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Hines JZ, Kapombe P, Mucheleng’anga A, Chanda SL, Hamukale A, Cheelo M, Kamalonga K, Tally L, Monze M, Kapina M, Agolory S, Auld AF, Lungu P, Chilengi R. COVID-19 mortality sentinel surveillance at a tertiary referral hospital in Lusaka, Zambia, 2020-2021. PLOS Glob Public Health 2024; 4:e0003063. [PMID: 38551924 PMCID: PMC10980196 DOI: 10.1371/journal.pgph.0003063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/06/2024] [Indexed: 04/01/2024]
Abstract
Deaths from COVID-19 likely exceeded official statistics in Zambia because of limited testing and incomplete death registration. We describe a sentinel COVID-19 mortality surveillance system in Lusaka, Zambia. We analyzed surveillance data on deceased persons of all ages undergoing verbal autopsy (VA) and COVID-19 testing at the University Teaching Hospital (UTH) mortuary in Lusaka, Zambia, from April 2020 through August 2021. VA was done by surveillance officers for community deaths and in-patient deaths that occurred <48 hours after admission. A standardized questionnaire about the circumstances proximal to death was used, with a probable cause of death assigned by a validated computer algorithm. Nasopharyngeal specimens from deceased persons were tested for COVID-19 using polymerase chain reaction and rapid diagnostic tests. We analyzed the cause of death by COVID-19 test results. Of 12,919 deceased persons at UTH mortuary during the study period, 5,555 (43.0%) had a VA and COVID-19 test postmortem, of which 79.7% were community deaths. Overall, 278 (5.0%) deceased persons tested COVID-19 positive; 7.1% during waves versus 1.4% during nonwave periods. Most (72.3%) deceased persons testing COVID-19 positive reportedly had fever, cough, and/or dyspnea and most (73.5%) reportedly had an antemortem COVID-19 test. Common causes of death for those testing COVID-19 positive included acute cardiac disease (18.3%), respiratory tract infections (16.5%), other types of cardiac diseases (12.9%), and stroke (7.2%). A notable portion of deceased persons at a sentinel site in Lusaka tested COVID-19 positive during waves, supporting the notion that deaths from COVID-19 might have been undercounted in Zambia. Many had displayed classic COVID-19 symptoms and been tested before death yet nevertheless died in the community, potentially indicating strained medical services during waves. The high proportion of cardiovascular diseases deaths might reflect the hypercoagulable state during severe COVID-19. Early supportive treatment and availability of antivirals might lessen future mortality.
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Affiliation(s)
- Jonas Z. Hines
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | | | | | - Amos Hamukale
- Zambia National Public Health Institute, Lusaka, Zambia
| | | | | | - Leigh Tally
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Mwaka Monze
- University Teaching Hospital, Lusaka, Zambia
| | - Muzala Kapina
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Simon Agolory
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Andrew F. Auld
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | | | - Roma Chilengi
- Zambia National Public Health Institute, Lusaka, Zambia
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Chanda SL, Tembo E, Sinyange N, Kayeyi N, Musonda K, Chewe O, Kasonde M, Kapona O, Ngomah A, Hamukale A, Zulu PM, Kapina M. Characteristics of cases and deaths arising from SARS-CoV-2 infection in Zambia: March 2020 to April 2021. Pan Afr Med J 2023; 45:155. [PMID: 37869234 PMCID: PMC10589408 DOI: 10.11604/pamj.2023.45.155.32018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/09/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction since March 2020, Zambia has been experiencing a SARS-CoV-2 epidemic. Little data has been reported on cases and deaths arising from COVID-19 in Africa. We described the demographic characteristics of these cases and deaths in Zambia. Methods we analyzed data on all persons testing positive for SARS-CoV-2 from 18th March 2020 to 25th April 2021 in Zambia. COVID-19 cases were identified through port-of-entry surveillance, contact-tracing, health-care-worker testing, health-facility-based and community-based screening and community-death screening. All diagnoses were confirmed using real-time-polymerase-chain-reaction and rapid-antigen-test-kits of nasopharyngeal specimens. We analyzed age, sex, and date-of-reporting according to whether the cases or deaths occurred during the first wave (1st July to 15th September 2020) or the second wave (15th December 2020 to 10th April 2021). We computed Mann-Whitney-U-test to compare medians of continuous variables and chi-square tests to compare differences between proportions using R. Results a total 1,246 (1.36%) deaths were recorded among 91,378 confirmed cases during March 2020-April 2021 in Zambia. Persons who died were older than those who did not (median age 50 years versus 32.0 years, p< 0.001). Although only 4.7% of cases were among persons aged >60 years, most deaths (31.6%) occurred in this age group (p<0.001). More deaths (83.5%) occurred in the community than in health facilities (p<0.001). Conclusion during the SARS-CoV-2 epidemic in Zambia, most deaths occurred in the community, indicating potential gaps in public health messaging about COVID-19. Improving health-seeking behaviors for COVID-19 through public messaging campaigns and engaging key community stakeholders in Zambia might reduce avoidable mortality. As the group most impacted by COVID-19 mortality, older persons might need enhanced outreach and linkage to care.
