Determinant factors of mortality among patients diagnosed with relapsing fever in a resource-limited setting in Ethiopia

OBJECTIVES: Relapsing fever (RF) remains a major public health concern in Ethiopia, causing severe illness and high mortality despite global declines since the 1940s. Mortality may reach 70% without treatment, yet research on outcomes and risk factors is limited in resource-limited settings. This study, conducted at Yekatit-12 Hospital Medical College, aimed to evaluate the clinical features, complications, and determinants of death among patients with RF, addressing a critical knowledge gap in Ethiopia. METHODS: A retrospective cross-sectional study was conducted among patients aged 14 years and older with blood film-confirmed relapsing fever between September 2021 and February 2023. A structured data collection tool was used to extract clinical, demographic, and laboratory information. Patient characteristics were described using descriptive statistics, while multivariable logistic regression was used to determine the independent predictors of mortality, and results were presented as adjusted odds ratios (AOR) with 95% confidence intervals. RESULTS: A total of 119 male patients were included, with a mean age of 24.1 years. Most were daily laborers (42.0%) or homeless (39.5%). The leading symptoms were fever (85.5%), chills (67.2%), respiratory distress (54.6%), and altered mental status (46.2%). Complications were observed in 88.2% of cases, most commonly anemia (74.7%), acute respiratory distress syndrome (69.7%), shock (60.5%), and Jarisch-Herxheimer reaction (36.1%). Mortality was 45.4% (n = 54), primarily from multi-organ failure (64.8%) and respiratory failure (25.9%). Independent predictors of death were symptom duration >5 days before admission (AOR = 3.1; 95% CI: 1.24-7.9), Jarisch-Herxheimer reaction (AOR = 2.8; 95% CI: 1.09-7.64), multi-organ failure (AOR = 3.8; 95% CI: 1.23-11.6), and requirement for mechanical ventilation (AOR = 2.7; 95% CI: 1.05-7.1). CONCLUSION: In Ethiopia, relapsing fever affects young, socioeconomically disadvantaged men, with high complication and mortality rates. Delayed treatment, Jarisch-Herxheimer reaction, multi-organ failure, and requiring mechanical ventilation during admission were predictors of mortality in mens, highlighting the importance of early diagnosis, antibiotics, and critical care.