Quantifying excess mortality during the COVID-19 pandemic in 2020 in The Gambia: a time-series analysis of three health and demographic surveillance systems

Mohammed, Nuredin; Mackenzie, Grant; Ezeani, Esu; Sidibeh, Mamadi; Jammeh, Lamin; Sarwar, Golam; Saine, Aji  Kumba Folawiyo; Sonko, Bakary; Gomez, Pierre; Dondeh, Bai Lamin; Hossain, M. Jahangir; Jasseh, Momodou; Usuf, Effua; Prentice, Andrew M.; Jeffries, David; D’Alessandro, Umberto; Roca, Anna

doi:10.1016/j.ijid.2022.12.017

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…These results suggest that the impact of the COVID-19 pandemic in Zambia was more widespread than o cial statistics indicate, and not only restricted to urban centres such as Lusaka (9,21,25,26). Similar ndings of excess mortality in other sub-Saharan countries during the COVID-19 pandemic have been observed (27,28). Globally, the World Health Organisation estimates excess mortality is 2.74 times higher than reported COVID-19 deaths (28).…”

Section: Discussionsupporting

confidence: 80%

An assessment of excess mortality during the COVID-19 pandemic, a retrospective post-mortem surveillance in 12 districts – Zambia, 2020-2022

Chanda,

Hines,

Malambo

et al. 2024

Preprint

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Background The number of COVID-19 deaths reported in Zambia (N=4,069) is most likely an underestimate due to limited testing, incomplete death registration and inability to account for indirect deaths due to socioeconomic disruption during the pandemic. We sought to assess excess mortality during the COVID-19 pandemic in Zambia. Methods We conducted a retrospective analysis of monthly-death-counts (2017-2022) and individual-daily-deaths (2020-2022) of all reported health facility and community deaths at district referral health facility mortuaries in 12 districts in Zambia. We defined COVID-19 wave periods based on a sustained nationally reported SARS-CoV-2 test positivity of greater than 5%. Excess mortality was defined as the difference between the pandemic monthly death counts (2020-2022) and the median pre-pandemic monthly death counts (2017-2019) using a Microsoft Excel-based tool. We compared median daily death counts, median age at death, and the proportion of deaths by place of death (health facility vs community) by wave period using the Mann-Whitney-U test and chi-square test respectively in R. Results A total of 112,768 deaths were reported in the 12 districts between 2020 and 2022, of which 17,111 (15.2%) were excess. Wave periods had higher median daily death counts than non-wave periods (median [IQR], 107 [95-126] versus 96 [85-107], p<0.001). The median age at death during wave periods was older than non-wave periods (44.0 [25.0-67.0] versus 41.0 [22.0-63.0] years, p<0.001). Approximately half of all reported deaths occurred in the community, with an even greater proportion during wave periods (50.58% versus 53.11%, p<0.001), respectively. Conclusion There was excess mortality during the COVID-19 pandemic in Zambia, with more deaths among the elderly, and occurring within the community during wave periods. This analysis suggests more COVID-19 deaths likely occurred in Zambia than suggested by officially reported numbers. Mortality surveillance can provide important information to monitor population health and inform public health programming during pandemics.

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Section: Discussionsupporting

confidence: 80%

An assessment of excess mortality during the COVID-19 pandemic, a retrospective post-mortem surveillance in 12 districts – Zambia, 2020-2022

Chanda,

Hines,

Malambo

et al. 2024

Preprint

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“…In conclusion, SARS-CoV-2 transmission in The Gambia was high during the first three COVID-19 waves. The high seroprevalence observed in our study combined with the former data of no excess mortality in The Gambia in 2020 [27] confirms that the clinical severity of infection during the COVID-19 epidemic has been milder in The Gambia than in other countries. Our results are important for policy makers to take decisions on how to manage the epidemic virus that is progressing into an endemic virus.…”

Section: Sars-cov-2 Sero-prevalence Increased Significantly Among Pre...supporting

confidence: 84%

“…Nevertheless, in Farafenni, it was detected an excess mortality among the vulnerable 65+ years age-group [27]. Transmission became even easier for the virus in the second and third waves when nationwide restrictions were eased further [17].…”

Section: Sars-cov-2 Sero-prevalence Increased Significantly Among Pre...mentioning

confidence: 99%

SARS-CoV-2 seroprevalence in pregnant women during the first three COVID-19 waves in The Gambia

