1921
Volume 103, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The COVID-19 pandemic and public health “lockdown” responses in sub-Saharan Africa, including Uganda, are now widely reported. Although the impact of COVID-19 on African populations has been relatively light, it is feared that redirecting focus and prioritization of health systems to fight COVID-19 may have an impact on access to non–COVID-19 diseases. We applied age-based COVID-19 mortality data from China to the population structures of Uganda and non-African countries with previously established outbreaks, comparing theoretical mortality and disability-adjusted life years (DALYs) lost. We then predicted the impact of possible scenarios of the COVID-19 public health response on morbidity and mortality for HIV/AIDS, malaria, and maternal health in Uganda. Based on population age structure alone, Uganda is predicted to have a relatively low COVID-19 burden compared with an equivalent transmission in comparison countries, with 12% of the mortality and 19% of the lost DALYs predicted for an equivalent transmission in Italy. By contrast, scenarios of the impact of the public health response on malaria and HIV/AIDS predict additional disease burdens outweighing that predicted from extensive SARS-CoV-2 transmission. Emerging disease data from Uganda suggest that such deterioration may already be occurring. The results predict a relatively low COVID-19 impact on Uganda associated with its young population, with a high risk of negative impact on non–COVID-19 disease burden from a prolonged lockdown response. This may reverse hard-won gains in addressing fundamental vulnerabilities in women and children’s health, and underlines the importance of tailoring COVID-19 responses according to population structure and local disease vulnerabilities.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. WHO, 2020. Coronavirus Disease (COVID-19) Pandemic. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed May 6, 2020.
    [Google Scholar]
  2. Tobias A, 2020. Evaluation of the lockdowns for the SARS-CoV-2 epidemic in Italy and Spain after one month follow up. Sci Total Environ 725: 138539.
    [Google Scholar]
  3. Wang Y et al., 2020. Estimating the basic reproduction number of COVID-19 in Wuhan, China. Zhonghua Liu Xing Bing Xue Za Zhi 41: 476479.
    [Google Scholar]
  4. WHO, 2020. Coronavirus Disease 2019 (COVID-19) Situation Report–153. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200426-sitrep-97-covid-19.pdf?sfvrsn=d1c3e800_6. Accessed May 27, 2020.
    [Google Scholar]
  5. El-Sadr WM, Justman J, 2020. Africa in the path of covid-19. N Engl J Med 383: e11.
    [Google Scholar]
  6. Peter T, Keita MS, Nkengasong J, 2016. Building laboratory capacity to combat disease outbreaks in Africa. Afr J Lab Med 5: 579.
    [Google Scholar]
  7. Baker T et al., 2020. Essential care of critical illness must not be forgotten in the COVID-19 pandemic. Lancet 395: 12531254.
    [Google Scholar]
  8. Napoli PE, Nioi M, 2020. Global spread of coronavirus disease 2019 and malaria: an epidemiological paradox in the early stage of A pandemic. J Clin Med 9: 1138.
    [Google Scholar]
  9. Friese CR, Veenema TG, Johnson JS, Jayaraman S, Chang J, Hawes Cleaver L, 2020. Respiratory protection considerations for healthcare workers during the COVID-19 pandemic. Health Secur 18: 237240.
    [Google Scholar]
  10. Chintalapudi N, Battineni G, Amenta F, 2020. COVID-19 virus outbreak forecasting of registered and recovered cases after sixty day lockdown in Italy: a data driven model approach. J Microbiol Immunol Infect 53: 396403.
    [Google Scholar]
  11. Chen Y, Li Z, Zhang YY, Zhao YH, Yu ZY 2020. Maternal health care management during the outbreak of coronavirus disease 2019. J Med Virol 92: 731739.
    [Google Scholar]
  12. Uganda Bureau of Statistics, 2020. National Mid Year Population Projections by Single Age 2015–2050. Available at: https://www.ubos.org/explore-statistics/statistical-datasets/6133/. Accessed May 6, 2020.
    [Google Scholar]
  13. United Nations Department of Economics and Population Affairs – Population Dynamics, 2019. World Population Prospects. New York, NY: United Nations. Available at: https://population.un.org/wpp/Download/Standard/Population/. Accessed May 6, 2020.
    [Google Scholar]
  14. Pearson CL, Schalkwyk CV, Foss AM, O’Reilly KM, Pulliam JRC, Sacema Modelling and Analysis Response Team, CMMID COVID-Working Group, 2020. Projected early spread of COVID-19 in Africa. Euro Surveill 25: 2000543.
    [Google Scholar]
  15. Murray JLC, Lopez AD. 1996. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020: Summary. Murray CJL, Lopez AD, eds. Geneva, Switzerland: World Health Organization. Available at: https://apps.who.int/iris/handle/10665/41864. Accessed May 6, 2020.
    [Google Scholar]
  16. The World Bank, 2020. Fertility Rate, Total (Births Per Woman) - Uganda. Washington, DC: The World Bank. Available at: https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=UG. Accessed May 6, 2020.
    [Google Scholar]
  17. WHO, 2019. Global Tuberculosis Report 2019. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/tb/global-report-2019. Accessed May 6, 2020.
    [Google Scholar]
  18. WHO, 2019. World Malaria Report 2019. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/publications-detail/world-malaria-report-2019. Accessed May 6, 2020.
    [Google Scholar]
  19. WHO, 2020. WHO Global Health Observatory: Uganda Statistics Summary (2002–Present). Geneva, Switzerland: World Health Organization. Available at: https://apps.who.int/gho/data/node.country.country-UGA. Accessed May 6, 2020.
