Assessing the impact of COVID-19 pandemic on all-cause mortality and child mortality in a population cohort of Iganga Mayuge HDSS in Eastern Uganda (2015-2021).

Publication date: Dec 08, 2025

Efforts to track the mortality and public health impact of the coronavirus disease (COVID-19) in Uganda have been hampered by weak Civil registration and vital statistics (CRVS) system and suboptimal health seeking behaviors or patterns. Evaluating unexplained increases in all-cause mortality provides a complete picture of the impact of COVID-19 pandemic and guide public health policies and resource allocation to protect the most vulnerable populations. The longitudinal population cohort data on demographic events and socioeconomic status collected from 2015 to 2021 within the Iganga Mayuge Health and Demographic Surveillance System (IMHDSS) was used. Number of deaths and person years at risk were counted for each quarter of the year from January 2015 to December 2021 and classified as “pre-pandemic” (before January 2020), and “during pandemic” (January 2020 to December 2021). Crude mortality rates were computed comparing the two periods. Time series model was used to estimate excess mortality and to locate the exact time when excess deaths occurred. Cox Proportional Hazard model was used to estimate the Hazard ratio associated with death. A total of 132,367 individuals were followed up from 2015 to 2021 and 3,424 deaths were registered. Slightly more than a half of all deaths (53%, n = 1,827) were male, and 65. 4% (n = 2,238) were rural residents. Children under five years had a significantly higher CMR during COVID-19 period of 18. 9, (95% CI 17. 2-20. 8) per 1000 person compared to 12. 5 (95% CI 11. 6-13. 4) per 1000 person years before COVID-19. The risk of dying among children under 5 years compared to those aged between 5 and 14 years was higher during the COVID-19 pandemic period (aHR = 18. 0, 95% CI 13. 6-24. 0) than pre-pandemic (aHR = 10. 4, 95% CI 8. 8-12. 3). The COVID-19 pandemic increased all-cause mortality in the Iganga Mayuge HDSS population cohort in Eastern Uganda, particularly among children under five, likely due to restricted healthcare access and economic disruptions. Pandemic response measures should prioritize vulnerable populations at higher risk of malnutrition and preventable diseases to mitigate future negative impacts.

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