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Children in sub-Saharan Africa dying of Covid-19 at a higher rate than elsewhere
Author: FMHS Marketing & Communications / FGGW Bemarking & Kommunikasie
Published: 20/01/2022

Children in sub-Saharan Africa who are hospitalised with Covid-19 are dying at a rate far greater than children in the United States (US) and Europe, according to a new multicentre study published yesterday (Wednesday 19 January 2022) in JAMA Pediatrics. The study was led by an infectious diseases epidemiologist, Prof Jean B. Nachega, who is associated with the University of Pittsburgh in the United States, as well as Stellenbosch University (SU) in South Africa.

Among African children admitted to 25 hospitals with Covid-19 between March and December 2020, infants younger than 1 year had nearly five times the risk of death than adolescents aged 15 to 19 years. Children of all ages with comorbidities, including high blood pressure, chronic lung diseases, haematological disorders, and cancer, were also at higher risk of dying.

“Although our study looked at data from earlier in the pandemic, the situation hasn't changed much for the children of Africa – if anything, it is expected to be worsening with the global emergence of the highly contagious Omicron variant," said Nachega (MD, PhD, MPH), who is an associate professor of infectious diseases and microbiology and epidemiology at Pitt's Graduate School of Public Health and extraordinary professor at SU's Faculty of Medicine and Health Sciences (FMHS). “Vaccines are not yet widely available, and paediatric intensive care is not easily accessible."

The study examined outcomes in 469 children who ranged in age from 3 months to 19 years and were hospitalised in one of six countries: the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa and Uganda. A quarter of the children had pre-existing conditions. Eighteen had confirmed or suspected multisystem inflammatory syndrome, a serious complication of Covid-19 where different parts of the body become inflamed.

The study, which included investigators across all six of the African countries that provided data, found that 34.6% of hospitalised children were admitted to an intensive care unit (ICU) or required supplemental oxygen, and 21.2% of those admitted to the ICU required invasive mechanical ventilation. During the time frame studied, 39 – over 8% – of the children died. This compares with rates between 1% and 5% that have been reported in high-income countries

“The high morbidity and mortality associated with hospitalised children with Covid-19 in our study challenge the existing understanding of Covid-19 as a mild disease in this population," said Nachega, who is also the Research Committee Chair of the African Forum for Research and Education in Health (AFREhealth). “But if a child has a comorbidity, is very young and is in a place where there are limited or no specialised doctors, facilities, or equipment for paediatric intensive care, then that child faces a very real possibility of dying."

Professor Mariana Kruger, executive head of the FMHS' Department of Paediatrics and Child Health said that it is concerning that children with comorbidities have prolonged hospital stays and poorer outcomes. “As we have so many children with comorbidities in South Africa, especially chronic lung disease, it is important to prioritise these children for early detection of Covid-19 and prevention with vaccines if available for the age group," said Kruger, who is also the clinical unit head of Paediatric Oncology at Tygerberg Hospital in Cape Town, South Africa, and a co-author of the study.

Nachega continued: “Our findings call for an urgent scale-up of Covid-19 vaccination and therapeutic interventions among at-risk eligible children and adolescents in Africa. They also raise further the acute need for capacity-building and support for paediatric intensive care in these settings."

Nachega noted recent progress on increasing the Covid-19 vaccine supply in Africa, but emphasised that those vaccines are not yet widely available and only about 5% of the continent's population have  been fully vaccinated.

“Covid-19 vaccine hesitancy is a global issue, and Africa is no exception," he said. “It is imperative that evidence-based public health campaigns address concerns in accessible, trustworthy ways so that there is high vaccine uptake as soon as it is available."


Photo caption: Prof Jean B. Nachega