SARS-CoV-2 Mortality Surveillance among Community Deaths brought to University Teaching Hospital Mortuary in Lusaka, Zambia, 2020

  1. Amos Hamukale
  2. Jonas Z. Hines
  3. Nyambe Sinyange
  4. Sombo Fwoloshi
  5. Warren Malambo
  6. Suilanji Sivile
  7. Stephen Chanda
  8. Luchenga Adam Mucheleng’anga
  9. Nkomba Kayeyi
  10. Cordelia Maria Himwaze
  11. Aaron Shibemba
  12. Tally Leigh
  13. Mazyanga L. Mazaba
  14. Nathan Kapata
  15. Paul Zulu
  16. Khozya Zyambo
  17. Francis Mupeta
  18. Simon Agolory
  19. Lloyd B. Mulenga
  20. Kennedy Malama
  21. Muzala Kapina

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Abstract

Introduction

During March-December 2020, Zambia recorded 20,725 confirmed COVID-19 cases, with the first wave peaking between July and August. Of the 388 COVID-19-related deaths occurring nationwide, most occurred in the community. We report findings from COVID-19 mortality surveillance among community deaths brought to the University Teaching Hospital (UTH) mortuary in Lusaka.

Methods

In Zambia, when a person dies in the community, and is brought into a health facility mortuary, they are recorded as ‘brought in dead’ (BID). The UTH mortuary accepts persons BID for Lusaka District, the most populated district in Zambia. We analyzed data for persons BID at UTH during 2020. We analyzed two data sources: weekly SARS-CoV-2 test results for persons BID and monthly all-cause mortality numbers among persons BID. For all-cause mortality among persons BID, monthly deaths during 2020 that were above the upper bound of the 95% confidence interval for the historic mean (2017-2019) were considered significant. Spearman’s rank test was used to correlate the overall percent positivity in Zambia with all-cause mortality and SARS-CoV-2 testing among persons BID at UTH mortuary.

Results

During 2020, 7,756 persons were BID at UTH (monthly range 556-810). SARS-CoV-2 testing began in April 2020, and through December 3,131 (51.9%) of 6,022 persons BID were tested. Of these, 212 (6.8%) were SARS-CoV-2 positive with weekly percent test positivity ranging from 0-32%, with the highest positivity occurring during July 2020. There were 1,139 excess persons BID from all causes at UTH mortuary in 2020 compared to the 2017-2019 mean. The monthly number of persons BID from all causes was above the upper bound of the 95% confidence interval during June-September and December.

Conclusion

Increases in all-cause mortality and SARS-CoV-2 test positivity among persons BID at UTH mortuary corresponded with the first peak of the COVID-19 epidemic in June and August 2020, indicating possible increased mortality related to the COVID-19 epidemic in Zambia. Combining all-cause mortality and SARS-CoV-2 testing for persons BID provides useful information about the severity of the epidemic in Lusaka and should be implemented throughout Zambia.

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  1. ScreenIT

    SciScore for 10.1101/2021.11.14.21266330: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analyses were performed using STATA version 14.0
    STATA
    suggested: (Stata, RRID:SCR_012763)
    (Stata Corp., College Station, TX, USA) and Microsoft Excel 2016 (
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study was subject to several limitations. We utilized data that were available from routine SARS-CoV-2 testing of persons BID and many persons BID were not tested for SARS-CoV-2, including no one during the month of August 2020 which was during the first peak of the epidemic in Zambia. During August 2020, case counts, and percent test positivity remained elevated, but when BID testing resumed in September 2020, test positivity had substantially reduced. Next, excess all-cause mortality does not necessarily reflect the impact of COVID-19, although there was an absence of other large-scale health events in Lusaka that could explain the peaks observed in the data. However, it is possible that patients with other underlying health conditions did not access health services because of fear of COVID-19 and some of them may have died as a result. Although the UTH mortuary is the largest in Zambia, and the majority of SARS-CoV-2 testing among persons BID have been reported from this facility, the findings from this study might not be representative of other mortuaries in Zambia or Africa. Lastly, as an observational study, associations reported in this study do not necessarily reflect a causal relationship. Mortality surveillance at UTH mortuary in Lusaka correlated with SARS-CoV-2 transmission in the general population. Mortality surveillance should be implemented to ensure timely detection and management of COVID-19 cases in resource-limited settings where testing rates are low...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

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  2. Version published to 10.1101/2021.11.14.21266330v1 on medRxiv