Children in sub-Saharan Africa who are hospitalised with COVID-19 are dying at a rate far greater than children in the US and Europe, according to a new multicentre study published in JAMA Pediatrics. 

The study was conducted in 25 hospital sites in South Africa, the Democratic Republic Congo, Ghana, Kenya, Nigeria and Uganda between March and December 2020.

Prof Refiloe Masekela, head of UKZN’s Discipline of Paediatrics and Child Health led the study at the UKZN site. She says they are concerned that among African children admitted to the 25 hospitals with Covid-19 between March and December 2020, infants younger than one year had nearly five times the risk of death than adolescents aged 15 to 19 years.

“Our study also found that children of all ages with comorbidities, including high blood pressure, chronic lung diseases, haematological disorders, and cancer, were also at higher risk of dying. HIV-infection also tended to confer a higher risk of death,” Prof Masekela said.

“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. Vaccines are not yet widely available, and paediatric intensive care is not easily accessible,” said lead author of the study, Prof Jean Nachega, associate professor of infectious diseases, microbiology and epidemiology at the University of Pittsburgh Graduate School of Public Health. Prof Nachega is also a professor extraordinary of medicine at Stellenbosch University’s Faculty of Medicine and Health Sciences

“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,” said Prof Nachega. Vaccines are not yet widely available, and paediatric intensive care is not easily accessible.”

A quarter of the children who died had pre-existing conditions. Eighteen had confirmed or suspected multisystem inflammatory syndrome, a serious complication of COVID-19 in children. 

 The study found that 34.6% of hospitalised children were admitted to an intensive care unit (ICU) or required supplemental oxygen, and 21.2% of those admitted to the ICU required invasive mechanical ventilation. During the time frame studied, 39—over 8%—of the children died. This compares with rates between 1% and 5% that have been reported in high-income countries.  

 “The high morbidity and mortality associated with hospitalized children with COVID-19 in our study challenge the existing understanding of COVID-19 as a mild disease in this population,” said Prof Nachega,. “But if a child has a comorbidity, is very young and is in a place where there are limited or no specialised doctors, facilities or equipment for paediatric 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,” Nachega continued. “They also raise further the acute need for capacity-building and support for paediatric intensive care in these settings.”

 He noted recent progress on increasing the COVID-19 vaccine supply in Africa but emphasised that those vaccines are not yet widely available and only about 5% of the continent’s population have been fully vaccinated. 

 “COVID-19 vaccine hesitancy is a global issue, and Africa is no exception,” he said. “It is imperative that evidence-based public health campaigns address concerns in accessible, trustworthy ways so that there is high vaccine uptake as soon as it is available.”

Source: https://www.upmc.com/media/news/011922-nachega-covid-kids-africa

 Reference:  Nachega JB, et al, Assessment
of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19
in 6 Sub-Saharan African Countries. JAMA Pediatrics, 2022.
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2788373