory is 
markedly different. These medications were not 
used in the context of a trial and the positive 
outcomes in this high-risk disease, encouraged 
their continued use during the 18-week period. 
The fact that the patients tolerated these 
medications without a risk of bacterial and 
malarial super-infection needs further evaluation. 
Meo et al (2020) proposed that chloroquine and 
hydroxychloroquine are beneficial in the 
management of COVID-19 and highlighted 
specific  mechanisms of action, viz: inhibition of 



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Dr. Bushra Mohsen Abdulla ET al.

MANUSCRIPT CENTRAL CMI 03 (02), 287−296 (2022) 293

the receptor binding by the virus, inhibition of 
membrane fusion by the virus and immune 
modulation leading to a decrease in cytokine 
release.   
The use of Vitamin D in the management of 
COVID-19 patients hinged on the autocrine 
function and has been supported by a single center, 
retrospective cohort study which found that persons 
who are deficient in Vitamin D at the time of 
testing were more likely to test positive for 
COVID-19 (Onifade and Arinola, 2020). A recent 
study concluded that vitamin D intoxication is 
common among Nigerian patients with COVID-19 
and the vitamin D intoxication is associated with 
low plasma hsCRP level. There is the need for 
public enlightenment on the dangers inherent in 
vitamin D supplement abuse in Nigerians (Onifade 
et al, 2022).
Immuno-modulatory function of Vitamin C depends 
on its requirement for collagen biosynthesis, 
maintenance of epithelial integrity, chemotaxis and 
phagocytosis (Arinola and Edem, 2020; Sureda et 
al., 2013). Vitamin C has a highly effective 
antioxidant capacity, thus protecting important 
biomolecules from damage by oxidants generated 
during normal cell metabolism (Alvarado et al., 
2006). Zinc affect the number and function of 
immune cells (macrophages, neutrophils, dendritic 
cells, mast cells, T cells and B cells) (Haase and 
Rink, 2007).  Zinc also play essential roles in the 
signaling and inflammatory output of monocytes and 
macrophages, including activation of mitogen-
activated protein kinase and NF-κB (Haase and 
Rink, 2007), reduction of lysosomes integrity 
(Siebenlist et al., 1994), activation of NLRP3 
inflammasome (Brieger et al., 2013), induction of 
IL-1β secretion by macrophages (Summersgill et al., 
2014), reduction of IL-6 and TNF-α in human 
monocytes (Mayer et al., 2014).
Activation of the immune system results in 
increased generation of reactive oxygen species 
which is neutralized by Zn (Arinola and Edem, 
2020b). Immunomodulatory and anti-inflammatory 
functions of vitamin D, vitamin C and Zn makes 
them appropriately supportive in the management 
of COVID-19 patients.

In a resource poor settings lacking access to 
novel therapies and local pharmaceutical 
industries engaged in drug discovery, exhaustive 
evaluation of well-tolerated repurposed drugs is 
probably justified.  This is particularly true in the 
case of chloroquine, hydroxychloroquine and 
azithromycin for which clinical trial data 
suggesting a lack of effectiveness in very 
dissimilar settings and modes of use contrasts 
with our experience of notably good outcomes 
and other lines of evidence pointing to the 
contrary (Yang et al., 2020; Chowdhury et al., 
2020; Boulware et al., 2020).  As many trials that 
could be informative are still in progress, the case 
management team of the Oyo State COVID-19 
Task Force maintained its consensus for 
continued use of these two anti-malarial 
medications for persons with the coronavirus 
infection along with other medications aimed at 
improving the immune systems of the patients, 
pending further review. While there is lack of 
clinical trial or comparator data, the use of a 
cocktail of chloroquine or hydroxychloroquine, 
Zinc, vitamin C and vitamin D along with 
azithromycin, clexane, dexamethasone and the 
appropriate antibiotic choice made in line with 
the antibiotic ladder for community pneumonia 
when required has been associated with full 
recovery of all patients without any mortality 
over an eighteen-week period (Joshua et al., 
2019; Meltzer et al., 2020). 
The consensus is therefore that strong evidence 
will be required to justify altering this affordable 
cocktail of medication during the pandemic in a 
resource poor setting while effective and 
acceptable COVID-19 vaccine is sourced by the 
government of Nigeria.

Conclusion

A treatment protocol based on prevailing 
scientific knowledge designed by the Case 
Management Team of the Oyo State COVID-19 
Task Force was adopted in the management of 
patients with mild and severe diseases at the first 
Oyo State Infectious Disease Center at Olodo, 
Ibadan from April, 2020. 



The outcome of care over the initial 18 weeks is 
impressively strong. In a resource poor setting, 
this protocol of supportive care may be considered 
along with the other preventive measures until 
such time when accessible therapies backed by 
strong evidence are available for treating 
COVID-19 patients. With the availability of 
vaccines in the developed countries, it is hoped 
that sub-Saharan Africa will soon benefit from 
this scheme.
Acknowledgment: The authors wish to 
acknowledge the support of the Oyo State 
COVID-19 Task Force chaired by Engineer Seyi 
Makinde FNSE, the Executive Governor of Oyo 
State. The authors wish to acknowledge Prof 
Iruka Okeke of the Department of Pharmacy, 
University of Ibadan for taking time to review this 
manuscript.
Conflict of Interest: None

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CMI 03 (02), 287−296 MANUSCRIPT CENTRAL 296


	Introduction
	Causes of nutritional disorder in HD
	Inadequate food intake
	Abnormal nutrient metabolism

	Aim and objectives
	Methodology
	Result 
	Assessment of nutritional status of HD. patients
	Prevalence of malnutrition using Subjective Global Assessment
	Body mass index in the study patients
	BMI and SGA score 
	 laboratory investigation 
	Association between nutrient intake and SGA

	Discussion
	Conclusions
	References
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