Excess mortality during the COVID-19 pandemic: a geospatial and statistical analysis in Aden governorate, Yemen.

Autor:	Koum Besson ES; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK emilie.koum-besson@lshtm.ac.uk., Norris A; Earth observation, Satellite Applications Catapult, Didcot, UK., Bin Ghouth AS; Department of Community Medicine, Hadhramout University, Mukalla, Yemen., Freemantle T; Earth observation, Satellite Applications Catapult, Didcot, UK., Alhaffar M; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK., Vazquez Y; Earth observation, Satellite Applications Catapult, Didcot, UK., Reeve C; Earth observation, Satellite Applications Catapult, Didcot, UK., Curran PJ; Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Checchi F; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Mar; Vol. 6 (3).
DOI:	10.1136/bmjgh-2020-004564
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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