Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa

Abstract

Children aged 0–19 years in sub-Saharan Africa bear a disproportionate proportion of the global burden of communicable and non-communicable diseases. Significant public health gains have been made in the fight against these diseases. However, factors such as underequipped health systems, disease outbreaks, and conflict and political instability continue to challenge prevention and control. The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) introduces new challenges to public health programs in sub-Saharan Africa. Of particular concern are programs targeting major conditions among children, such as undernutrition, vaccine-preventable pneumonia and diarrhea, malaria, tuberculosis, HIV, and sickle cell disease. This article focuses on the impact of the COVID-19 pandemic on child health in sub-Saharan Africa. We review the epidemiology of major pediatric diseases and, referencing modeling projections, discuss the short- and long-term impact of the pandemic on major disease control. We deliberate on potential complications of SARS-CoV-2 co-infections/co-morbidities and identify critical social and ethical issues. Furthermore, we highlight the paucity of COVID-19 data and clinical trials in this region and the lack of child participants in ongoing studies. Lastly, approaches and interventions to mitigate the pandemic’s impact on child health outcomes are discussed. Impact Children in sub-Saharan Africa bear a disproportionate burden of communicable and non-communicable diseases globally; this remains true even as the COVID-19 pandemic persists.Amidst the fast-expanding COVID-19 literature, there is little comprehensive coverage of the pandemic’s indirect impact on child health in sub-Saharan Africa.This article comprehensively outlines the threat that the pandemic poses to major disease prevention and control for children in sub-Saharan Africa. It discusses the potential impact of SARS-CoV-2 co-infections/co-morbidities, highlights research gaps, and advocates for data and action to mitigate the ripple effects of the pandemic on this population.

Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo

“…We also provide data on 34 children, a population for whom there are even less COVID-19 data available from SSA. 9 Finally, the use of robust statistical methods such as MSM and IPTW creates more balanced comparisons between treatment groups, similar to those that would be found in a randomized clinical trial.…”

“… 7 , 8 Furthermore, in SSA, there are little data on the prevalence of SARS-CoV-2 coinfection or comorbidity with noncommunicable diseases (NCDs) (e.g., hypertension, diabetes, and obesity) and communicable diseases (e.g., HIV, tuberculosis [TB], and malaria), which may influence COVID-19 presentations and outcomes. 9 , 10 We aimed to describe clinical characteristics, laboratory features, and outcomes of hospitalized patients with COVID-19 in DRC and to differentiate them from other non-African populations.…”

Minimizing the impact of the triple burden of COVID-19, tuberculosis and HIV on health services in sub-Saharan Africa

“…Several explanations have been put forward for this unexpected finding: early and strong political commitment and implementation of public health measures, robust community engagement, and coordinated public health responses and messaging. Other postulated but yet-to-be proven factors include a less COVID-19-vulnerable younger population, and cross-immunity from parasitic diseases and/or other circulating coronaviruses (Coker et al, 2020;Massinga Loembé et al, 2020;Mehtar et al, 2020;Musa et al, 2021).…”

“…However, as it is for TB (Global Tuberculosis Report 2020, n.d.), inadequate case identification and reporting may be contributing to an underestimation of the COVID-19 burden in sub-Saharan Africa (SSA); mortality surveillance systems in SSA may also not be optimal. In addition, country-level data on COVID-19 epidemiology and outcomes among African children is scanty (Coker et al, 2020). Furthermore, there is little data on the prevalence, clinical manifestations, and outcomes of SARS-CoV-2 coinfection with chronic infectious diseases of public health importance such as TB and HIV, which are highly prevalent in SSA (Coker et al, 2020).…”

Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration

“…This is especially true for sub-Saharan Africa (SSA), where there is coexisting and highly prevalent HIV, tuberculosis (TB), malaria, and malnutrition, and some of the poorest maternal and child health outcomes globally. 1 , 2 As of December 5, 2020, the WHO African region had recorded 1,529,436 COVID-19 cases and 34,125 deaths (case fatality rate: 2.2%). 3 To the best of our knowledge, there have been no published prospective or large-scale studies evaluating the impact of SARS-CoV-2 infection on pregnancy in SSA.…”