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Affiliation(s)
- Stephen Longa Chanda
- Field Epidemiology Training Program (FETP), Zambia National Public Health Institute, Lusaka, Zambia
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Emmanuel Tembo
- Field Epidemiology Training Program (FETP), Zambia National Public Health Institute, Lusaka, Zambia
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Nyambe Sinyange
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Nkomba Kayeyi
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Kunda Musonda
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Orbie Chewe
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Mpanga Kasonde
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Otridah Kapona
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Albertina Ngomah
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Amos Hamukale
- Field Epidemiology Training Program (FETP), Zambia National Public Health Institute, Lusaka, Zambia
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Paul Msanzya Zulu
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
| | - Muzala Kapina
- Zambia National Public Health Program, Surveillance and Disease Intelligence Cluster, Lusaka, Zambia
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Hamukale A, Imamura T, Kapina M, Borkovska O, Musuka CA, Tembo E, Xie Y, Tedesco C, Zulu PM, Sakubita P, Kapaya F, Hamoonga R, Mazaba ML, Nagata C, Ishiguro A, Kapata N, Mukonka V, Sinyange N. Spatial factors for COVID-19 associated community deaths in an urban area of Lusaka, Zambia: an observational study. Pan Afr Med J 2023; 45:32. [PMID: 37545603 PMCID: PMC10403767 DOI: 10.11604/pamj.2023.45.32.37069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/11/2023] [Indexed: 08/08/2023] Open
Abstract
We retrospectively analyzed spatial factors for coronavirus disease 2019 (COVID-19)-associated community deaths i.e., brought-in-dead (BID) in Lusaka, Zambia, between March and July 2020. A total of 127 cases of BID with geocoordinate data of their houses were identified during the study period. Median interquartile range (IQR) of the age of these cases was 49 (34-70) years old, and 47 cases (37.0%) were elderly individuals over 60 years old. Seventy-five cases (75%) of BID were identified in July 2020, when the total number of cases and deaths was largest in Zambia. Among those whose information regarding their underlying medical condition was available, hypertension was most common (22.9%, 8/35). Among Lusaka's 94 townships, the numbers (median, IQR) of cases were significantly larger in those characterized as unplanned residential areas compared to planned areas (1.0, 0.0-4.0 vs 0.0, 0.0-1.0; p=0.030). The proportion of individuals who require more than 30 minutes to obtain water was correlated with a larger number of BID cases per 105 population in each township (rho=0.28, p=0.006). The number of BID cases was larger in unplanned residential areas, which highlighted the importance of targeted public health interventions specifically to those areas to reduce the total number of COVID-19 associated community deaths in Lusaka. Brought-in-dead surveillance might be beneficial in monitoring epidemic conditions of COVID-19 in such high-risk areas. Furthermore, inadequate access to water, sanitation, and hygiene (WASH) might be associated with such distinct geographical distributions of COVID-19 associated community deaths in Lusaka, Zambia.