Janha,

Bah,

Jah

et al. 2023

Preprint

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Objectives SARS-CoV-2 transmission in Sub-Saharan Africa has probably been underestimated. Population-based seroprevalence studies are needed to determine the extent of transmission in the continent. Methods Blood samples from a cohort of Gambian pregnant women were tested for SARS-CoV-2 total IgM/IgG before (Pre-pandemic1: October-December 2019 and Pre-pandemic2: February-June 2020) and during the pandemic (Post-wave1: October-December 2020, Post-wave2: May-June 2021; and Post-wave3: October-December 2021). Samples positive for total SARS-CoV-2 IgM/IgG were tested for protein-specific antibodies. Results SARS-CoV-2 total IgM/IgG seroprevalence was 0.9% 95%CI (0.2, 4.9) in Pre-pandemic1; 4.1% (1.4, 11.4) in Pre-pandemic2; 31.1% (25.2, 37.7) in Post-wave1; 62.5% (55.8, 68.8) in Post-wave2 and 90.0% (85.1, 93.5) in Post-wave3. S-protein IgG and NCP-protein IgG seroprevalence also increased at each Post-wave period. Although S-protein IgG and NCP-protein IgG seroprevalence was similar at Post-wave1, S-protein IgG seroprevalence was higher at Post-wave2 and Post-wave3, [prevalence difference (PD) 13.5 (0.1, 26.8) and prevalence ratio (PR) 1.5 (1.0, 2.3) in Post-wave2; and 22.9 (9.2, 36.6) and 1.4 (1.1, 1.8) in Post-wave3 respectively, p<0.001]. Conclusion SARS-CoV-2 transmission in The Gambia during the first three COVID-19 waves was high, differing significantly from official numbers of COVID-19 cases reported. Our findings are important for policy makers in managing the near-endemic COVID-19.

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“…Though our trial covers only a narrow time window, it suggests that the impact of COVID-19 on the overall mortality may have been less severe than feared. Hence, as also shown in other African HDSS sites [ 33 , 34 ], the lower death toll in some African settings cannot be fully explained by lack of data.…”

Section: Discussionmentioning

confidence: 81%

Effect of distributing locally produced cloth facemasks on COVID-19-like illness and all-cause mortality–a cluster-randomised controlled trial in urban Guinea-Bissau

Nanque,

Jensen,

Diness

et al. 2024

PLOS Glob Public Health

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Facemasks have been employed to mitigate the spread of SARS-CoV-2. The community effect of providing cloth facemasks on COVID-19 morbidity and mortality is unknown. In a cluster randomised trial in urban Bissau, Guinea-Bissau, clusters (geographical areas with an average of 19 houses), were randomised to an intervention or control arm using computer-generated random numbers. Between 20 July 2020 and 22 January 2021, trial participants (aged 10+ years) living in intervention clusters (n = 90) received two 2-layer cloth facemasks, while facemasks were only distributed later in control clusters (n = 91). All participants received information on COVID-19 prevention. Trial participants were followed through a telephone interview for COVID-19-like illness (3+ symptoms), care seeking, and mortality for 4 months. End-of-study home visits ensured full mortality information and distribution of facemasks to the control group. Individual level information on outcomes by trial arm was compared in logistic regression models with generalised estimating equation-based correction for cluster. Facemasks use was mandated. Facemask use in public areas was assessed by direct observation. We enrolled 39,574 trial participants among whom 95% reported exposure to groups of >20 persons and 99% reported facemasks use, with no difference between trial arms. Observed use was substantially lower (~40%) with a 3%, 95%CI: 0–6% absolute difference between control and intervention clusters. Half of those wearing a facemask wore it correctly. Few participants (532, 1.6%) reported COVID-19-like illness; proportions did not differ by trial arm: Odds Ratio (OR) = 0.81, 95%CI: 0.57–1.15. 177 (0.6%) participants reported consultations and COVID-19-like illness (OR = 0.83, 95%CI: 0.56–1.24); 89 participants (0.2%) died (OR = 1.34, 95%CI: 0.89–2.02). Hence, though trial participants were exposed to many people, facemasks were mostly not worn or not worn correctly. Providing facemasks and messages about correct use did not substantially increase their use and had limited impact on morbidity and mortality. Trial registration: clinicaltrials.gov: NCT04471766.

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Quantifying excess mortality during the COVID-19 pandemic in 2020 in The Gambia: a time-series analysis of three health and demographic surveillance systems

Cited by 7 publications

References 16 publications

An assessment of excess mortality during the COVID-19 pandemic, a retrospective post-mortem surveillance in 12 districts – Zambia, 2020-2022

An assessment of excess mortality during the COVID-19 pandemic, a retrospective post-mortem surveillance in 12 districts – Zambia, 2020-2022

SARS-CoV-2 seroprevalence in pregnant women during the first three COVID-19 waves in The Gambia

Effect of distributing locally produced cloth facemasks on COVID-19-like illness and all-cause mortality–a cluster-randomised controlled trial in urban Guinea-Bissau

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