Infants younger than a year in Africa have nearly five times (4,89) the risk of dying from COVID than adolescents aged 15 to 19, suggests a recent study published in the Journal of the American Medical Association (JAMA Network).
The study also found that children in sub-Saharan Africa who are admitted to hospital with COVID-19 are dying at a rate far greater than those in the United States and Europe, highlighting the critical need to fast-track COVID-19 vaccinations and therapeutic interventions in Africa.
During the period under review – March to December 2020 – more than 8% of the children died. In comparison, high-income countries had mortality rates of between 1% and 5%, the Mail & Guardian reports.
Children of all ages with comorbidities, including high blood pressure, chronic lung diseases, haematological disorders and cancer, were also at higher risk of dying. The study, conducted in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa and Uganda, examined the outcome of COVID-19 in 469 children aged between three months and 19 years old in hospitals.
“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,” found the study.
Professor Jean Nachega, an infectious diseases epidemiologist from the Center for Global Health, University of Pittsburgh, and the study leader, said although it looked at data from earlier in the pandemic, the situation hadnʼt 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 … Vaccines are not yet widely available, and paediatric intensive care is not easily accessible.”
Most African countries did not reach the World Health Organizationʼs target of vaccinating 40% of their populations against COVID-19 by the end of December. At the beginning of 2022, only about 9% of eligible people on the continent were fully vaccinated.
Nachega questioned the understanding of COVID-19 as “a mild disease” when faced with a high morbidity and death rate associated with hospitalised children who had the virus.
Worsening infections occur when 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”, Nachega noted.
The study, which involved collaboration from various institutions, including Stellebosch University, Johns Hopkins School of Public Health and the Institute of Human Virology Nigeria, among others, concludes that COVID-19 vaccinations and therapeutic interventions are vital for young populations in regions such as sub-Saharan Africa where the morbidity and mortality rates are high.
Africa hopes to become self-reliant on vaccines after the launch of a state-of-the-art manufacturing campus last Wednesday (19 January), a first for the continent.
“Africa stands ready to enter a new age of medical science,” President Cyril Ramaphosa said at the official launch of NantSAʼs manufacturing campus at Brackengate, Cape Town. NantSA is a division of US-based multinational conglomerate NantWorks.
The event also saw the launch of the Africaʼs Access to Advanced Healthcare Coalition. NantSA and the coalition want to accelerate the production of pharmaceuticals, biologics and vaccines on the continent.
Study details
Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries
Jean B. Nachega, Nadia A. Sam-Agudu, Rhoderick N. Machek et al
Published in JAMA Network on 19 January 2022
Key Points
Question What are the clinical outcomes and associated factors among children and adolescents hospitalised with COVID-19 in sub-Saharan Africa?
Findings In this cohort study of 469 children and adolescents hospitalised with COVID-19 in 6 sub-Saharan African countries, morbidity and mortality were substantially higher than reported among those in non-African settings and were independently associated with age younger than 1 year and select noncommunicable disease comorbidities.
Meaning This study’s findings may have implications for clinical practice and health policy regarding paediatric COVID-19 in African countries; given their high risk of adverse outcomes, COVID-19 vaccination and therapeutic interventions are needed for African children and adolescents.
Abstract
Importance Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.
Objective
To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalised with COVID-19 in 6 countries in sub-Saharan Africa.
Design, Setting, and Participants
This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalised patients aged 0 to 19 years with SARS-CoV-2 infection.
Main Outcomes and Measures
An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalisation without oxygen supplementation, (2) hospitalisation with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
Results
Among 469 hospitalised children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalised. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a haematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
Conclusions and Relevance
In this cohort study of children and adolescents hospitalised with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
See more from MedicalBrief archives:
COVID-19 in children: The South African experience and way forward
Scaling up COVID-19 vaccination in Africa: lessons from the HIV pandemic
Pandemic confounded expectations of preparedness and resilience in Africa