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Affiliation(s)
- Amos Hamukale
- Public Health National Tuberculosis and Leprosy Program, Ministry of Health, Lusaka, Zambia
| | - Tadatsugu Imamura
- Japan International Cooperation Agency, Tokyo, Japan
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | | | - Olena Borkovska
- Geo-Referenced Infrastructure and Demographic Data for Development, Columbia University, New York, USA
| | - Chisenga Abel Musuka
- Zambia Data Hub, National Spatial Data Infrastructure (NSDI), Lusaka, Zambia
- Ministry of Lands and Natural Resources, Lusaka, Zambia
| | - Emmanuel Tembo
- Zambia Data Hub, National Spatial Data Infrastructure (NSDI), Lusaka, Zambia
| | - Yingtao Xie
- Department of Analytics, Fraym Arlington, Virginia, USA
| | | | | | | | - Fred Kapaya
- National Public Health Institute, Lusaka, Zambia
| | | | | | - Chie Nagata
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
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Himwaze C, Mucheleng'anga LA, Telendiy V, Hamukale A, Tembo J, Kapata N, Ntoumi F, Zumla A. Cardiac cysticercosis and neurocysticercosis in sudden and unexpected community deaths in Lusaka, Zambia: a descriptive medico-legal post-mortem examination study. Int J Infect Dis 2021; 115:195-200. [PMID: 34896266 DOI: 10.1016/j.ijid.2021.11.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cysticercosis is a World Health Organization designated neglected human zoonosis worldwide. Data on cardiac cysticercosis and its contribution to sudden and unexpected community deaths are scarce and require study. METHODS A study was performed of cysticercosis-related deaths and other incidental cases of cysticercosis seen at forensic post-mortem examination over a period of 12 months, in individuals who died suddenly and unexpectedly in the community in Lusaka, Zambia. Whole-body post-mortem examinations were performed according to standard operating procedures for post-mortem examinations. Representative samples were obtained from all body organs and subjected to histopathological examination. Information was obtained on circumstances surrounding the death. Data were collated on patient demographics, history, co-morbidities, pathological gross and microscopic findings, and forensic autopsy cause(s) of death. The available literature on cardiac cysticercosis was also reviewed. RESULTS Nine cases of cysticercosis were identified. Eight of the nine cases had cardiac cysticercosis. There was no prior history of cysticercosis before death. All were male, aged between 28 and 56 years, and from high population density and low socioeconomic communities. There was no community case clustering identified. CONCLUSIONS Cardiac cysticercosis and neurocysticercosis are important incidental findings in sudden and unexpected deaths in the community and can easily be missed antemortem. More investment in forensic autopsy services is required to define the undiagnosed burden of deaths due to treatable communicable diseases.
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Affiliation(s)
- Cordilia Himwaze
- University Teaching Hospital, Department of Pathology and Microbiology, Lusaka, Zambia.
| | - Luchenga Adam Mucheleng'anga
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Lusaka, Zambia; UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Victor Telendiy
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Lusaka, Zambia
| | - Amos Hamukale
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - John Tembo
- UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Nathan Kapata
- UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Faculty of Sciences and Technology, University Marien Ngouabi, Brazzaville, Republic of Congo
| | - Alimuddin Zumla
- UNZA-UCLMS, PANDORA-ID-NET and HERPEZ R&D Program, University Teaching Hospital, Lusaka, Zambia; Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCLHospitals NHS Foundation Trust, London, UK
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Mucheleng'anga LA, Telendiy V, Hamukale A, Shibemba AL, Zumla A, Himwaze CM. COVID-19 and Sudden Unexpected Community Deaths in Lusaka, Zambia, Africa - A Medico-Legal Whole-Body Autopsy Case Series. Int J Infect Dis 2021; 109:160-167. [PMID: 34320461 PMCID: PMC8255190 DOI: 10.1016/j.ijid.2021.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/06/2023] Open
Abstract
Background Data from Africa regarding sudden and unexpected COVID-19 community deaths and underlying pathological, demographic, and co-morbidity features require definition. Methods We performed a case series of COVID-19-related deaths seen at Forensic Post-Mortem examination of sudden and unexpected Community Deaths in Lusaka, Zambia, Africa. Whole-body Post-Mortem examinations were performed according to Standard Operating Procedures. Patient demographics, history, co-morbidities, pathological gross and microscopic findings, and cause(s) of death were recorded. Variables were grouped as frequencies and percentages. Comparison of data was made with autopsy findings of hospital COVID-19 deaths. Findings Of 21 COVID-19 decedents, 14/21 (66.7%) were male; 18/21, (85.7%) were below 55 years of age (mean age, 40 ± 12.3; range, 20-73). The median duration of symptoms was 1 day (range 0-2); 9/21 (42.9%) had co-morbidities, with hypertension and obesity being the most common. Main post-mortem findings were diffuse alveolar damage (DAD) (80.9%), saddle and shower emboli (38.1%, respectively), and pneumonia (14.3%). Pulmonary thromboembolism (76.2%), DAD (14.3%), and SARS-CoV-2 pneumonia (9.5%) were common causes of death. Conclusions COVID-19 is an important cause of death to consider in forensic investigations of sudden and unexpected community deaths. Risk factors for the younger age of COVID-19 deaths and thromboembolism need to be identified.
