Surveillance and Disease Intelligence Cluster, Zambia National Public Health Institute, Stand No. 1186 Corner of Chaholi & Addis Ababa Roads, Lusaka, Zambia.
United States Centers for Disease Control and Prevention, Lusaka, Zambia.
BMC Public Health. 2024 Sep 27;24(1):2625. doi: 10.1186/s12889-024-20045-3.
The number of COVID-19 deaths reported in Zambia (N = 4069) is most likely an underestimate due to limited testing, incomplete death registration and inability to account for indirect deaths due to socioeconomic disruption during the pandemic. We sought to assess excess mortality during the COVID-19 pandemic in Zambia.
We conducted a retrospective analysis of monthly-death-counts (2017-2022) and individual-daily-deaths (2020-2022) of all reported health facility and community deaths at district referral health facility mortuaries in 12 districts in Zambia. We defined COVID-19 wave periods based on a sustained nationally reported SARS-CoV-2 test positivity of greater than 5%. Excess mortality was calculated as the difference between observed monthly death counts during the pandemic (2020-2022) and the median monthly death counts from the pre-pandemic period (2017-2019), which served as the expected number of deaths. This calculation was conducted using a Microsoft Excel-based tool. We compared median daily death counts, median age at death, and the proportion of deaths by place of death (health facility vs. community) by wave period using the Mann-Whitney-U test and chi-square test respectively in R.
A total of 112,768 deaths were reported in the 12 districts between 2020 and 2022, of which 17,111 (15.2%) were excess. Wave periods had higher median daily death counts than non-wave periods (median [IQR], 107 [95-126] versus 96 [85-107], p < 0.001). The median age at death during wave periods was older than non-wave periods (44.0 [25.0-67.0] versus 41.0 [22.0-63.0] years, p < 0.001). Approximately half of all reported deaths occurred in the community, with an even greater proportion during wave periods (50.6% versus 53.1%, p < 0.001), respectively.
There was excess mortality during the COVID-19 pandemic in Zambia, with more deaths occurring within the community during wave periods. This analysis suggests more COVID-19 deaths likely occurred in Zambia than suggested by officially reported numbers. Mortality surveillance can provide important information to monitor population health and inform public health programming during pandemics.
由于检测能力有限、死亡登记不完整以及无法统计大流行期间因社会经济动荡而间接导致的死亡人数，赞比亚报告的 COVID-19 死亡人数（N=4069）很可能被低估了。我们试图评估 COVID-19 大流行期间赞比亚的超额死亡率。
我们对 12 个地区转诊卫生机构太平间报告的所有卫生机构和社区死亡的每月死亡人数（2017-2022 年）和个人每日死亡人数（2020-2022 年）进行了回顾性分析。我们根据全国持续报告的 SARS-CoV-2 检测阳性率大于 5%来定义 COVID-19 波次。超额死亡率的计算方法是将大流行期间（2020-2022 年）观察到的每月死亡人数与大流行前（2017-2019 年）的每月死亡人数中位数进行比较，前者为预期死亡人数。这项计算是使用基于 Microsoft Excel 的工具进行的。我们在 R 中分别使用曼-惠特尼 U 检验和卡方检验比较了各波次的每日死亡人数中位数、死亡时的中位年龄以及按死亡地点（卫生机构与社区）划分的死亡比例。
2020 年至 2022 年间，12 个地区共报告了 112768 例死亡，其中 17111 例（15.2%）为超额死亡。波次期间的每日死亡人数中位数高于非波次期间（中位数[IQR]，107[95-126]比 96[85-107]，p<0.001）。波次期间的死亡时中位年龄大于非波次期间（44.0[25.0-67.0]比 41.0[22.0-63.0]岁，p<0.001）。大约一半的报告死亡发生在社区，波次期间这一比例甚至更高（50.6%比 53.1%，p<0.001）。
赞比亚 COVID-19 大流行期间存在超额死亡率，且波次期间社区内的死亡人数更多。这一分析表明，赞比亚的 COVID-19 死亡人数可能比官方报告的数字更多。死亡率监测可以提供重要信息，以监测大流行期间的人口健康并为公共卫生规划提供信息。
