Study finds higher mortality rates among African children and adolescents hospitalized with COVID-19

Reviewed by Emily Henderson, B.Sc.Feb 16 2022

African children and adolescents hospitalized with COVID-19 experience much higher mortality rates than Europeans or North Americans of the same age, according to a recently published study conducted by researchers from the Institute of Human Virology (IHV) at the University of Maryland School of Medicine (UMSOM) and the Institute of Human Virology Nigeria (IHVN). Both organizations are members of the Global Virus Network (GVN).

The study, titled, "Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized with COVID-19 in six Sub-Saharan African Countries," was conducted by a collaboration under AFREhealth (the African Forum for Research and Education in Health), a consortium of cross-disciplinary health personnel across Africa. The research was published on January 19 in JAMA Pediatrics, the highest-ranked pediatrics journal in the world.

This study provides important information about COVID-19 among African children, which was not previously available at this scale. We now have evidence from multiple countries to show that African children also experience severe COVID-19; they experience multisystem inflammatory syndrome; some require intensive care; some also die, and at much higher rates than outside Africa."

Nadia Sam-Agudu, MD, Associate Professor of Pediatrics at the UMSOM's Institute of Human Virology, and Senior Technical Advisor for Pediatric and Adolescent HIV, Institute of Human Virology Nigeria

Dr. Sam-Agudu is a co-first author along with Principal Investigator Dr. Jean Nachega of the University of Pittsburgh and Stellenbosch University in Cape Town, South Africa.

The AFREhealth study collected data from 25 health facilities across Nigeria, Ghana, Democratic Republic of the Congo, Kenya, South Africa, and Uganda. The study included 469 African children and adolescents aged three months to 19 years hospitalized with COVID-19 between March and December 2020. The team reported a high overall mortality rate of 8.3%, compared with 1% or less totaled from Europe and North America. Furthermore, African children less than a year old and with pre-existing, non-communicable diseases were more likely to have poorer outcomes, such as requiring intensive care, and death.

Eighteen participants had suspected or confirmed multisystem inflammatory syndrome (also known as MIS-C), and four of these children died.

Dr. Sam-Agudu, who led the West Africa team for the study, urged health authorities and policymakers in Nigeria and other African countries to act upon the study findings "to protect children by expanding vaccine approvals and procurements for children specifically, as the variants emerging since our study's completion have either caused more severe disease and/or more cases overall. We cannot leave children behind in the pandemic response."

Dr. Sam-Agudu was recently awarded a 2022 Dr. Thomas Hall-Dr. Nelson Sewankambo Mid-Career Leadership Award from The Consortium of Universities for Global Health. The award acknowledges outstanding individuals for accomplishments and commitment to contributing to the advancement of global health worldwide.

According to Associate Professor of Epidemiology and Public Health at the Institute of Human Virology of UMSOM and IHVN Chief Executive Officer, Patrick Dakum, MBBS, MPH, "This data from Dr. Sam-Agudu and AFREhealth collaborators puts science from Nigeria and the rest of Africa squarely on the map for pandemic-responsive research, particularly for young populations. We will continually work towards contributing to research discoveries in Nigeria, West Africa and beyond," he said.

Alash'le Abimiku, PhD, Professor of Medicine at the UMSOM's Institute of Human Virology, and Executive Director of the Institute of Human Virology Nigeria's International Research Center of Excellence, also noted that, "The high impact pediatric COVID-19 findings of this collaborative research underscores the value of sustained investments in strong research institutions, collaborations, and leadership in Nigeria and across Africa. We can generate rigorous local data to guide local, regional, and international health policy and practice."

The Director-General of the Nigeria Centre for Disease Control, Dr. Ifedayo Adetifa, remarked: "The AFREhealth study findings show that COVID-19 affects children and can cause severe consequences. Thus, we seriously need to factor children into age-disaggregated COVID-19 disease surveillance and reporting, and consider COVID-19 illness when they present to the hospital. Furthermore, the high in-hospital mortality rate reported indicates a need for investments in critical care for children in African settings. We need more of such rigorous multicenter studies to inform evidence-based policy-making in Nigeria and other African countries."

Robert Gallo, MD, The Homer & Martha Gudelsky Distinguished Professor in Medicine, Co-Founder and Director of the Institute of Human Virology at the University of Maryland School of Medicine, a GVN Center of Excellence, and Co-Founder and International Scientific Advisor of the GVN, said, "I am pleased to see our team of researchers continue to build upon the Institute's eighteen years of work in African nations, particularly Nigeria, and successfully advance a study across varying nations to garner much needed data as this pandemic continues to evolve. Africa is the epicenter of many epidemics, and an important partner in researching viral threats. 'Pan' means all, and we must all work together to combat viral threats against mankind."

Dean E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, University of Maryland Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor at UMSOM, added: "Studies like this are essential to ensure that no one country or region is suffering any unneeded hardship. As a result, policy makers and world leaders can better allocate resources to those people and places who need them most."

The research builds upon the presence of the UMSOM's Institute of Human Virology International Program and the network of international experts who work with local stakeholders to combat infectious diseases across the globe.