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Affiliation(s)
| | - Viktor Telendiy
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Nationalist Road, Lusaka, Zambia
| | | | - Aaron Lunda Shibemba
- University Teaching Hospitals, Department of Pathology and Microbiology, Nationalist Road, Lusaka, Zambia
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK, and UNZA-UCLMS R&D Program, Lusaka, Zambia
| | - Cordelia Maria Himwaze
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Nationalist Road, Lusaka, Zambia; University Teaching Hospitals, Department of Pathology and Microbiology, Nationalist Road, Lusaka, Zambia
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Himwaze CM, Telendiy V, Maate F, Mupeta S, Chitalu C, Chanda D, Julius P, Mumba C, Marimo C, Hamukale A, Mulenga L, Shibemba AL, Zumla A, Mucheleng'anga LA. Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series. Int J Infect Dis 2021; 108:363-369. [PMID: 34146690 PMCID: PMC8215884 DOI: 10.1016/j.ijid.2021.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Since information on the pathology of COVID-19 from sub-Saharan Africa (SSA) remains scarce, the objective of our study was to define the gross pathology and histological features of COVID-19. We report data from 29 whole-body autopsies of COVID-19 deaths occurring in hospitals in Lusaka, Zambia - the first large autopsy case series from Africa. METHODS We performed a descriptive post-mortem examination study of inpatient COVID-19 related deaths at two hospitals in Lusaka, Zambia. Whole-body autopsies were conducted according to Standard Operating Procedures. Gross and histopathological examinations of all organs were performed. Patient demographics, history, co-morbidities, autopsy gross and microscopic findings, and cause(s) of death were recorded and analyzed using STATA version 14. Variables were grouped and presented as frequencies and percentages. FINDINGS Autopsies were performed on 29 decedents (mean age = 44 ± 15.8years; age range = 19-82; 17/29 [58.8%] males). 22/29 [75.9%] cases were <55 years of age. A spectrum of pathological manifestations of COVID-19 were seen in all organs. The commonest causes of death were pulmonary thromboembolism (13/29, 45%), Diffuse Alveolar Damage (9/29, 31%), and COVID-19 pneumonia (7/29, 25%). 22/29 (76%) had co-morbidities. Common co-morbidities included HIV (8/29, 28%), Hypertension (6/29, 20%) Tuberculosis (3/29, 10%), Diabetes (3/29, 10%). CONCLUSIONS A spectrum of gross anatomical and histopathological findings are seen in COVID-19 deaths in hospitalized decedents. These appear broadly similar to those reported from China, Europe and USA. Differences include a younger age group, and co-morbidities of HIV and TB co-infection which require further investigation.
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Affiliation(s)
- Cordilia Maria Himwaze
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Nationalist Road, Lusaka, Zambia; Department of Pathology and Microbiology, Adult and Emergency Hospital-University Teaching Hospitals, Nationalist Road, Lusaka, Zambia
| | - Viktor Telendiy
- Ministry of Home Affairs, Office of the State Forensic Pathologist, Nationalist Road, Lusaka, Zambia
| | - Fred Maate
- The University of Zambia, School of Medicine, Department of Pathology and Microbiology, Nationalist Road, Lusaka, Zambia
| | - Songwe Mupeta
- Department of Pathology and Microbiology, Adult and Emergency Hospital-University Teaching Hospitals, Nationalist Road, Lusaka, Zambia
| | - Chanda Chitalu
- University Teaching Hospitals, Infectious Disease Unit, Nationalist Road, Lusaka, Zambia
| | - Duncan Chanda
- University Teaching Hospitals, Infectious Disease Unit, Nationalist Road, Lusaka, Zambia
| | - Peter Julius
- The University of Zambia, School of Medicine, Department of Pathology and Microbiology, Nationalist Road, Lusaka, Zambia
| | - Chibamba Mumba
- The University of Zambia, School of Medicine, Department of Pathology and Microbiology, Nationalist Road, Lusaka, Zambia
| | - Clemence Marimo
- Cavendish University Zambia, School of Medicine, Department of Research, Longacres Campus, Lusaka, Zambia
| | - Amos Hamukale
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Llyod Mulenga
- University Teaching Hospitals, Infectious Disease Unit, Nationalist Road, Lusaka, Zambia
| | - Aaron Lunda Shibemba
- Department of Pathology and Microbiology, Adult and Emergency Hospital-University Teaching Hospitals, Nationalist Road, Lusaka, Zambia; UNZA-UCLMS R&D Program, University Teaching Hospital, Lusaka, Zambia
| | - Alimuddin Zumla
- UNZA-UCLMS R&D Program, University Teaching Hospital, Lusaka, Zambia; Division of Infection and Immunity, University College London, NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
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