Mortality In Africa Research Articles

High‐skilled emigration and child health in Africa

Africa is estimated to lose a very significant number of high‐skilled individuals through emigration. This has resulted in a number of studies investigating the effect of high‐skilled emigration on socio‐economic indicators in Africa. Notwithstanding, the majority of these studies have examined the effect of high‐skilled emigration on economic growth, with less attention paid to health outcomes. Meanwhile, health outcomes, especially child health outcomes, have major implications for future human capital and overall economic development. With sub‐Saharan Africa (SSA) having the highest child mortality rate in the world, this study, therefore, investigates the effect of the emigration of high‐skilled individuals on child health in 48 African countries for the period, 1985–2010. Neonatal mortality and infant mortality rates are used to proxy child health. The panel fixed effects and the dynamic panel system Generalised Methods of Moments (GMM) regressions are employed as estimation techniques. Using the panel fixed effects, we find that, while the emigration of high‐skilled individuals is detrimental to neonatal mortality, in the case of infant mortality, it is insignificant. However, after controlling for endogeneity using the dynamic panel system GMM, the emigration of high‐skilled individuals is found to be detrimental to both neonatal mortality and infant mortality. The results suggest that, in order to enhance child mortality in Africa, attention should be paid towards decreasing high‐skilled emigration on the continent.

Simulation Training: An Original Pedagogical Tool to Reduce Maternal and Neonatal Mortality in Africa

Simulation Training: An Original Pedagogical Tool to Reduce Maternal and Neonatal Mortality in Africa

Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

BackgroundMaternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in...

Performance of case definitions and clinical predictors for influenza surveillance among patients followed in a rural cohort in Senegal

BackgroundInfluenza is a major cause of morbidity and mortality in Africa. However, a lack of epidemiological data remains for this pathology, and the performances of the influenza-like illness (ILI) case definitions used for sentinel surveillance have never been evaluated in Senegal. This study aimed to i) assess the performance of three different ILI case definitions, adopted by the WHO, USA-CDC (CDC) and European-CDC (ECDC) and ii) identify clinical factors associated with a positive diagnosis for Influenza in order to develop an algorithm fitted for the Senegalese context.MethodsAll 657 patients with a febrile pathological episode (FPE) between January 2013 and December 2016 were followed in a cohort study in two rural villages in Senegal, accounting for 1653 FPE observations with nasopharyngeal sampling and influenza virus screening by rRT-PCR. For each FPE, general characteristics and clinical signs presented by patients were collected. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for the three ILI case definitions were assessed using PCR result as the reference test. Associations between clinical signs and influenza infection were analyzed using logistic regression with generalized estimating equations. Sore throat, arthralgia or myalgia were missing for children under 5 years.ResultsWHO, CDC and ECDC case definitions had similar sensitivity (81.0%; 95%CI: 77.0–85.0) and NPV (91.0%; 95%CI: 89.0–93.1) while the WHO and CDC ILI case definitions had the highest specificity (52.0%; 95%CI: 49.1–54.5) and PPV (32.0%; 95%CI: 30.0–35.0). These performances varied by age groups. In children < 5 years, the significant predictors of influenza virus infection were cough and nasal discharge. In patients from 5 years, cough, nasal discharge, sore throat and asthenia grade 3 best predicted influenza infection. The addition of “nasal discharge” as a symptom to the WHO case definition decreased sensitivity but increased specificity, particularly in the pediatric population.ConclusionIn summary, all three definitions studies (WHO, ECDC & CDC) have similar performance, even by age group. The revised WHO ILI definition could be chosen for surveillance purposes for its simplicity. Symptomatic predictors of influenza virus infection vary according the age group.

The Determinants of the Low COVID-19 Transmission and Mortality Rates in Africa: A Cross- Country Analysis

