High rates of undocumented COVID-19 mortality in Zambia without testing challenges the idea that Africa has been spared

Simon Collins, HIV i-Base

A paper published ahead of peer-review reported significant levels of COVID-19 in post mortum testing of people who died in Lusaka, Zambia.

The results show that COVID-19 is a serious cause of death, including in children.

Between June to September 2020, the study enrolled 372 people who had recently  died and whose bodies were in the mortuary of the University Teaching Hospital (UTH) in Lusaka, Zambia.

COVID-19 was detected in 70/364 (19%) of those with PCR results.

The median age for the COVID-19 deaths was 48 years (IQR: 36 to 72; range: <1 to 105) and 70% were male. However, 75% of deaths were <60 years old and 7/70 (10%) were children. Three of the children were <1, two were 1 to 3 years and two were teenagers. Symptoms recorded in the children were predominantly GI gastrointestinal symptoms (nausea, vomiting, diarrhea or abdominal pains).

Most COVID-19 deaths (51/70, 73%) occurred in the community and none had been previously tested for COVID-19. 

Of the 19/70 deaths that occurred in hospital, 6/19 had been tested for COVID-19 during admission.

Of the 52/70 with information recorded on their symptoms, 44/52 included common COVID-19 symptoms (cough, fever, shortness of breath), but only 5/44 had been tested for COVID-19.

The five most common recorded co-morbidities were: tuberculosis (31%); hypertension (27%); HIV (23%); alcohol use (17%); and diabetes (13%).

The paper has since been accepted for publication in the BMJ.


These results represented approximately 10% of 3676 deaths registered over this period.

The paper explains that due to the high number of deaths, enrollment was limited to weekdays during working hours, and that, for example, every fifth death was registered during July and every third death in August, with a daily cap of five deaths per day in both cases.

The paper comments that the high percentage of dealths in the community, where the was no COVID-19 tested was contributing to a significant underestimations of COVID-19 in Zambia. This is compounded by rarity of testing in people hospitalised, even with common symptoms of COVID-19.

The authors comment that if similar findings occur in other countries in Africa, noting that Zambia is hardly the poorest country, then the idea that COVID-19 spared the continent is clearly challenged by these results.


Mwananyanda L et al. COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa. Pre-peer reviews. MedRxiv. 10.1101/2020.12.22.20248327. (24 December 2021).

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