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Open Access

The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

Janica Adams, Mary J. MacKenzie, Adeladza Kofi Amegah, Alex Ezeh, Muktar A. Gadanya, Akinyinka Omigbodun, Ahmed M. Sarki, Paul Thistle, Abdhalah K. Ziraba, Saverio Stranges and Michael Silverman
Global Health: Science and Practice September 2021, 9(3):433-443; https://doi.org/10.9745/GHSP-D-21-00172
Janica Adams
aDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Mary J. MacKenzie
bDepartment of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Adeladza Kofi Amegah
cPublic Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
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Alex Ezeh
dDornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
eSchool of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
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Muktar A. Gadanya
fBayero University, Kano, Kano State, Nigeria.
gAminu Kano Teaching Hospital, Kano, Kano State, Nigeria.
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Akinyinka Omigbodun
hUniversity of Ibadan, Ibadan, Nigeria.
iCollege of Medicine, University of Ibadan, Ibadan, Nigeria.
jPan African University Life & Earth Sciences Institute (PAULESI), Ibadan, Nigeria.
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Ahmed M. Sarki
kSchool of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.
lFamily and Youth Health Initiative (FAYOHI), Jigawa State, Nigeria.
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Paul Thistle
mKaranda Hospital, Mount Darwin, Zimbabwe.
nThe University of Zimbabwe, Harare, Zimbabwe.
oUniversity of Toronto, Toronto, Canada.
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Abdhalah K. Ziraba
pAfrican Population and Health Research Center, Nairobi, Kenya.
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Saverio Stranges
aDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
bDepartment of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
qDepartment of Family Medicine, Western University, London, Ontario, Canada.
rThe Africa Institute, Western University, London, Ontario, Canada.
sDepartment of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
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Michael Silverman
aDepartment of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
bDepartment of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
rThe Africa Institute, Western University, London, Ontario, Canada.
tDivision of Infectious Diseases, Western University, London, Ontario, Canada.
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  • For correspondence: michael.silverman@sjhc.london.on.ca
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Key Messages

  • Evidence suggests the demographic age structure of sub-Saharan Africa is the leading factor of the low morbidity and mortality of COVID-19 compared to other regions of the world.

  • Widespread social mitigation strategies, such as lockdowns, have resulted in severe economic and societal consequences in terms of food security, adolescent pregnancy, gender-based violence, and disruptions in treating other diseases.

  • It is imperative to weigh the risks and benefits of social mitigation strategies for future waves.

BACKGROUND

COVID-19 has impacted the world immensely since its discovery in the city of Wuhan, China, in December 2019.1,2 As of June 27, 2021, approximately 181.9 million COVID-19 cases have been confirmed with more than 3.9 million deaths.3 COVID-19 has dramatically impacted the Americas, Europe, and Asia. As of June 27, 2021, in the Americas, 73.1 million confirmed COVID-19 cases with 1.9 million deaths have been reported, 47.8 million confirmed cases with more than 1 million deaths in Europe, and 55.4 million confirmed cases with 784,965 deaths in Asia.4

The impact of COVID-19 in Africa has been substantially lower compared to countries in the Americas, Europe, and Asia. The World Health Organization (WHO) African Region reported more than 3.9 million confirmed cases and 94,217 deaths, as of June 27, 2021.5 Moreover, the mortality rate of COVID-19 per million in Africa is considerably lower than in all other WHO regions other than the Western Pacific (Table 1).5–11 Public health preparedness is a significant aspect in the success of reducing COVID-19 transmission. Lessons learned from countries across Eastern Asia imply the need for community-oriented strategies and rapid response from public health officials to successfully contain the COVID-19 pandemic.12 Strategies such as early case identification, widespread laboratory testing and screening, outbreak mitigation (up to and including lockdowns), contact tracing, …

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In this issue

Global Health: Science and Practice: 9 (3)
Global Health: Science and Practice
Vol. 9, No. 3
September 30, 2021
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The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?
Janica Adams, Mary J. MacKenzie, Adeladza Kofi Amegah, Alex Ezeh, Muktar A. Gadanya, Akinyinka Omigbodun, Ahmed M. Sarki, Paul Thistle, Abdhalah K. Ziraba, Saverio Stranges, Michael Silverman
Global Health: Science and Practice Sep 2021, 9 (3) 433-443; DOI: 10.9745/GHSP-D-21-00172

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The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?
Janica Adams, Mary J. MacKenzie, Adeladza Kofi Amegah, Alex Ezeh, Muktar A. Gadanya, Akinyinka Omigbodun, Ahmed M. Sarki, Paul Thistle, Abdhalah K. Ziraba, Saverio Stranges, Michael Silverman
Global Health: Science and Practice Sep 2021, 9 (3) 433-443; DOI: 10.9745/GHSP-D-21-00172
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  • Article
    • BACKGROUND
    • POTENTIAL MITIGATING FACTORS INFLUENCING THE MORBIDITY AND MORTALITY OF COVID-19 IN SUB-SAHARAN AFRICA
    • SOUTH AFRICA AS AN OUTLIER
    • IMPLICATIONS FOR POLICIES AND PROGRAMS
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