Using mortuary and burial data to place COVID-19 in Lusaka, Zambia within a global context

Richard J. Sheppard, Oliver J. Watson, Rachel Pieciak, James Lungu, Geoffrey Kwenda, Crispin Moyo, Stephen Longa Chanda, Gregory Barnsley, Nicholas F. Brazeau, Ines C. G. Gerard-Ursin, Daniela Olivera Mesa, Charles Whittaker, Simon Gregson, Lucy C. Okell, Azra C. Ghani, William B. MacLeod, Emanuele Fava, Alessia Melegaro, Jonas Z. Hines, Lloyd B. Mulenga, Patrick G. T. Walker (), Lawrence Mwananyanda and Christopher J. Gill
Additional contact information
Richard J. Sheppard: Imperial College
Oliver J. Watson: Imperial College
Rachel Pieciak: Boston University School of Public Health
James Lungu: Avencion Limited
Geoffrey Kwenda: University of Zambia
Crispin Moyo: Avencion Limited
Stephen Longa Chanda: Zambia National Public Health Institute
Gregory Barnsley: Imperial College
Nicholas F. Brazeau: Imperial College
Ines C. G. Gerard-Ursin: Imperial College
Daniela Olivera Mesa: Imperial College
Charles Whittaker: Imperial College
Simon Gregson: Imperial College
Lucy C. Okell: Imperial College
Azra C. Ghani: Imperial College
William B. MacLeod: Boston University School of Public Health
Emanuele Fava: Bocconi University
Alessia Melegaro: Bocconi University
Jonas Z. Hines: Centers for Disease Control and Prevention
Lloyd B. Mulenga: Zambia Ministry of Health
Patrick G. T. Walker: Imperial College
Lawrence Mwananyanda: Boston University School of Public Health
Christopher J. Gill: Boston University School of Public Health

Nature Communications, 2023, vol. 14, issue 1, 1-15

Abstract: Abstract Reported COVID-19 cases and associated mortality remain low in many sub-Saharan countries relative to global averages, but true impact is difficult to estimate given limitations around surveillance and mortality registration. In Lusaka, Zambia, burial registration and SARS-CoV-2 prevalence data during 2020 allow estimation of excess mortality and transmission. Relative to pre-pandemic patterns, we estimate age-dependent mortality increases, totalling 3212 excess deaths (95% CrI: 2104–4591), representing an 18.5% (95% CrI: 13.0–25.2%) increase relative to pre-pandemic levels. Using a dynamical model-based inferential framework, we find that these mortality patterns and SARS-CoV-2 prevalence data are in agreement with established COVID-19 severity estimates. Our results support hypotheses that COVID-19 impact in Lusaka during 2020 was consistent with COVID-19 epidemics elsewhere, without requiring exceptional explanations for low reported figures. For more equitable decision-making during future pandemics, barriers to ascertaining attributable mortality in low-income settings must be addressed and factored into discourse around reported impact differences.

Date: 2023
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DOI: 10.1038/s41467-023-39288-6

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