Background: More than one year after the beginning of the international spread of COVID- 19, the reasons explaining its apparently lower reported burden in Africa is still to be fully elucidated. Few studies previously investigated the potential reasons explaining this epidemiological observation using data at the level of a few African countries. However, an updated analysis considering the various epidemiological waves and variables across an array of categories, with a focus on African countries might help to better understand the COVID-19 pandemic on the continent. Thus, we investigated the potential reasons for the persistently lower transmission and mortality rates of COVID-19 in Africa. Methods: Data were collected from publicly available and well-known online sources. Cumulative numbers of COVID-19 cases and deaths per one million population reported by African countries up to February 2021 were used to estimate the transmission and mortality rates of COVID-19, respectively. Covariates were collected across several data sources: clinical/diseases data, health system performance, demographic parameters, economic indicators, climatic, pollution and radiation variables, and use of social media. Collinearities were corrected using variance inflation factor (VIF) and selected variables were fitted to a multiple regression model using the R statistical package. Results: Our model (adjusted R-squared: 0.7) found that the number of COVID-19 tests per one million population, GINI index, global health security (GHS) index and mean body mass index (BMI) were significantly associated (P<0.05) with COVID-19 cases per one million population. No association was found with the median life expectancy, proportion of rural population and BCG coverage rate. On the other hand, diabetes prevalence, number of nurses and GHS index were found to be significantly associated with COVID-19 deaths per one million population (adjusted R-squared of 0.5). Moreover, the median life expectancy and lower respiratory infections rate showed a trend towards significance. No association was found with BCG coverage or communicable disease burden. Conclusions: Low health system capacity, together with some clinical and socio-economic factors were predictors of the reported burden of COVID-19 in Africa. Our results emphasise the need for Africa to strengthen its overall health system capacity to efficiently detect and respond to public health crises.

Point of care tests for invasive fungal infections: a blueprint for increasing availability in Africa.

Invasive fungal infections (IFIs) such as cryptococcosis, disseminated histoplasmosis, and chronic pulmonary aspergillosis are significant causes of morbidity and mortality in Africa. Lack of laboratory infrastructure and laboratory personnel trained in diagnostic mycology hamper prompt detection and management of IFIs on the continent. Point-of-care tests (POCT) obviate the need for complex infrastructure, skilled technicians, and stable electricity and have had major impacts on the diagnosis of bacterial, viral, and parasitic infections in low- and middle-income countries. Over the last 10 years, POCTs for IFIs have become increasingly available and they have the potential to revolutionize the management of these infections if scaled up in Africa. At the beginning of 2021, the World Health Organization (WHO) Essential Diagnostic List (EDL) included a cryptococcal antigen test for the diagnosis of cryptococcosis, Histoplasma antigen test for the diagnosis of disseminated histoplasmosis, and Aspergillus-specific test for the diagnosis of chronic pulmonary aspergillosis. All of these are available in formats that may be used as POCTs and it is hoped that this will improve the diagnosis of these life-threatening IFIs, especially in low- and middle-income countries. This perspective review discusses commercially available POCTs and outlines strategies of a blueprint to achieve their roll-out in Africa. The strategies include raising awareness, conducting research that uncovers the exact burden of IFIs, increasing advocacy, integrating diagnosis of IFIs into existing public health programs, adoption of the WHO EDL at country levels, and improving logistics and supply chains.

High Seroprevalence of SARS-CoV-2 Eight Months After Introduction in Nairobi, Kenya

Background: The lower-than-expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. We set out to estimate the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya.Methods: We conducted a population based cross-sectional survey using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for IgM and IgG antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Risk factors were determined using logistic regression and Infection fatality ratios (IFRs) calculated by comparing our estimates to reported cases and deaths.Findings: Of 1,164 individuals from 527 households tested, the adjusted seroprevalence was 34·7% (95%CI 31·8-37·6), indicating that approximately 1·5 million Nairobi residents had been infected. Some 261 (49·5%) households had at least one positive participant, and positivity rates increased in more densely populated areas (spearman’s r=0·63; p=0·009). Individuals aged 20-59 years had up to 2-fold higher seropositivity when compared to those aged 0-9 years or ≥60 years. The IFR was 40 per 100,000 infections, with individuals ≥40 years old having higher IFRs.Interpretation: Over one third of Nairobi residents in half of the households were infected by November 2020, indicating extensive transmission in the city, comparable to countries reporting more severe forms of the pandemic. However, the IFR was >10-fold lower than that reported in Europe and the United States, supporting the perceived low morbidity and mortality in sub–Saharan Africa.Funding Statement: Funding was provided by the US National Institutes of Health (NIH), grant number U01AI151799, through the Centre for Research in Emerging Infectious Diseases – East and Central Africa (CREID-ECA).Declaration of Interests: The authors declare that they have no competing interestsEthics Approval Statement: This study was reviewed and approved by the Kenya Medical Research Institute Scientific and Ethical Review Committee (number SSC 4098), National Commission for Science Technology and Innovation (number 827570), U.S. CDC (number CGH-ET-4/12/21-f3b82), and a reliance approval provided by Washington State University Institutional Review Board based on in-country ethical reviews as provided for in Code of Federal Regulations (45 C.F.R part 46 and 21 C.F.R. part 56). Administrative approval was provided by the Kenya MoH and Nairobi City County administration. All participants provided written consent prior to enrollment.

