Sub-Saharan African children dying of Covid-19 at a higher rate

An international multi-centre study has found that children in sub-Saharan Africa who are hospitalised with Covid-19 are dying at a rate far greater than children in the United States and Europe.

The study, which was recently published in JAMA Pediatrics, was conducted in 25 hospital sites in South Africa, the Democratic Republic of Congo, Ghana, Kenya, Nigeria and Uganda between March and December 2020.

The study examined outcomes in 469 children who ranged in age from 3 months to 19 years, with the average age being 5.9 years.

One quarter of the children had pre-existing conditions. Eighteen had confirmed or suspected multi-system inflammatory syndrome, a serious complication of Covid-19 where different parts of the body become inflamed.

University of KwaZulu-Natal’s (UKZN) Discipline of Paediatrics and Child Health Head Professor Refiloe Masekela led the study at the UKZN site. 

Study findings

Of the African children who were admitted at 25 hospitals between March and December 2020 with the virus, infants below the age of one had nearly five times the risk of death than adolescents aged 15 to 19 years.

“Our study also found that children of all ages with co-morbidities, including high blood pressure, chronic lung diseases, haematological disorders, and cancer, were also at higher risk of dying. HIV-infection also tended to confer a higher risk of death,” said Masekela.

Associate professor of infectious diseases and microbiology and epidemiology at the University of Pittsburgh Graduate School of Public Health and lead author of the study, Professor Jean Nachega, explained the study used data from earlier in the pandemic.

But he says there has been very little change in the situation.

“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 pediatric intensive care is not easily accessible,” said Nachega.

The study, which included investigators across six of the African countries, 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 is far higher than rates between 0.1% and 0.5% 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.

“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.”

The study recommends an urgent scale-up of Covid-19 vaccination roll-outs and therapeutic interventions among at-risk eligible children and adolescents in Africa.

Further, the study also highlighted the need for capacity-building and support for pediatric intensive care in these settings.

While noting the recent progress on increasing the Covid-19 vaccine supply in Africa, Nachega emphasised that jabs are not yet widely available.

Currently, only about 5% of the continent’s population have been fully vaccinated.

Compiled by Narissa Subramoney

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