ArticleBMJ (Clinical research ed.)2021
Covid-19 deaths in Africa: prospective systematic postmortem surveillance study.
Article in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 118 papers, 3 of them syntheses that pooled it.
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Who cites it
118 citing papers in PubMed, 3 syntheses or guidelines pooled it, 215 citations in OpenAlex.
- Preparedness of the Ghana Health Service for field epidemiology and applied biostatistics: a systematic review of infectious disease surveillance, outbreak investigation methodologies, and statistical modeling capacities in resource-limited settings.Frontiers in public health · 2026Pooled it
- Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications.BMJ global health · 2022Pooled it
- Active pulmonary tuberculosis and coronavirus disease 2019: A systematic review and meta-analysis.PloS one · 2021Pooled it
- COVID-19 Knowledge and Prevention Behaviors in Rural Zambia: A Qualitative Application of the Information-Motivation-Behavioral Skills Model.The American journal of tropical medicine and hygiene · 2023Trial
- Do Mobile Phone Surveys Supplement Other Mortality Surveillance Methods? Results From a National Study in Bangladesh.Tropical medicine & international health : TM & IH · 2026Article
- Genomic analysis ofbioRxiv : the preprint server for biology · 2026Article
- Rethinking the evidence on COVID-19 in Africa.The Lancet. Infectious diseases · 2025Review
- Article
- Post-Mortem Community Surveillance of COVID-19: Implementation and Evaluation of a Pilot System in the Funeral Sector in England, UK, January 2021 to February 2022.Influenza and other respiratory viruses · 2025Article
- Article
- Clinical outcomes of patients with coronavirus disease 2019 and active tuberculosis co-infection in Beijing China: A retrospective single-center descriptive study.Infectious medicine · 2025Article
- Using Minimally Invasive Tissue Sampling and Determination of Cause of Death to Establish Etiologies of Community Respiratory Deaths Among Zambian Infants and Children.Journal of the Pediatric Infectious Diseases Society · 2025Article
- Surveillance of Excess Mortality Based on Community Perceptions of Funeral Frequency in Northern Malawi during the COVID-19 Pandemic.The American journal of tropical medicine and hygiene · 2025Article
- Spatiotemporal prevalence of COVID-19 and SARS-CoV-2 variants in Africa.Frontiers in public health · 2025Article
- Assessment of COVID-19 death surveillance during the pandemic period in Recife.Revista brasileira de enfermagem · 2025Article
- Association Between COVID19 Vaccination Uptake and Socio-Demographic Characteristics Among Pregnant Women in Kenya.The East African health research journal · 2025Article
- Impact of the COVID-19 pandemic on number of deaths in Ghana: an application of ARIMA with intervention analysis.Frontiers in public health · 2025Article
- Post-Omicron SARS-CoV-2 antibody prevalence in Sierra Leone: A cross-sectional, nationally representative, follow-up serosurvey.PLOS global public health · 2025Article
- Article
- Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021.The Lancet. Infectious diseases · 2024Article
58 more citing papers are in PubMed but not listed here.
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Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo directly measure the fatal impact of coronavirus disease 2019 (covid-19) in an urban African population.
designProspective systematic postmortem surveillance study.
settingZambia's largest tertiary care referral hospital.
participantsDeceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death.
main outcome measurePostmortem nasopharyngeal swabs were tested via reverse transcriptase quantitative polymerase chain reaction (PCR) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Deaths were stratified by covis-19 status, location, age, sex, and underlying risk factors.
results372 participants were enrolled between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%) according to the recommended cycle threshold value of <40 and in 70/364 (19.2%) when expanded to any level of PCR detection. The median age at death among people with a positive test for SARS-CoV-2 was 48 (interquartile range 36-72) years, and 69% (n=48) were male. Most deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death. Among the 19/70 people who died in hospital, six were tested before death. Among the 52/70 people with data on symptoms, 44/52 had typical symptoms of covid-19 (cough, fever, shortness of breath), of whom only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53) of people who died were aged under 60 years. The five most common comorbidities among people who died with covid-19 were tuberculosis (22; 31%), hypertension (19; 27%), HIV/AIDS (16; 23%), alcohol misuse (12; 17%), and diabetes (9; 13%).
conclusionsContrary to expectations, deaths with covid-19 were common in Lusaka. Most occurred in the community, where testing capacity is lacking. However, few people who died at facilities were tested, despite presenting with typical symptoms of covid-19. Therefore, cases of covid-19 were under-reported because testing was rarely done not because covid-19 was rare. If these data are generalizable, the impact of covid-19 in Africa has been vastly underestimated.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.