Relative Burdens of the COVID-19, Malaria, Tuberculosis, and HIV/AIDS Epidemics in Sub-Saharan Africa

• Published in: The American journal of tropical medicine and hygiene 2021-12, Vol.105 (6), p.1510-1515
• Main Authors: Bell, David, Schultz Hansen, Kristian
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Africa South of the Sahara - epidemiology; AIDS; Coronaviruses; Cost of Illness; COVID-19; COVID-19 - epidemiology; Disability-Adjusted Life Years; HIV; HIV Infections - epidemiology; HIV-1; Human immunodeficiency virus; Humans; Infectious diseases; Malaria; Malaria - epidemiology; Mortality; SARS-CoV-2; Tuberculosis; Tuberculosis - epidemiology
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.21-0899

COVID-19 has had considerable global impact; however, in sub-Saharan Africa, it is one of several infectious disease priorities. Prioritization is normally guided by disease burden, but the highly age-dependent nature of COVID-19 and that of other infectious diseases make comparisons challenging unless considered through metrics that incorporate life-years lost and time lived with adverse health. Therefore, we compared the 2020 mortality and disability-adjusted life-years (DALYs) lost estimates for malaria, tuberculosis, and HIV/AIDS in sub-Saharan African populations with more than 12 months of COVID-19 burden (until the end of March 2021) by applying known age-related mortality to United Nations estimates of the age structure. We further compared exacerbations of disease burden predicted from the COVID-19 public health response. Data were derived from public sources and predicted exacerbations were derived from those published by international agencies. For sub-Saharan African populations north of South Africa, the estimated recorded COVID-19 DALYs lost in 2020 were 3.7%, 2.3%, and 2.4% of those for tuberculosis, HIV/AIDS, and malaria, respectively. Predicted exacerbations of these diseases were greater than the estimated COVID-19 burden. Including South Africa and Lesotho, COVID-19 DALYs lost were < 12% of those for other compared diseases; furthermore, the mortality of compared diseases were dominant in all age groups younger than 65 years. This analysis suggests the relatively low impact of COVID-19. Although all four epidemics continue, tuberculosis, HIV/AIDS, and malaria remain far greater health priorities based on their disease burdens. Therefore, resource diversion to COVID-19 poses a high risk of increasing the overall disease burden and causing net harm, thereby further increasing global inequities in health and life expectancy.