COVID-19 in Ethiopia: a geospatial analysis of vulnerability to infection, case severity and death

Kefyalew Addis Alene; Yalemzewod Assefa Gelaw; Dagnachew Muluye Fetene; Digsu N Koye; Yohannes Adama Melaku; Hailay Gesesew; Mulugeta Molla Birhanu; Akilew Awoke Adane; Muluken Dessalegn Muluneh; Berihun Assefa Dachew; Solomon Abrha; Atsede Aregay; Asnakew Achaw Ayele; Woldesellassie M Bezabhe; Kidane Tadesse Gebremariam; Tesfaye Gebremedhin; Amanuel Tesfay Gebremedhin; Lemlem Gebremichael; Ayele Bali Geleto; Habtamu Tilahun Kassahun; Getiye Dejenu Kibret; Cheru Tesema Leshargie; Alemayehu Mekonnen; Alemnesh H Mirkuzie; Hassen Mohammed; Henok Getachew Tegegn; Azeb Gebresilassie Tesema; Fisaha Haile Tesfay; Befikadu Legesse Wubishet; Yohannes Kinfu

doi:10.1136/bmjopen-2020-044606

COVID-19 in Ethiopia: a geospatial analysis of vulnerability to infection, case severity and death

BMJ Open. 2021 Feb 18;11(2):e044606. doi: 10.1136/bmjopen-2020-044606.

Authors

Kefyalew Addis Alene^{1

2

3}, Yalemzewod Assefa Gelaw^#^{3

4}, Dagnachew Muluye Fetene⁵, Digsu N Koye⁶, Yohannes Adama Melaku⁷, Hailay Gesesew^{7

8}, Mulugeta Molla Birhanu^{9

10}, Akilew Awoke Adane^{3

11}, Muluken Dessalegn Muluneh^{12

13}, Berihun Assefa Dachew^{2

3}, Solomon Abrha^{14

15}, Atsede Aregay^{16

17}, Asnakew Achaw Ayele^{18

19}, Woldesellassie M Bezabhe²⁰, Kidane Tadesse Gebremariam^{8

21

22}, Tesfaye Gebremedhin¹⁴, Amanuel Tesfay Gebremedhin^{23

2}, Lemlem Gebremichael^{15

24}, Ayele Bali Geleto^{25

26}, Habtamu Tilahun Kassahun²⁷, Getiye Dejenu Kibret^{28

29}, Cheru Tesema Leshargie^{28

29}, Alemayehu Mekonnen^{30

31}, Alemnesh H Mirkuzie^{32

33}, Hassen Mohammed^{34

35}, Henok Getachew Tegegn^{19

36}, Azeb Gebresilassie Tesema^{8

37}, Fisaha Haile Tesfay^{8

38}, Befikadu Legesse Wubishet²⁶, Yohannes Kinfu^#^{14

39}

Affiliations

¹ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia kefyalew.alene@curtin.edu.au.
² School of Population Health, Curtin University, Perth, Western Australia, Australia.
³ Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
⁴ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Burnet Institute, Melbourne, Victoria, Australia.
⁶ Department of Medicine at Royal Melbourne Hospital and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
⁷ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
⁸ School of Public Health, Mekelle University, Mekelle, Ethiopia.
⁹ Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
¹⁰ St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
¹¹ Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.
¹² Western Sydney University, Penrith South, New South Wales, Australia.
¹³ Monitoring Evaluation and Research, Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia.
¹⁴ University of Canberra, Canberra, Australian Capital Territory, Australia.
¹⁵ School of Pharmacy, Mekelle University, Mekelle, Ethiopia.
¹⁶ Monash University, Clayton, Victoria, Australia.
¹⁷ School of Nursing, Mekelle University, Mekelle, Ethiopia.
¹⁸ School of Pharmacy, University of Gondar, Gondar, Ethiopia.
¹⁹ University of New England, Armidale, New South Wales, Australia.
²⁰ University of Tasmania Faculty of Health, Hobart, Tasmania, Australia.
²¹ Queensland University of Technology, Brisbane, Queensland, Australia.
²² Lifelong Health, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia.
²³ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia.
²⁴ School of Pharmacy and Medical Sciences, Therapeutics Research Centre, University of South Australia, Adelaide, South Australia, Australia.
²⁵ Haramaya University, Dire Dawa, Ethiopia.
²⁶ Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.
²⁷ Australian Rivers Institute, Griffith University, Nathan, Queensland, Australia.
²⁸ College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
²⁹ University of Technology Sydney, Sydney, New South Wales, Australia.
³⁰ Deakin University, Burwood, Victoria, Australia.
³¹ School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia.
³² Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
³³ Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
³⁴ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
³⁵ Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
³⁶ Clinical Pharmacy Department, School of Pharmacy, University of Gondar, Gondar, Ethiopia.
³⁷ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
³⁸ Deakin University, Geelong, Institute for Health Transformation, Melbourne, Victoria, Australia.
³⁹ College of Medicine, Qatar University, Doha, Qatar.

^# Contributed equally.

Abstract

Background: COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia.

Methods: Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km.

Results: This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples' Region. The risk of COVID-19-related death is high in the country's border regions, where public health preparedness for responding to COVID-19 is limited.

Conclusion: This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia.

Keywords: epidemiology; public health.

MeSH terms

COVID-19 / epidemiology*
COVID-19 / mortality
Ethiopia / epidemiology
Female
Geography, Medical*
Humans
Male
Pandemics
Risk Factors