The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

doi:10.9745/GHSP-D-21-00172

Review

. 2021 Sep 30;9(3):433-443.

doi: 10.9745/GHSP-D-21-00172. Print 2021 Sep 30.

The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

Janica Adams¹, Mary J MacKenzie², Adeladza Kofi Amegah³, Alex Ezeh^{4

5}, Muktar A Gadanya^{6

7}, Akinyinka Omigbodun^{8

9

10}, Ahmed M Sarki^{11

12}, Paul Thistle^{13

14

15}, Abdhalah K Ziraba¹⁶, Saverio Stranges^{1

2

17

18

19}, Michael Silverman^{20

2

18

21}

Affiliations

¹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
³ Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
⁴ Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
⁵ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Bayero University, Kano, Kano State, Nigeria.
⁷ Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria.
⁸ University of Ibadan, Ibadan, Nigeria.
⁹ College of Medicine, University of Ibadan, Ibadan, Nigeria.
¹⁰ Pan African University Life & Earth Sciences Institute (PAULESI), Ibadan, Nigeria.
¹¹ School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.
¹² Family and Youth Health Initiative (FAYOHI), Jigawa State, Nigeria.
¹³ Karanda Hospital, Mount Darwin, Zimbabwe.
¹⁴ The University of Zimbabwe, Harare, Zimbabwe.
¹⁵ University of Toronto, Toronto, Canada.
¹⁶ African Population and Health Research Center, Nairobi, Kenya.
¹⁷ Department of Family Medicine, Western University, London, Ontario, Canada.
¹⁸ The Africa Institute, Western University, London, Ontario, Canada.
¹⁹ Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
²⁰ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. michael.silverman@sjhc.london.on.ca.
²¹ Division of Infectious Diseases, Western University, London, Ontario, Canada.

PMID: 34593571
PMCID: PMC8514030
DOI: 10.9745/GHSP-D-21-00172

Review

The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

Janica Adams et al. Glob Health Sci Pract. 2021.

. 2021 Sep 30;9(3):433-443.

doi: 10.9745/GHSP-D-21-00172. Print 2021 Sep 30.

Authors

Affiliations

¹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
³ Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
⁴ Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
⁵ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Bayero University, Kano, Kano State, Nigeria.
⁷ Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria.
⁸ University of Ibadan, Ibadan, Nigeria.
⁹ College of Medicine, University of Ibadan, Ibadan, Nigeria.
¹⁰ Pan African University Life & Earth Sciences Institute (PAULESI), Ibadan, Nigeria.
¹¹ School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.
¹² Family and Youth Health Initiative (FAYOHI), Jigawa State, Nigeria.
¹³ Karanda Hospital, Mount Darwin, Zimbabwe.
¹⁴ The University of Zimbabwe, Harare, Zimbabwe.
¹⁵ University of Toronto, Toronto, Canada.
¹⁶ African Population and Health Research Center, Nairobi, Kenya.
¹⁷ Department of Family Medicine, Western University, London, Ontario, Canada.
¹⁸ The Africa Institute, Western University, London, Ontario, Canada.
¹⁹ Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
²⁰ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. michael.silverman@sjhc.london.on.ca.
²¹ Division of Infectious Diseases, Western University, London, Ontario, Canada.

PMID: 34593571
PMCID: PMC8514030
DOI: 10.9745/GHSP-D-21-00172

Abstract

The demographic age structure of sub-Saharan Africa contributes significantly to the low morbidity and mortality of COVID-19 compared to other regions in the world.

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Figures

**FIGURE 1**
Proposed Hypotheses Explaining the Limited Impact of COVID-19 in SSA Abbreviations: COVID-19, coronavirus disease; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SSA, sub-Saharan Africa.

**FIGURE 2**
Population Pyramids of Uganda and Canada^,

**FIGURE 3**
Age Distribution of COVID-19 Cases Deceased in Canada as of June 25, 2021

See this image and copyright information in PMC

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References

1. Centers for Disease Control and Prevention. About COVID-19. Updated May 24, 2021. Accessed June 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/cdcresponse/about-COVID-19.html
1. World Health Organization (WHO). Archived: WHO timeline-COVID-19. April 27, 2020. Accessed June 21, 2021. https://www.who.int/news/item/27-04-2020-who-timeline–-covid-19
1. World Health Organization (WHO). WHO coronavirus disease (COVID-19) dashboard. Accessed June 21, 2021. https://covid19.who.int/
1. Worldometers. COVID-19 Coronavirus Pandemic. Updated June 21, 2021. Accessed June 21, 2021. https://www.worldometers.info/coronavirus/
1. Coronavirus (COVID-19). World Health Organization Regional Office for Africa. Accessed June 21, 2021. https://www.afro.who.int/health-topics/coronavirus-covid-19

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[1] Centers for Disease Control and Prevention. About COVID-19. Updated May 24, 2021. Accessed June 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/cdcresponse/about-COVID-19.html

[2] Centers for Disease Control and Prevention. About COVID-19. Updated May 24, 2021. Accessed June 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/cdcresponse/about-COVID-19.html

[3] World Health Organization (WHO). Archived: WHO timeline-COVID-19. April 27, 2020. Accessed June 21, 2021. https://www.who.int/news/item/27-04-2020-who-timeline–-covid-19

[4] World Health Organization (WHO). Archived: WHO timeline-COVID-19. April 27, 2020. Accessed June 21, 2021. https://www.who.int/news/item/27-04-2020-who-timeline–-covid-19

[5] World Health Organization (WHO). WHO coronavirus disease (COVID-19) dashboard. Accessed June 21, 2021. https://covid19.who.int/

[6] World Health Organization (WHO). WHO coronavirus disease (COVID-19) dashboard. Accessed June 21, 2021. https://covid19.who.int/

[7] Worldometers. COVID-19 Coronavirus Pandemic. Updated June 21, 2021. Accessed June 21, 2021. https://www.worldometers.info/coronavirus/

[8] Worldometers. COVID-19 Coronavirus Pandemic. Updated June 21, 2021. Accessed June 21, 2021. https://www.worldometers.info/coronavirus/

[9] Coronavirus (COVID-19). World Health Organization Regional Office for Africa. Accessed June 21, 2021. https://www.afro.who.int/health-topics/coronavirus-covid-19

[10] Coronavirus (COVID-19). World Health Organization Regional Office for Africa. Accessed June 21, 2021. https://www.afro.who.int/health-topics/coronavirus-covid-19

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The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

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The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

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