Article: Excess mortality during the COVID-19 pandemic: a geospatial and statistical analysis in Aden governorate, Yemen.
BMJ global health
2021 Volume 6, Issue 3
Abstract: ... across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and ... impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous ... and burials during May-June 2020. To estimate excess mortality during the epidemic period ...
| Abstract | Background: The burden of COVID-19 in low-income and conflict-affected countries remains unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May-June 2020. To estimate excess mortality during the epidemic period, we quantified activity across all identifiable cemeteries within Aden governorate (population approximately 1 million) by analysing very high-resolution satellite imagery and compared estimates to Civil Registry office records. Methods: After identifying active cemeteries through remote and ground information, we applied geospatial analysis techniques to manually identify new grave plots and measure changes in burial surface area over a period from July 2016 to September 2020. After imputing missing grave counts using surface area data, we used alternative approaches, including simple interpolation and a generalised additive mixed growth model, to predict both actual and counterfactual (no epidemic) burial rates by cemetery and across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and thereby compute excess burials. We also analysed death notifications to the Civil Registry office over the same period. Results: We collected 78 observations from 11 cemeteries. In all but one, a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated ≈1500 excess burials up to 6 July, and 2120 up to 19 September, corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data, which indicated a peak 1823 deaths in May alone. However, both sources suggested the epidemic had waned by September 2020. Discussion: To our knowledge, this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial, under-ascertained impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous mathematical modelling predictions, though our method cannot distinguish direct from indirect virus deaths. Satellite imagery burial analysis appears a promising novel approach for monitoring epidemics and other crisis impacts, particularly where ground data are difficult to collect. |
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| MeSH term(s) | COVID-19/mortality ; Cemeteries ; Humans ; Pandemics ; Pneumonia, Viral/mortality ; Pneumonia, Viral/virology ; Registries ; Risk Factors ; SARS-CoV-2 ; Satellite Imagery ; Yemen/epidemiology |
| Language | English |
| Publishing date | 2021-03-20 |
| Publishing country | England |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ISSN | 2059-7908 |
| ISSN | 2059-7908 |
| DOI | 10.1136/bmjgh-2020-004564 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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