COVID-19 Mortality in Women and Men in Sub-Saharan Africa: A Cross Sectional Study
Authors: Dalal Jyoti , Triulzi Isotta , James Ananthu , Nguimbis Benedict , Dri Gabriela Guizzo , Venkatasubramanian Akarsh , Royd Lucie Noubi Tchoupopnou , Mesa Sara Botero , Somerville Claire , Turchetti Giuseppe , Stoll Beat , Abbate Jessica Lee , Mboussou Franck , Impouma Benido , Keiser Olivia , Coelho Flávio Codeço 
Published: August 2021

AbstractObjectiveTo investigate differences of COVID-19 related mortality among women and men across sub-Saharan Africa (SSA) from the beginning of the pandemic.DesignA cross sectional study.SettingData from 20 member nations of the WHO African region until September 1, 2020.Participants69,580 cases of COVID-19, stratified by sex (men, n=43071; women, n=26509) and age (0-39 years, n=41682; 40-59 years, n=20757; 60+ years, n=7141).Main outcome measuresWe computed the SSA- and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach.ResultsA total of 1,656 (2.4% of total cases reported; 1656/69580) deaths were reported, with men accounting for 1168/1656 (70.5%) of total deaths. In SSA, women had a lower CFR than men (mean CFRdiff = -0.9%; 95% credible intervals -1.1% to -0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 or more (40-59 age-group: mean CFRdiff = -0.7%; 95% credible intervals -1.1% to -0.2%; 60+ age-group: mean CFRdiff = -3.9%; 95% credible intervals -5.3% to -2.4%). At the country level, seven of the twenty SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ age-group in seven countries and 40-59 age-group in one country.Conclusions>Sex and age are important predictors of COVID-19 mortality. Countries should prioritize the collection and use of sex-disaggregated data to understand the evolution of the pandemic. This is essential to design public health interventions and ensure that policies promote a gender sensitive public health response.Summary BoxWhat is already known on this topicLittle is known on the impact of COVID-19 among different sexes and age-groups in sub-Saharan Africa (SSA).The availability of data on COVID-19 cases and deaths, disaggregated by both age and sex from the WHO African region has been scarce.In most of the non-African countries, sex-specific COVID-19 severity and mortality were substantially worse for men than for women, during the first wave of the novel coronavirus (COVID-19) pandemic.What this study addsTo the best of our knowledge, this is the largest study focussing on the COVID-19 related fatalities among men and women in SSA, and it confirmed that both sex and age are important predictors of COVID-19 mortality in SSA, similar to other regions.In SSA, overall, men had a higher case fatality rate (CFR) than women. When disaggregated by age, this difference persisted only in individuals aged 40 or more. 7 among the 20 SSA countries included in this study also reported significantly higher CFRs in men than women for the age-aggregated dataset.Public health prevention activities and responses should take into account gender differences in terms of disease severity and mortality, especially among men aged 40 or more in SSA.