A new report has shown that children and adolescents in Sub Saharan Africa hospitalised with COVID-19 experience higher mortality rates than their counterparts in the United States of America and Europe.
The report, titled; “Assessment of Clinical Outcome amongst Children and Adolescents Hospitalised with COVID-19 in Six Sub-Saharan African Countries,” was conducted by a collaboration under the African Forum for Research and Education in Health (AFREhealth), a consortium of cross-disciplinary health personnel across Africa.
The study, which was published in the international JAMA Pediatrics journal, featured researchers from the Institute of Human Virology Nigeria (IHVN), and Ahmadu Bello University, Zaria, Nigeria.
The study collected data from 25 health facilities across Nigeria, Ghana, the Democratic Republic of the Congo, Kenya, South Africa, and Uganda.
This included 469 African children and adolescents aged three months to 19 years hospitalised with COVID-19 between March and December 2020.
Study Findings
Findings from the study show that African children reported a high overall mortality rate of 8.3 per cent compared with 1 per cent or less reported from Europe and North America.
It also shows that infants younger than one year had nearly five times the risk of death than adolescents aged 15 to 19 years.
Children of all ages with comorbidities including high blood pressure, chronic lung diseases, haematological disorders, and cancer, also were at higher risk of dying.
Furthermore, African children less than a year old and with pre-existing non-communicable diseases were more likely to have poorer outcomes, including intensive care requirements and death.
The report shows that 18 participants had suspected or confirmed multisystem inflammatory syndrome, a serious complication of COVID-19 where different parts of the body become inflamed. About four of the children died from this complication, the study indicates.
“Although our study looked at data from earlier in the pandemic, the situation hasn’t changed much for the children of Africa — if anything, it is expected to be worsening, with the global emergence of the highly contagious Omicron variant,” an associate professor of infectious diseases and microbiology and epidemiology at Pitt’s Graduate School of Public Health, Jean Nachega, said.
Mr Nachega, who is also the lead author of the study, said vaccines are not yet widely available, and that pediatric intensive care is not easily accessible.
The study, which included investigators across all six of the African countries that provided data, found that 34.6 per cent of hospitalised children were admitted to an intensive care unit (ICU) or required supplemental oxygen, and 21.2 per cent of those admitted to the ICU required invasive mechanical ventilation.
High morbidity
Mr Nachega said the high morbidity and mortality associated with hospitalised children with COVID-19 challenge the existing understanding of the virus as a mild disease in this population.
“But if a child has comorbidity, is very young and is in a place where there are limited or no specialised doctors, facilities, or equipment for pediatric intensive care, then that child faces a very real possibility of dying.
“Our findings call for an urgent scale-up of COVID-19 vaccination and therapeutic interventions among at-risk eligible children and adolescents in Africa,” he said.
He said this also raises further, the acute need for capacity-building and support for pediatric intensive care in these settings.
Applying findings
In a statement issued late Friday, IHVN’s Senior Technical Advisor for Paediatric and Adolescent HIV and first co-author of the publication, Sam Agudu, said the findings serve as evidence from multiple countries to show that African children also experience severe COVID-19.
Mr Agudu urged Nigerian authorities to act upon the study findings, “to protect children; including the expansion of vaccine approvals and procurements to include children, as variants emerging since our study’s completion have either caused more severe disease and/or more cases overall.
“We cannot leave children behind in the pandemic response,” he said.
The chief executive officer of IHVN, Patrick Dakum, said the data from the study puts science from Nigeria and the rest of Africa squarely on the map for pandemic-responsive research, particularly for young populations.
Mr Dakum said the institute will continually work towards contributing to research discoveries in Nigeria, West Africa, and beyond.
Reacting to the findings, the director-general of the Nigeria Centre for Disease Control (NCDC), Ifedayo Adetifa, said there is an urgent need to factor children into age-disaggregated COVID-19 disease surveillance and reporting, and consider COVID-19 illness when they present to the hospital.
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Mr Adetifa said the high in-hospital mortality rate reported indicates a need for investments in critical care for children in African settings.
“We need more of such rigorous multicenter studies to inform evidence-based policy-making in Nigeria and other African countries,” he said.
Similarly, the Executive Director of the IHVN International Research Centre of Excellence, Alash’le Abimiku, said the pediatric COVID-19 findings of the collaborative research underscores the value of sustained investments in strong research institutions and collaborations.
Mr Abimiku said Nigeria could generate rigorous local data to guide local, regional, and international health policy and practice.
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