Africa's low COVID-19 mortality rate: A paradox?

Int J Infect Dis. 2021 Jan;102:118-122. doi: 10.1016/j.ijid.2020.10.038. Epub 2020 Oct 16.


Background: COVID-19 continues to spread worldwide, with high numbers of fatalities reported first in China, followed by even higher numbers in Italy, Spain, the UK, the USA, and other advanced countries. Most African countries, even with their less advanced healthcare systems, continue to experience lower COVID-19 mortality rates. This was the case as the pandemic reached its first peak, plateaued, and declined. It is currently rising again in some countries, though not as rapidly as before. This study aimed to determine the predictors of COVID-19 mortality rate. This may help explain why Africa's COVID-19 mortality rate is, ironically, lower than that of more advanced countries with better health systems. This will also assist various governments in balancing their COVID-19 restrictive and socioeconomic measures.

Methodology: This was an analytical review, which used pre-COVID-19 era population data and current COVID-19 mortality figures to determine predictors of COVID-19 mortality rates. Pearson's correlation was used to test the association between some population variables and COVID-19 mortality rates. Next, stepwise multiple regression analysis was used to determine significant predictors of COVID-19 mortality rates.

Results: Significant positive predictors of COVID-19 mortality rate included pre-COVID-19 era '65-yr+ mortality %' (R2 = 0.574, B = 2.86, p < 0.001), population mean age (R2 = 0.570, B = 4.77, p = 0.001), and life expectancy (R2 = 0.524, B = 1.67, p = 0.008). Pre-COVID-19 era CVD death rate was a negative predictor of COVID-19 mortality rate (R2 = 0.524, B = -0.584, p = 0.012).

Conclusion: Africa's lower COVID-19 mortality rate is due to the lower population mean age, lower life expectancy, lower pre-COVID-19 era '65yr+ mortality rate', and smaller pool of people surviving and living with cardiovascular diseases.

Keywords: Africa; COVID-19; Cardiovascular disease; Case fatality rate; Elderly; Mortality rate.

MeSH terms

  • Adolescent
  • Adult
  • Africa / epidemiology
  • Aged
  • Aged, 80 and over
  • COVID-19 / mortality*
  • Humans
  • Life Expectancy
  • Middle Aged
  • SARS-CoV-2*
  • Young Adult