Relative Burdens of the COVID-19, Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa

  1. David Bell
  2. Kristian Schultz Hansen

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Abstract

COVID-19 has had considerable global impact; however, in sub-Saharan Africa, it is one of several infectious disease priorities. Prioritization is normally guided by disease burden, but the highly age-dependent nature of COVID-19 and that of other infectious diseases make comparisons challenging unless considered through metrics that incorporate life-years lost and time lived with adverse health. Therefore, we compared the 2020 mortality and disability-adjusted life-years (DALYs) lost estimates for malaria, tuberculosis, and HIV/AIDS in sub-Saharan African populations with more than 12 months of COVID-19 burden (until the end of March 2021) by applying known age-related mortality to United Nations estimates of the age structure. We further compared exacerbations of disease burden predicted from the COVID-19 public health response. Data were derived from public sources and predicted exacerbations were derived from those published by international agencies. For sub-Saharan African populations north of South Africa, the estimated recorded COVID-19 DALYs lost in 2020 were 3.7%, 2.3%, and 2.4% of those for tuberculosis, HIV/AIDS, and malaria, respectively. Predicted exacerbations of these diseases were greater than the estimated COVID-19 burden. Including South Africa and Lesotho, COVID-19 DALYs lost were < 12% of those for other compared diseases; furthermore, the mortality of compared diseases were dominant in all age groups younger than 65 years. This analysis suggests the relatively low impact of COVID-19. Although all four epidemics continue, tuberculosis, HIV/AIDS, and malaria remain far greater health priorities based on their disease burdens. Therefore, resource diversion to COVID-19 poses a high risk of increasing the overall disease burden and causing net harm, thereby further increasing global inequities in health and life expectancy.

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  1. Version published to 10.4269/ajtmh.21-0899
  2. ScreenIT

    SciScore for 10.1101/2021.03.27.21254483: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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 data analysis has a number of limitations. COVID-19 mortality reporting in sub-Saharan Africa is doubtless incomplete, though low mortality is predicted by population age structure and lower prevalence of major co-morbidities including obesity,5,7,32 while other lifestyle factors and prior immunity may also be protective.10,33–35 Given lack of strong local data on age-related mortality, we assumed that mortality rates reflect those found elsewhere.25 Lack of transmission appears an unlikely explanation for low recorded mortality as high seroprevalence has been recorded in various sub-Saharan African settings.36–40 While the higher mortality of COVID-19 in South Africa could be partially explained by higher reporting rates, South Africa also has higher rates of known mortality risk factors.41 Evidence of very high asymptomatic infection,40 and the level of community testing taking place (868823 tests for 333 deaths by 23 February 2021),42 suggests that the low recorded mortality in most countries reflects reality, in common with much of Asia.43 The relative burden of COVID-19 in 2020 is also subject to the first cases only being reported in March in most of these populations,43 compared with a full year for the comparator diseases. Twelve months of COVID-19 data will clearly present a higher burden, though as the total mortality rate is declining across the continent at time of writing,43 the bulk of COVID-19 burden may already have been accrued. DALYs lost through COVID-...

    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.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.27.21254483 on medRxiv