Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda

Abstract

The COVID-19 pandemic and public health "lockdown" responses in sub-Saharan Africa, including Uganda, are now widely reported. Although the impact of COVID-19 on African populations has been relatively light, it is feared that redirecting focus and prioritization of health systems to fight COVID-19 may have an impact on access to non-COVID-19 diseases. We applied age-based COVID-19 mortality data from China to the population structures of Uganda and non-African countries with previously established outbreaks, comparing theoretical mortality and disability-adjusted life years (DALYs) lost. We then predicted the impact of possible scenarios of the COVID-19 public health response on morbidity and mortality for HIV/AIDS, malaria, and maternal health in Uganda. Based on population age structure alone, Uganda is predicted to have a relatively low COVID-19 burden compared with an equivalent transmission in comparison countries, with 12% of the mortality and 19% of the lost DALYs predicted for an equivalent transmission in Italy. By contrast, scenarios of the impact of the public health response on malaria and HIV/AIDS predict additional disease burdens outweighing that predicted from extensive SARS-CoV-2 transmission. Emerging disease data from Uganda suggest that such deterioration may already be occurring. The results predict a relatively low COVID-19 impact on Uganda associated with its young population, with a high risk of negative impact on non-COVID-19 disease burden from a prolonged lockdown response. This may reverse hard-won gains in addressing fundamental vulnerabilities in women and children's health, and underlines the importance of tailoring COVID-19 responses according to population structure and local disease vulnerabilities.

Figure 1.

(A) HIV incidence and initiation of antiretroviral therapy in Uganda, week 40 (October 2019) to week 14 (mid-April) 2020. (B) Facility deliveries and maternal mortality, Uganda, 2019–2020.

Figure 2.

(A) Comparison of age profiles of Uganda with countries with COVID-19 outbreaks previously recorded and instituting varying degrees of physical distancing policies: China, the United States, Spain, Italy, and Iceland. (B) Relative mortality and burden of disability-adjusted life years from COVID-19 predicted by age distribution alone, assuming an equivalent infection rate per country, standardized against the burden predicted for Italy. Age-specific infection fatality rate is based on China.