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Main modulators of COVID-19 epidemic in sub-Saharan Africa
Boris-Enock Zinsou1, Diane Letourneur2, Joël Siko1
1Clinical Research Institute of Benin (IRCB), Atlantique, 04 BP: 1114 Abomey Calavi, Benin.
Insights
Sub-Saharan Africa (SSA) experienced lower COVID-19 mortality, with higher rates linked to economic status, not age. This contrasts with typical infectious disease patterns, suggesting unique factors at play in SSA.
Area of Science:
- Epidemiology
- Global Health
- Infectious Disease Dynamics
Background:
- The COVID-19 pandemic has caused significant global mortality, yet Sub-Saharan Africa (SSA) appears relatively protected.
- The underlying reasons for this observed lower impact in SSA remain largely unexplained.
Purpose of the Study:
- To investigate the correlations between COVID-19 data and various demographic, socioeconomic, climatic, diagnostic, and comorbidity factors across 47 SSA countries.
- To understand the unique epidemiological profile of COVID-19 in the SSA region.
Main Methods:
- Analysis of COVID-19 case and death data from February 2020 to May 2021.
- Utilized data from WHO, Our World in Data, and the World Bank for 47 Sub-Saharan African countries.
- Examined correlations with demographic, socioeconomic, health system, and comorbidity variables.
Main Results:
- As of May 2021, SSA accounted for 2% of global COVID-19 cases and 2.9% of deaths.
- COVID-19 mortality showed positive correlations with obesity, diabetes, cancer, cardiovascular disease, tourism, health expenditure, HDI, schooling, and testing rates.
- Mortality was negatively correlated with the population under 15 and the malaria index.
Conclusions:
- Higher economic status in SSA was associated with increased COVID-19 mortality, positioning it as a disease of wealthier societies.
- This finding contrasts with historical patterns of infectious diseases disproportionately affecting lower-income populations.
- Further research is essential to confirm these correlational findings and elucidate causal relationships.
Background:
The coronavirus disease 2019 (COVID-19) pandemic is responsible for an important global death toll from which sub-Saharan Africa (SSA) seems mostly protected. The reasons explaining this situation are still poorly understood.
Methods:
We analyzed the correlation between reported COVID-19 data between February 14, 2020 and May 18, 2021, and demographic, socioeconomic, climatic, diagnostic data, and comorbidities in 47 SSA countries. Different databases including the WHO data center, Our World in Data, and the World Bank were used.
Findings:
As of May 17, 2021, SSA reported 2% of COVID-19 cases and 2.9% of deaths, with the southern region being the most affected with 56.4% of cases and 75.0% of deaths. COVID-19 mortality was positively correlated with medical variables (national obesity rate, diabetes prevalence, cancer incidence, and cardiovascular disease mortality rate), socioeconomic characteristics (international tourism, per capita health expenditure, human development index, HDI, and years of schooling), and health system variables (nurse density, number of COVID-19 tests per capita), but negatively correlated with the population under 15 years of age and the malaria index.
Interpretation:
Our study suggests that higher economic status fits with high COVID-19 mortality in SSA. In this regard, it represents primarily a disease of modern and wealthy societies, and can therefore be considered as an exception among infectious diseases that historically affected more severely underserved populations living in low- and middle-income countries. However, it should be made clear that observed correlations do not imply inevitably causation and that additional studies are necessary to confirm our observations.
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