Associations between socioeconomic and public health indicators and the case-fatality rate of COVID-19 in sub-Saharan Africa

Annika Kreienbrinck, Hajo Zeeb, Heiko Becher
2021 One Health & Implementation Research  
Aim: To investigate the influence of socioeconomic and public health indicators on the COVID-19 case-fatality rate (CFR) in sub-Saharan African countries. Methods: Ecological study using publicly available, aggregated COVID-19 data, between February 2020 to May 2021, from 46 sub-Saharan African countries. As the outcome of interest, country-specific CFRs were calculated for five 13-week periods. Spatial and temporal distributions of the variables were analysed, and negative binomial regressions
more » ... with rate ratios (RR) were conducted to estimate the association between socioeconomic and public health indicators with CFR of COVID-19. Results: There were 1.7 million confirmed COVID-19 cases and 29,685 deaths in the 46 sub-Saharan African countries during the investigated time period. The median CFR was between 1% and 2%. A higher human development index (RR = 0.80; 95%CI: 0.63-1.02), higher political stability index (RR = 0.94; 95%CI: 0.90-1.00), higher number of hospital beds (RR = 0.84; 95%CI: 0.73-0.97), and higher population density (RR = 0.85; 95%CI: 0.71-1.01) resulted in a lower CFR. Elevated prevalence of diabetes mellitus (RR = 1.56; 95%CI: 0.99-2.45) and cardiovascular disease mortality (RR = 1.51; 95%CI: 1.04-2.20) were associated with higher CFR. Chronic respiratory disease and handwashing facilities presented little to no effects on COVID-19 CFR. Conclusion: The results draw attention to the vulnerabilities of the sub-Saharan African region which must be considered in the interpretation of our study. Nevertheless, the potential benefits of a lower proportion of pre-existing medical conditions and the young age structure seem to be contrasted by challenges due to socioeconomic and public health factors, which may present possible drivers of CFR on a population level.
doi:10.20517/ohir.2021.08 fatcat:y43kajfdpzbjhfweu7kuo6cnbm