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Excess Mortality in the Face of COVID-19: Evidence from Addis Ababa Mortality Surveillance Program

Background: The COVID-19 pandemic has been a major global public health disaster causing huge number of deaths. However, there is knowledge gap in understanding the impact of COVID-19 on mortality especially in low- and middle-income countries like Ethiopia where registration systems of vital events are incomplete. This study aimed to assess excess mortality due to COVID-19 in Addis Ababa, using burial site based mortality surveillance. 
 
Methods: Mortality data from all cemeteries in Addis Ababa since 2015 was analyzed to assess whether the adult mortality during the pandemic (January 2020 to September 2020) was different from the expected mortality for that period. The analysis was stratified by sex and by age. In addition, data on COVID-19 symptoms were collected using InterVA COVID-19 rapid mortality surveillance (CRMS) tool to estimate the probability of death involved COVID-19 in the third quarter of 2020. 
 
Finding: The number of deaths (3,747) during the third quarter of 2020 was higher than the upper limit of the 99% confidence interval for the expected deaths for that period, which was 2,893 (99% confidence interval: 2522, 3263)—i.e., about 30% excess mortality. The statistically significant excess mortality (p<0.1) was higher among males and older age groups. From all deceased individuals in the third quarter of 2020, probable number of the death involved COVID-19 was 699 (95% confidence interval: 664, 735), which is 21.5%. 
 
Interpretation: This study has indicated an excess mortality in Addis Ababa likely due to the COVID-19 pandemic. 
 
Funding Statement: Addis Ababa University and Bill and Melinda Gates Foundation. 
 
Declaration of Interests: BS was supported by research funding from the Bill and Melinda gates foundation and Addis Ababa University. All other authors declare no competing interests. 
 
Ethics Approval Statement: The Institutional Review Board (IRB) of the College of Health Sciences, Addis Ababa University, approved the research.