In Africa, ascertainment of COVID-19-specific deaths was constrained by limited access to COVID-19 testing. They cover only a fraction of the national population and cannot be considered representative of the whole country, but they provide a robust empiric insight into the longitudinal mortality experience of selected African populations throughout the pandemic. Health and demographic surveillance systems (HDSS), which conduct longitudinal population-based mortality surveillance, provide an alternative source of mortality data. For example, predictions of a lower mortality impact in Africa, based on its youthful population structure, stimulated arguments to sustain health spending on existing threats such as malaria, HIV, and respiratory tract infections in children rather than redirect funding to COVID-19 response measures 7. This lack of data has led to controversy in the interpretation of the pandemic’s impact in Africa and this has significant consequences for policy. In Kenya, national vital registration now records more than half of all deaths but the increasing coverage of deaths in recent years makes it unsuitable to estimate temporal trends in mortality patterns 6. Across sub-Saharan Africa, most countries lack vital registration systems and only South Africa contributed national mortality data to these models the estimates of deaths in all other countries were extrapolated from mortality patterns observed elsewhere. An important factor driving this variation is uncertainty regarding the impact of COVID-19 in Africa 5. Estimates of global excess mortality during the COVID-19 pandemic in 2020–2021 vary widely from 14.8 million to 19.8 million 1, 2, 3, 4.
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