COVID-19 morbidity, mortality high among sub-Saharan African children
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A study published in JAMA Pediatrics reported high morbidity and mortality rates among hospitalized children and adolescents with COVID-19 in six sub-Saharan African countries, even among those who were otherwise healthy.
Co-author Jean Nachega, MD, PhD, MPH, associate professor of epidemiology, infectious diseases and microbiology at the University of Pittsburgh Graduate School of Public Health and professor extraordinary of medicine at Stellenbosch University in Cape Town, is also research committee chair of the African Forum for Research and Education in Health (AFREhealth). In an interview, Nachega said the inspiration for the study came from pilot data in the Democratic Republic of the Congo (DRC) that showed a poor survival rate among children with COVID-19.
“We wanted to try to understand a bit better what the outcomes have been for children and adolescents with COVID in Africa because much of the data were from the U.S. and Europe or China, where overall mortality was reported to be between 1% to 3%,” Nachega told Healio. “One cannot extrapolate those results because Africa has its own specificity in terms of communicable and non-communicable comorbidities as well as a limited access to pediatric intensive care That's what triggered us to conduct this important study.”
Nachega and colleagues conducted a retrospective cohort study that reviewed medical records or national COVID-19 databases of COVID-19 response teams and examined pediatric cases on the WHO’s severity scale. They used an ordinal primary outcome scale adapted from WHO comprising five categories: hospitalization without oxygen supplementation, hospitalization with oxygen supplementation, ICU admission, invasive mechanical ventilation, and death. The secondary outcome was length of hospital stay.
Among 469 children and adolescents in the DRC, Ghana, Kenya, Nigeria, South Africa and Uganda who were hospitalized from March 1 to Dec. 31, 2020, 8% of patients died, including 22 of 69 (32%) who required ICU admission and four of 18 with suspected or confirmed multisystem inflammatory syndrome in children.
“The high morbidity and mortality associated with hospitalized children with COVID-19 in our study challenge the existing understanding of COVID-19 as a mild disease in this population,” Nachega said.
In an accompanying editorial, Ethwako Mlia-Phiri, MMed, a physician from Queen Elizabeth Central Hospital in Malawi, and colleagues noted that the study “described slightly lower rates of comorbidities (24.5%) among children hospitalized with COVID-19 in sub-Saharan Africa, despite documentation of more severe disease at the time of hospitalization,” compared with findings from the U.S. and United Kingdom.
“This is an important point because a major narrative during the course of the COVID-19 pandemic has been that children without pre-existing medical conditions are largely protected from progression to severe COVID-19 illness,” they wrote. “Although age younger than 1 year and the presence of a comorbid condition, such as hypertension, chronic lung disease, or hematologic disorders, were associated with higher risk of mortality, the findings of the Nachega et al study suggested that approximately 75% of hospitalized children were otherwise healthy before receiving a COVID-19 diagnosis.”
“COVID-19 vaccination and therapeutic interventions are urgently required for eligible African children and adolescents,” Nachega said. “This is all part of the general equity for vaccines globally, not just for children, because even less than 10% of adults are fully vaccinated for COVID-19 in Africa. We need to really to make much progress to get those vaccines in the developing world.”
References:
Ethwako M, et al. JAMA Pediatr. 2022;doi: 10.1001/jamapediatrics.2021.6446.
Nachega J, et al. JAMA Pediatr. 2022;doi:10.1001/jamapediatrics.2021.6436.