    [Google Scholar]
  20. UNAIDS, 2020. UNAIDS Global HIV & AIDS Statistics–2019 Fact Sheet. Geneva, Switzerland: UNAIDS. Available at: https://www.unaids.org/en/resources/fact-sheet. Accessed May 6, 2020.
    [Google Scholar]
  21. The World Bank, 2020. Hospital Beds (Per 1,000 People). Washington, DC: The World Bank. Available at: https://dataworldbankorg/indicator/SHMEDBEDSZS?view=chart. Accessed May 6, 2020.
    [Google Scholar]
  22. Ministry of Health, Government of Uganda, 2020. Coronavirus (Pandemic) COVID-19. Kampala, Uganda: Government of Uganda. Available at: https://www.health.go.ug/covid/. Accessed June 22, 2020.
    [Google Scholar]
  23. Johns Hopkins University, 2020. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Baltimore, MD: Johns Hopkins University Corona Virus Resource Center. Available at: https://coronavirus.jhu.edu/map.html. Accessed June 22, 2020.
    [Google Scholar]
  24. Uganda Bureau of Statistics, 2020. Census 2014 Preliminary Report. Kampala, Uganda: Government of Uganda. Available at: http://wwwubosorg/2014-census/census-2014-final-results. Accessed May 2, 2020.
    [Google Scholar]
  25. PEPFAR, 2020. USAID Strategic Information Technical Support (SITES). PEPFAR HIV Surge Implementing Partner’s Performance. Kampala, Uganda: PEPFAR. Reporting period October 1, 2019 to April 5, 2020 (Week 40, 2019 to Week 14, 2020).
    [Google Scholar]
  26. Ministry of Health, Government of Uganda, 2016. Consolidated Guidelines for Prevention and Treatment of HIV in Uganda. Kampala, Uganda: Government of Uganda.
    [Google Scholar]
  27. Ministry of Health, Government of Uganda, 2019. Uganda Population-Based HIV Impact Assessment (UPHIA) 2016–2017: Final Report. Kampala, Uganda: Government of Uganda.
    [Google Scholar]
  28. Ministry of Health, Government of Uganda, 2020. HMIS Dashboard. Kampala, Uganda: Government of Uganda. Available at: https://hmis2.health.go.ug/#/. Accessed May 6, 2020.
    [Google Scholar]
  29. WHO, 2018. WHO Methods and Data Sources for Global Burden of Disease Estimates 2000–2015. Global Health Estimates Technical Paper WHO/HIS/IER/GHE/2018.4. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/healthinfo/global_burden_disease/GlobalDALYmethods_2000_2015.pdf. Accessed April 26, 2020.
    [Google Scholar]
  30. United Nations, 2020. World Population Prospects 2019. New York, NY: United Nations. Available at: https://population.un.org/wpp/Download/Standard/Population/. Accessed May 6, 2020.
    [Google Scholar]
  31. WHO, 2020. The Potential Impact of Health Service Disruptions on the Burden of Malaria: A Modelling Analysis for Countries in Sub-Saharan Africa. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  32. Institute for Health Metrics and Evaluation (IHME), 2020. Global Health Data Exchange. Seattle, WA: IHME, University of Washington. Available at: http://ghdx.healthdata.org/gbd-results-tool. Accessed April 30, 2020.
    [Google Scholar]
  33. et al., 2020. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis 20: 669677.
    [Google Scholar]
  34. Huang I, Lim MA, Pranata R, 2020. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia–a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr 14: 395403.
    [Google Scholar]
  35. Richardson S et al., 2020. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA 323: 20522059.
    [Google Scholar]
  36. Bahendeka S, Wesonga R, Mutungi G, Muwonge J, Neema S, Guwatudde D, 2016. Prevalence and correlates of diabetes mellitus in Uganda: a population-based national survey. Trop Med Int Health 21: 405416.
    [Google Scholar]
  37. Nabwire J, Namasopo S, Hawkes M, 2018. Oxygen availability and nursing capacity for oxygen therapy in Ugandan paediatric wards. J Trop Pediatr 64: 97103.
    [Google Scholar]
  38. Otiangala D et al., 2020. Oxygen insecurity and mortality in resource-constrained healthcare facilities in rural Kenya. Pediatr Pulmonol 55: 10431049.
    [Google Scholar]
  39. Bendavid E et al., 2020. COVID-19 antibody seroprevalence in Santa Clara county, California. Medrxiv. Available at: https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1. Accessed April 29, 2020.
    [Google Scholar]
  40. PEPFAR, 2020. USAID Strategic Information Technical Support (SITES). PEPFAR HIV Surge Implementing Partner’s Performance. Kampala, Uganda: PEPFAR. Reporting period October 1, 2019 to June 7, 2020 (Week 40, 2019 to Week 23, 2020).
    [Google Scholar]
  41. World Food Programme, 2020. WFP Chief Warns of Hunger Pandemic as COVID-19 Spreads (Statement to UN Security Council). Relief Web. OCHA Services. New York, NY: United Nations. Available at: https://reliefweb.int/report/world/wfp-chief-warns-hunger-pandemic-covid-19-spreads-statement-un-security-council. Accessed April 27, 2020.
    [Google Scholar]
  42. Roberts L, 2020. Why measles deaths are surging - and coronavirus could make it worse. Nature 580: 446447.
    [Google Scholar]
  43. The World Bank, 2020. COVID-19 (Coronavirus) Drives Sub-Saharan Africa toward First Recession in 25 Years. Washington, DC: The World Bank. Available at: https://www.worldbank.org/en/news/press-release/2020/04/09/covid-19-coronavirus-drives-sub-saharan-africa-toward-first-recession-in-25-years. Accessed April 27, 2020.
    [Google Scholar]
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  • Received : 28 May 2020
  • Accepted : 16 Jul 2020
  • Published online : 23 Jul 2020
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