Atrial fibrillation and obstructive sleep apnea in African populations: uncovering a neglected association.

Atrial fibrillation (AF), the most common sustained arrhythmia, is one of the risk factors with the largest relative increase in attributed cardiovascular mortality in Africa. There are important knowledge gaps in the epidemiology of AF in Africa, along with inadequate service provision for cardiac arrhythmias including AF. This paper comments on the available data on the prevalence and correlates of obstructive sleep apnea (OSA) in patients with AF in Africa. Two studies from Tunisia revealed a high prevalence of OSA based on polysomnography (77% and 90%) among patients with AF. Patients with OSA were more likely to report snoring, were older and had longer AF duration compared to those without OSA. The implications of these findings are discussed. Furthermore, key points on the mechanisms underlying the association between AF and OSA, the impact of OSA on AF-related outcomes and the screening and management of OSA in patients with AF are highlighted.

Modeling the dynamics of tuberculosis with drug resistance in North Shoa Zone, Oromiya Regional State, Ethiopia

Tuberculosis (TB) is a major public health concern in many developing countries. Mycobacterium tuberculosis is a major cause of morbidity and mortality in Africa. Tuberculosis infection is curable but in the cases of incomplete treatment, the remains of Mycobacterium tuberculosis in the human body usually results in the bacterium developing resistant to antibiotics. In this study we developed a model that explains the dynamics of tuberculosis infection in the presence of drug resistance. The basic reproduction number of the model was computed using the next generation matrix approach. The disease free equilibrium and endemic equilibrium were obtained and their stability analysis were carried out. It revealed that they were locally and globally asymptotically stable whenever the reproductive number was less than unity. Numerical simulation of the TB model was conducted and the result revealed that contact rate can reduce or eliminate the sensitive strain and reduce drug resistant of tuberculosis.

Coronavirus Disease 2019: The Emergence of Popular Unverified Myths and Realities to Its Spread

In December &nbsp;2019 &nbsp;there &nbsp;was a plague of a novel &nbsp;human &nbsp;coronavirus &nbsp;disease &nbsp;called &nbsp;coronavirus &nbsp;disease &nbsp;2019 &nbsp;and abbreviated as COVID-19. It's caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The disease is being described &nbsp;as a world pandemic &nbsp;following its spread across over 199 nations and territories in several regions of the globe. The disease &nbsp;is characterized &nbsp;by respiratory &nbsp;distress &nbsp;and fever, &nbsp;with &nbsp;the likelihood &nbsp;of being&nbsp; &nbsp;transmitted &nbsp;via contact &nbsp;with &nbsp;droplets emanating &nbsp;from the cough and sneezing of an infected patient which readily contaminates &nbsp;animate and inanimate &nbsp;surfaces &nbsp;with a period of 2-14 days. On contact, approximately &nbsp;80%, 5% and 14% of infected persons display mild symptoms, critical condition and develop severe conditions respectively, while the opposite 1 % are asymptomatic. &nbsp;Based on online data available as at March 30th&nbsp;&nbsp;&nbsp; &nbsp;2020,&nbsp; &nbsp;15:49&nbsp; &nbsp;GMT,&nbsp; &nbsp;over&nbsp; &nbsp;746,&nbsp; &nbsp;066&nbsp; &nbsp;confirmed&nbsp; &nbsp;cases,&nbsp; &nbsp;35,347&nbsp; &nbsp;fatalities&nbsp; &nbsp;and&nbsp; &nbsp;157,078&nbsp; &nbsp;recovered&nbsp; &nbsp;cases have&nbsp; &nbsp;been ascertained. According &nbsp;to current global trends at the time of this study, the mortality in Africa, Asia, Australia/Oceania, &nbsp;South America, North America and Europe were 3.10%, 4.07%, 0.39%, 6.31%, 1.79% and 2.29% respectively.&nbsp;&nbsp; &nbsp;The continuous spread of the virus has also given way to the popularization &nbsp;of numerous&nbsp; misconceptions &nbsp;or myths hovering through the news and social media &nbsp;channels. &nbsp;Hence, &nbsp;this paper&nbsp; clarifies information &nbsp;about &nbsp;the virus&nbsp; with respect &nbsp;to various &nbsp;terms (its spread, &nbsp;intermediate host, creation/source, &nbsp;conditions for survival, treatment drugs/vaccines, persistence on inanimate surfaces, among others) and the need for research to be carried out on the myths surrounding the virus.

