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Impact of COVID-19 on mortality in coastal Kenya: a longitudinal open cohort study
Mark O Otiende; Amek Nyaguara; Christian Bottomley; David Walumbe; George Mochamah; David Amadi; Christopher Nyundo; Eunice Kagucia; Anthony Etyang'; Ifedayo Adetifa; Sam PC Brand; Eric Maitha; Elwyn Chondo; Eddy Nzomo; Rashid Aman; Mercy Mwangangi; Patrick Amoth; Kadondi Kasera; Wangari Ng'ang'a; Edwine Barasa; Benjamin Tsofa; Joseph Mwangangi; Philip Bejon; Ambrose Agweyu; Tom Williams; Anthony Scott.
Affiliation
  • Mark O Otiende; KEMRI-Wellcome Trust Research Programme
  • Amek Nyaguara; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Christian Bottomley; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  • David Walumbe; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • George Mochamah; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • David Amadi; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Christopher Nyundo; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Eunice Kagucia; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Anthony Etyang'; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Ifedayo Adetifa; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  • Sam PC Brand; The Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick
  • Eric Maitha; Department of Health, Kilifi County, Kenya
  • Elwyn Chondo; Department of Health, Kilifi County, Kenya
  • Eddy Nzomo; Kilifi County Hospital, Kilifi, Kenya
  • Rashid Aman; Ministry of Health, Government of Kenya, Nairobi, Kenya
  • Mercy Mwangangi; Ministry of Health, Government of Kenya, Nairobi, Kenya
  • Patrick Amoth; Ministry of Health, Government of Kenya, Nairobi, Kenya
  • Kadondi Kasera; Ministry of Health, Government of Kenya, Nairobi, Kenya
  • Wangari Ng'ang'a; Presidential Policy and Strategy Unit, The Presidency, Government of Kenya, Nairobi, Kenya
  • Edwine Barasa; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Benjamin Tsofa; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Joseph Mwangangi; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Philip Bejon; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Ambrose Agweyu; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Tom Williams; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
  • Anthony Scott; KEMRI-Wellcome Research Trust Programme, Kilifi, Kenya
Preprint in English | medRxiv | ID: ppmedrxiv-22281019
ABSTRACT
BackgroundThere is uncertainty about the mortality impact of the COVID-19 pandemic in Africa because of poor ascertainment of cases and limited national civil vital registration. We analysed excess mortality from 1st January 2020-5th May 2022 in a Health and Demographic Surveillance Study in Coastal Kenya where the SARS-CoV-2 seroprevalence reached 75% among adults in March 2022 despite vaccine uptake of only 17%. MethodsWe modelled expected mortality in 2020-2022 among a population of 306,000 from baseline surveillance data between 2010-2019. We calculated excess mortality as the ratio of observed/expected deaths in 5 age strata for each month and for each national wave of the pandemic. We estimated cumulative mortality risks as the total number of excess deaths in the pandemic per 100,000 population. We investigated observed deaths using verbal autopsy. FindingWe observed 16,236 deaths among 3,410,800 person years between 1st January 2010 and 5th May 2022. Across 5 waves of COVID-19 cases during 1st April 2020-16th April 2022, population excess mortality was 4.1% (95% PI -0.2%, 7.9%). Mortality was elevated among those aged [≥]65 years at 14.3% (95% PI 7.4%, 21.6%); excess deaths coincided with wave 2 (wild-type), wave 4 (Delta) and wave 5 (Omicron BA1). Among children aged 1-14 years there was negative excess mortality of -20.3% (95% PI -29.8%, -8.1%). Verbal autopsy data showed a transient reduction in deaths from acute respiratory infections in 2020 at all ages. For comparison with other studies, cumulative excess mortality risk for January 2020-December 2021, age-standardized to the Kenyan population, was 47.5/100,000. InterpretationNet excess mortality during the pandemic was substantially lower in Coastal Kenya than in many high income countries. However, adults, aged [≥]65 years, experienced substantial excess mortality suggesting that targeted COVID-19 vaccination of older persons may limit further COVID-19 deaths by protecting the residual pool of naive individuals. FundingWellcome Trust
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Full text: Available Collection: Preprints Database: medRxiv Type of study: Cohort_studies / Experimental_studies / Observational study / Prognostic study Language: English Year: 2022 Document type: Preprint
Full text: Available Collection: Preprints Database: medRxiv Type of study: Cohort_studies / Experimental_studies / Observational study / Prognostic study Language: English Year: 2022 Document type: Preprint
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