Spatialtemporal trends of COVID-19 infection and mortality in Sudan | Scientific Reports – Nature.com

Description of COVID-19 infection rate in Sudan

COVID-19 infection in Sudan had wide variation during the study period across the different states of Sudan. The highest incidence rate had occurred in December-2020 with a total incidence of 4863 cases ranging from 0 cases in some of the states to 4164 cases in other states (mean=270946, median=21 cases). Followed by the incidence in May, 2020 with a total of 4524 cases ranging from 4 to 3509 cases (mean=251794, median=31 cases). Table 1 below illustrates the incidence rate of COVID-19 in Sudan.

The incidence rate of COVID-19 across the different states of Sudan was studied (Fig.1). The spatialtemporal trend of this pandemic varied across different states. Khartoum State was the most affected state during all the months, followed by El Gezira State. Both of these states lay in the middle of the country. The western states of the country had lower incidence rate of COVID-19 infection. October, 2020 had the lowest incidence rate in all states. Furthermore, five states had zero incidence of COVID-19 infection in October, 2020. The wavy nature was apparent in the different states across the months. Figure1 below shows the spatialtemporal presentation of COVID-19 infection.

COVID-19 Infection rate across the states of Sudan May 2020March 2021 developed through ArcGIS 10.8 by Abd El-Raheem et al. (Shp. files of the base maps https://www.diva-gis.org/gdata).

On assessing the correlation between COVID-19 infection and the population density in each state, a strong positive correlation (Pearsons correlation=0.885, p-value=0.000) was found between cumulative infection and population density across Sudan States. The middle states (Khartoum and El Gezira) had the highest infection rate and the highest population density (Fig.2). While, the western states (Western Darfur, Central Darfur and Eastern Darfur) had the lowest rate of COVID-19 infection. These western states had low population density (Fig.2).

Cumulative COVID-19 Infection across the Sudan States and population of each State developed through ArcGIS 10.8 by Abd El-Raheem et al. (Shp. files of the base maps https://www.diva-gis.org/gdata).

Mortality rate among COVID-19 cases had wide variations, yet it had less variability than the infection rate. During all of the months, some of the states had zero mortalities. Nevertheless, the rate of mortality showed similar pattern of the wavy nature. These surges of COVID-19 were apparent, the peaks of mortality rate were during May and June -2020, with total mortalities of 295 (mean=1639) and 301 (mean=1730) cases respectively. Then another surge was apparent in December-2020 and January-2021, with mortalities of 192 (mean=1137) and 191 (mean=1129) cases respectively. As well as, another surge was starting in March-2021, which showed mortality rate of 181 cases (mean=1024 cases). The cumulative mortality of COVID-19 during the 11month of the study period was 1565 cases with a mean of 87188 cases (median=29 cases). Table 2 below illustrated the statistics of mortality for each month.

Mortality rate across the different states was studied (Fig.3). The monthly mortality cases of COVID-19 were presented spatially. Mortality rate had differed from one state to another and from one month to the other (Fig.3). Interestingly, in the surge of May and June-2020, the mortalities were prevalent in almost all the states. In May-2020, Khartoum, El Gezira, Northern Darfur and Northern Kordofan had the highest mortality rates (167, 56, 23 and 12 dead cases/month respectively). In June-2020, mortality was the highest in Khartoum, El Gezira and Northern Darfur (115, 78 and 19 dead cases/month respectively). The mortality rate was zero in October-2020 in 17 states of Sudan consistent with the infection rate. Only one state (El Gezira) had reported mortalities during October-2020 (one dead case). During the surge of December-2020 and January-2021; mortalities were centered in the middle states (Khartoum and El Gezira). About 10 states had zero mortalities in the surge of December and January. In March-2021, mortality rates were rising again; especially in Khartoum State (100 dead cases/month). Figure3 illustrates the details of the mortality trend in Sudan across the different months.

COVID-19 Mortality rate across the states of Sudan May 2020-March 2021 developed through ArcGIS 10.8 by Abd El-Raheem et al. (Shp. files of the base maps https://www.diva-gis.org/gdata).

Cumulative COVID-19 mortality map (Fig.4) showed the overall mortality in Sudan at state level. The states with the highest cumulative mortality were Khartoum and El Gezira (801 and 326 dead cases respectively). While, the lowest mortalities were in Western Kordofan and Southern Darfur (1 dead case each). In general, the western and southern states of the country had the lowest mortality rates. While, the middle states (Khartoum and El Gezira) had the highest mortalities. Northern and eastern states had lower mortalities than the middle states, yet, higher than the western and southern states (Fig.4).

Cumulative COVID-19 Mortality across the Sudan States developed through ArcGIS 10.8 by Abd El-Raheem et al. (Shp. files of the base maps https://www.diva-gis.org/gdata).

Prevalence of COVID-19 infection in Sudan was obtained. The number of cases per thousand populations were calculated for each of the states of Sudan to develop the risk map (Fig.5). Areas with the highest risk were the center and the east parts of the country. Khartoum State had the highest prevalence (2.6 cases/1000 populations). While, the areas with the lowest risk were the western parts of the country; with Western Darfur having the lowest risk of COVID-19 infection (prevalence=0.09 cases/1000 populations). Figure5 presented the risk map of COVID-19 in Sudan.

Risk Map of COVID-19 Infection in Sudan developed through ArcGIS 10.8 by Abd El-Raheem et al. (Shp. files of the base maps https://www.diva-gis.org/gdata).

Infection and mortality rates were studied together to find the correlation between these rates. Strong positive correlation between infection and mortality (Pearsons correlation=0.789, p-value=0.004) was found in Fig.6, the peaky nature of COVID-19 infection is clear; showing two peaks and the third peak was starting. Infection rate was high in May and June-2020, then started decreasing until October-2020 (lowest infection rate). During the peak of May 2020, mortality accounted for 6.5% of the cases (295/4524). After that, infection had started in increase in November, reaching a peak in December-2020.On the peak, COVID-19 mortality was 3.9% (192/4863). The December 2020 peak was then decreased in February-2021. In March, the infection rate had started to rise. Mortality trend was less peaky; mortality rates were much lower than the infection rates. Even though, increases in mortality rates were apparent in Fig.6 consistent with the peaks of infection.

Correlation between COVID-19 infection and mortality over time (May, 2020March, 2021).

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Spatialtemporal trends of COVID-19 infection and mortality in Sudan | Scientific Reports - Nature.com