The doctoral dissertation in the field of General Medicine will be examined at the Faculty of Health Sciences at Kuopio Campus.
What is the topic of your doctoral research? Why is it important to study the topic?
My doctoral research examines how inflammatory rheumatic diseases (IRDs) and broader musculoskeletal disorders influence COVID-19 infection and all-cause mortality among hospitalised patients in Nairobi, Kenya. Using both cross-sectional and two-year prospective data from over 4,300 patients, the study explores whether these chronic inflammatory conditions increase vulnerability to infection and death, and which demographic and clinical factors shape these risks.
The topic is important because almost all global evidence on COVID-19 and rheumatic diseases comes from high-income countries. Sub-Saharan Africa, with its distinct comorbidity patterns, limited specialist care, and different treatment access, has been largely absent from this evidence base. Generating local data is essential for guiding clinical decisions, vaccination priorities, and resource allocation in Kenya and similar settings, and for reducing health inequities rooted in geographically skewed medical knowledge.
What are the key findings or observations of your doctoral research?
My research produced several key findings. First, hospitalised patients with musculoskeletal disorders (MSDs) had more than twice the odds of testing positive for COVID-19 compared to non-MSD patients, with the risk especially high among men and those with infectious-type MSDs. Second, contrary to expectations, inflammatory rheumatic diseases (IRDs) did not increase the risk of acquiring COVID-19 over a 15-month follow-up, even in the presence of obesity, smoking, or/and comorbidities. Third, IRD patients faced a 42% higher risk of two-year all-cause mortality after hospital discharge, with the highest risk among those with coexisting blood disorders. Fourth, younger MSD patients (≤60 years) unexpectedly showed elevated mortality, suggesting accelerated biological aging in resource-constrained settings.
The novelty and value of this work lie in being the first longitudinal study in East Africa examining COVID-19 and IRDs. Global evidence has come almost exclusively from Europe and North America, leaving Sub-Saharan Africa absent from clinical guidelines despite distinct comorbidity patterns and healthcare realities. For clinicians and policymakers, the findings provide locally relevant evidence to guide risk assessment, vaccination priorities, and long-term follow-up. For the scientific community, they challenge the assumption that high-income country findings are universally transferable and underscore the need for context-specific research.
I would like to emphasise that this dissertation is a starting point rather than a conclusion. Several important questions remain open: the long-term effects of COVID-19 in patients with inflammatory rheumatic diseases, the effectiveness of vaccination in immunosuppressed East African patients, and the impact of pandemic-related disruptions on rheumatology care. I hope this work stimulates further research partnerships between Kenyan institutions and international universities, and that it supports the development of simplified, context-appropriate tools for risk assessment and integrated chronic disease management. Ultimately, the goal is to ensure that patients with inflammatory rheumatic diseases in Sub-Saharan Africa receive care informed by evidence generated in and for their own context.
How can the results of your doctoral research be utilised in practice?
The findings can be applied in several practical ways. Clinicians in Kenya and similar settings can use the results to identify higher-risk patients, particularly men with musculoskeletal disorders, younger patients with inflammatory conditions, and those with coexisting illnesses such as blood disorders, and tailor monitoring, follow-up, and preventive care accordingly. Policymakers can use the evidence to prioritise vaccination, resource allocation, and integrated chronic disease management during future infectious disease outbreaks. The study also supports the use of clinical diagnosis where specialist serological testing is unavailable, validating a practical approach for resource-constrained settings. For the wider region, the results provide a reference point for Sub-Saharan African rheumatology research and can inform context-appropriate risk assessment tools, patient education, and healthcare system resilience planning.
What are the key research methods and materials used in your doctoral research?
This research was an observational study conducted at a major public hospital in Nairobi, Kenya. It combined two complementary designs: a cross-sectional analysis of 4,374 hospitalised patients admitted in 2022, and a prospective follow-up of 4,273 of these patients over a period of two years. Data were drawn from paper-based and electronic medical records, supplemented by text messages and phone calls to patients or their families to confirm survival and COVID-19 status. Inflammatory rheumatic disease diagnoses were based on patient history, clinical examination, imaging, and laboratory tests interpreted against international classification criteria, with serological validation in a subsample of 360 patients. Statistical analyses used logistic regression for the cross-sectional component and Cox proportional hazards models for the follow-up, adjusting for demographic, lifestyle, and clinical factors.
Is there something else about your doctoral dissertation you would like to share in the press release?
The doctoral dissertation of Benwillies Onchong'a, MSc, entitled All-cause mortality and COVID-19 among patients with inflammatory rheumatic disease during and after hospitalization in Nairobi, Kenya, will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Anneli Uusküla of the University of Tartu, and the Custos will be Docent Ari Voutilainen of the University of Eastern Finland. The public examination will be held in English.
For further information, please contact:
Benwillies Onchong'a, MSc, https://uefconnect.uef.fi/benwillies.onchonga/