Intimate partner violence, contextual factors and under-5 mortality: a multilevel analysis of cross-sectional surveys from 20 Sub-Saharan African countries

BackgroundUnder-5 mortality remains a public health concern in low-income and middle-income countries. Africa contributes about one-fifth of the burden of global under-5 mortality; intimate partner violence (IPV) and polygyny, which...

The spectrum of splenic complications in patients with sickle cell disease in Africa: a systematic review.

The majority of the global population of sickle cell disease (SCD) patients resides in Africa. Individuals with this condition are at great risk of serious infections and early mortality secondary to splenic dysfunction without preventative measures. This review investigated the spectrum of splenic complications encountered in SCD among populations in Africa. We systematically searched several databases for all articles published through March 3, 2020. We included 55 studies from 14 African countries. This review reveals the difference in frequency of splenic complications in SCD in Africa when compared with their counterparts in the United State and Europe. While several studies (n=45) described splenomegaly with a prevalence of 12% to 73% among children, and 4% to 50% among adults with HbSS, the reported prevalence for acute splenic sequestration crisis (n=6 studies) and hypersplenism (n=4 studies) was <10% and <5% respectively. A total of 30 surgical splenectomy was reported across eight studies. Only two (3.7%) studies provided data on spleen function. A conflicting pattern was observed amongst studies that evaluated the relationship between splenomegaly and the presence of bacterial and malaria infections. This review reveals the paucity of studies describing the role of SCD-induced splenic dysfunction in morbidity and infection related mortality in Africa.

Factors associated with COVID-19 infections and mortality in Africa: a cross-sectional study using publicly available data

IntroductionThe current COVID-19 pandemic is a global threat. This elicits questions on the level of preparedness and capacity of health systems to respond to emergencies relative to other parts of...

The President's Emergency Plan for AIDS Relief and adult mortality: A replication study of HIV development assistance effects in Sub-Saharan African countries.

The US budget for global health funding, which was by far the largest of similar funding in the world, increased from US $1.3 billion in 2001 to more than US $10 billion in recent years. More than 54% of this funding was allocated to the Global Fund to Fight HIV/AIDS through the US President’s Emergency Plan for AIDS Relief (PEPFAR) in Africa. However, recent studies indicate contradictory results regarding the effectiveness of PEPFAR. One by Bendavid, Holmes, Bhattacharya, and Miller shows positive effects of PEPFAR in reducing adult mortality in Africa, while another by Duber, Coates, Szekeras, Kaji, and Lewis finds that there are no significant differences in reducing adult mortality in countries that received PEPFAR funding vs countries that did not. Due to their potential impact on policy decisions regarding critical global health funding, we wanted to assess why the results are discrepant. To do this, we replicated the Bendavid study. The replication provides verification that the study replicable and that the analytic choices of the authors are robust to different assumptions or restrictions. This allows us to assess the different choices and data available to the two research groups and draw some conclusions about why the results may be different. Then, focusing on two of the prominently discrepant studies, i.e., the Bendavid study (1998–2008) and the Duber study (2000–2006), we establish why the two studies are in disagreement. We apply appropriate individual-level and country-level analytical methodology as used by Bendavid over the analytical time period used for the Duber study (2000–2006), which originally focused on nationally aggregated data and differed in some key focus countries. For our first objective, we replicated the original Bendavid study findings and our findings support their conclusion that between 1998–2008 all-cause mortality decreased significantly more (OR = 0.84, CI, 0.72–0.99) in countries that implemented PEPFAR. For our second objective (Bendavid’s data and methodology applied to Duber’s study period), we found reduction in all cause adult mortality to be borderline insignificant (OR = 0.87 CI, 0.75–1.01, p = 0.06), most possibly reflecting the abbreviated fewer number of events and sample size over a shorter period. Therefore, our overall analyses are consistent with the conclusion of positive impact of the PEPFAR program in reducing adult mortality. We believe that the discrepancy observed in the original studies mainly a reflection of shortcomings in the analytical approach necessitated by the Duber study’s nationally aggregated dataset or “may reflect a lack of data quality” in the Duber study (Duber, et al. 2010).

