COVID-19 Mortality in Women and Men in Sub-Saharan Africa: A Cross Sectional Study

Dalal, J.; Triulzi, I.; James, A.; Nguimbis, B.; Dri, G. G.; Venkatasubramanian, A.; Lucie, N. T. R.; Mesa, S. B.; Somerville, C.; Turchetti, G.; Stoll, B.; Abbate, J. L.; Mboussou, F.; Impouma, B.; Keiser, O.; Coelho, F. C.

Objective: To investigate differences of COVID-19 related mortality among women and men across sub-Saharan Africa (SSA) from the beginning of the pandemic. Design: A cross sectional study. Setting: Data from 20 member nations of the WHO African region until September 1, 2020. Participants: 69,580 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 measures: We computed the SSA- and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach. Results: A 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 CFR = -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 CFR = -0.7%; 95% credible intervals -1.1% to -0.2%; 60+ age-group: mean CFR = -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.