Geospatial analysis: a new frontier in humanitarian health research?

Geospatial analysis: a new frontier in humanitarian health research?

Assessment of Immunostimulating effect of Carica papaya-based Immunostimulatory Complexes Against Streptococcus pneumoniae Infections

Objectives: Streptococcus pneumoniae infection is a bacterial infection responsible for one-fifth of child mortality in Africa. The aim of this study was to formulate and evaluate Carica papaya-based Immunostimulatory complexes against Streptococcus pneumoniae infections. Methods: Leaves of the plant were harvested, air-dried, pulverized and the saponin content extracted using distilled water and but anole in a Soxhlet’s apparatus. The formulation of Immunostimulatory complexes was prepared using the ethanol injection method. Acute toxicity test and Immunological assays, namely: neutrophil adhesion, carbon clearance, hem agglutinating antibody titer were conducted using healthy laboratory mice. The results were compared to standard drug (levamisole). Results: The aqueous extract and butanol fraction yielded 7.45% and 0.38% saponin. At 5000mg/ kg body weight of administered immunostimulatory complexes, no death or behavioral changes were recorded. Neutrophil adhesion showed no significant increase (20.82±4.34) as against the levamisole (20.74±3.31). The increased phagocytic index (0.089± 0.017) showed better stimulation of reticuloendothelial system when compared to both controls (distilled water = 0.032 ± 0.001; levamisole = 0.071 ± 0.001).The lower Hemagglutination antibody titre value indicates the potency of the formulated ISCOM to elicit an immune response. The ISCOM dose (250 mg/kg body weight) significantly elevated hemagglutination antibody titre (7.81±1.60). Conclusion: It can be inferred from this study that Carica papaya leaves has immunomodulatory capacity and has significant saponin yield which could potentially serve as a component of Immunostimulatory complexes formulation. Carica papaya-based Immunostimulatory complexes exhibit improved immunogenicity against Streptococcus pneumoniae infections.

Optimal management of esophageal cancer in Africa: A systemic review of treatment strategies.

Esophageal cancer (EC) is a leading cause of cancer morbidity and mortality in Africa. Despite the high burden of disease, optimal management strategies for EC in resource-constrained settings have yet to be established. This systematic review evaluates the literature on treatments for EC throughout Africa and compares the efficacy and safety of varying treatment strategies in this context (PROSPERO CRD42017071546). PubMed, Embase and African Index Medicus were searched for studies published on treatment strategies for EC in Africa from 1980 to 2020. Searches were supplemented by examining bibliographies of included studies and relevant conference proceedings. Methodological quality/risk of bias was assessed using the Cochrane Risk-of-Bias tool and the Newcastle-Ottawa Scale. Forty-six studies were included. Case series constituted the majority of studies: 13 were case series reporting on outcomes of esophagectomies, 17 on palliative luminal or surgical interventions, four on radiotherapy and three on concurrent chemoradiation. Nine randomized controlled trials were identified, of which four prospectively compared different treatment modalities (one investigating radiotherapy vs chemoradiation, three evaluating rigid plastic stents vs other treatments). This review summarizes the research on EC treatments in Africa published over the last four decades and outlines critical gaps in knowledge related to management in this context. Areas in need of further research include (a) evaluation of the safety and efficacy of neoadjuvant therapy in patients with locally advanced disease; (b) strategies to improve long-term survival in patients treated with definitive chemoradiation; and (c) the comparative effectiveness of modern palliative interventions, focusing on quality of life and survival as outcome measures.

Advancing pediatric lung health in Africa: COVID-19 and beyond

Respiratory illnesses in children are an important cause of morbidity and mortality in Africa where poverty, food insecurity, malnutrition, and human immunodeficiency virus infection are aggravating factors in many countries. These factors, in addition to under resourced health-care infrastructure, remain important barriers to improving child lung health outcomes in Africa. However, despite these challenges, there have been significant recent advancements in understanding the epidemiology, causes, measurement tools, and treatment of childhood respiratory illnesses. In this review, we highlight some advances in childhood pneumonia, tuberculosis, asthma, and other important non-communicable lung diseases common in children. Furthermore, we discuss the role of environmental influences on children’s lung health in Africa and highlight novel methods of measuring lung function in children. Although children contribute a small role in the global epidemiology of COVID-19 pandemic, socioeconomic and health-care delivery disruptions caused by government responses to contain the pandemic have resulted in significant indirect setbacks to child health. We further highlight how the COVID-19 pandemic has impacted areas of pediatric lung health and discuss ways to mitigate effects of COVID-19 in Africa.

Incidence of neonatal mortality and its predictors among live births in Ethiopia: Gompertz gamma shared frailty model

BackgroundNeonatal mortality remains a serious public health concern in developing countries including Ethiopia. Ethiopia is one of the countries with the highest neonatal mortality in Africa. However, there is limited evidence on the incidence and predictors of neonatal mortality at the national level. Therefore, this study aimed to investigate the incidence of neonatal mortality and its predictors among live births in Ethiopia. Investigating the incidence and predictors of neonatal mortality is essential to design targeted public health interventions to reduce neonatal mortality.MethodsA secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 live births was included in the analysis. The shared frailty model was applied since the EDHS data has hierarchical nature, and neonates are nested within-cluster, and this could violate the independent and equal variance assumption. For checking the proportional hazard assumption, Schoenfeld residual test was applied. Akakie Information Criteria (AIC), Cox-Snell residual test, and deviance were used for checking model adequacy and for model comparison. Gompertz gamma shared frailty model was the best-fitted model for this data since it had the lowest deviance, AIC value, and the Cox-Snell residual graph closet to the bisector. Variables with a p-value of less than 0.2 were considered for the multivariable Gompertz gamma shared frailty model. In the multivariable Gompertez gamma shared frailty model, the Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was reported to identify significant predictors of neonatal mortality.ResultsOverall, the neonatal mortality rate in Ethiopia was 29.1 (95% CI: 26.1, 32.4) per 1000 live births. In the multivariable Gompertz gamma shared frailty model; male sex (AHR = 1.92, 95% CI: 1.52, 2.43), twin birth (AHR = 5.22, 95% CI: 3.62, 7.53), preceding birth interval less than 18 months (AHR = 2.07, 95% CI: 1.51, 2.85), small size at birth (AHR = 1.64, 95% CI: 1.24, 2.16), large size at birth (AHR = 1.53, 95% CI: 1.16, 2.01) and did not have Antenatal Care (ANC) visit (AHR = 2.10, 95% CI: 1.44, 3.06) were the significant predictors of neonatal mortality.ConclusionOur study found that neonatal mortality remains a public health problem in Ethiopia. Shorter birth interval, small and large size at birth, ANC visits, male sex, and twin births were significant predictors of neonatal mortality. These results suggest that public health programs that increase antenatal care service utilization should be designed to reduce neonatal mortality and special attention should be given for twin births, large and low birth weight babies. Besides, providing family planning services for mothers to increase birth intervals and improving accessibility and utilization of maternal health care services such as ANC is crucial to improve neonatal survival.

Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis

SummaryBackgroundSubstantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control.MethodsUsing an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents.FindingsWe estimated 215·2 (95% uncertainty interval 143·7–311·6) million cases and 386·4 (307·8–497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths: 224·1 (148·7–326·8) million cases and 487·9 (385·3–634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7–342·5) million cases and 597·4 (468·0–784·4) thousand deaths with a 50% reduction; and 242·3 (158·7–358·8) million cases and 715·2 (556·4–947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%–75% also increased malaria burden to a total of 230·5 (151·6–343·3) million cases and 411·7 (322·8–545·5) thousand deaths with a 25% reduction; 232·8 (152·3–345·9) million cases and 415·5 (324·3–549·4) thousand deaths with a 50% reduction; and 234·0 (152·9–348·4) million cases and 417·6 (325·5–553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5–358·2) million cases and 520·9 (404·1–691·9) thousand deaths with a 25% reduction; 251·0 (162·2–377·0) million cases and 640·2 (492·0–856·7) thousand deaths with a 50% reduction; and 261·6 (167·7–396·8) million cases and 768·6 (586·1–1038·7) thousand deaths with a 75% reduction.InterpretationUnder pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19.FundingBill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.