Kreienbrinck et al. One Health Implement Res 2021;1:66-79 DOI: 10.20517/ohir.2021.08 One Health & Implementation Research © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. www.ohirjournal.com Open Access Original Article Associations between socioeconomic and public health indicators and the case-fatality rate of COVID- 19 in sub-Saharan Africa Annika Kreienbrinck 1,2 , Hajo Zeeb 2,3 , Heiko Becher 1 1 Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany. 2 Faculty 11: Human and Health Sciences, University of Bremen, Bremen 28359, Germany. 3 Leibniz Institute for Prevention Research and Epidemiology-BIPS GmbH, Bremen 28359, Germany. Correspondence to: Prof. Heiko Becher, Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg- Eppendorf, Martinistr. 52, Hamburg 20246, Germany. E-mail: h.becher@uke.de How to cite this article: Kreienbrinck A, Zeeb H, Becher H. Associations between socioeconomic and public health indicators and the case-fatality rate of COVID-19 in sub-Saharan Africa. One Health Implement Res 2021;1:66-79. https://dx.doi.org/10.20517/ohir.2021.08 Received: 3 Nov 2021 First Decision: 1 Dec 2021 Revised: 8 Dec 2021 Accepted: 17 Dec 2021 Published: 30 Dec 2021 Academic Editor: Jorg Heukelbach Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen Abstract Aim: To investigate the influence of socioeconomic and public health indicators on the COVID-19 case-fatality rate (CFR) in sub-Saharan African countries. Methods: Ecological study using publicly available, aggregated COVID-19 data, between February 2020 to May 2021, from 46 sub-Saharan African countries. As the outcome of interest, country-specific CFRs were calculated for five 13-week periods. Spatial and temporal distributions of the variables were analysed, and negative binomial regressions with rate ratios (RR) were conducted to estimate the association between socioeconomic and public health indicators with CFR of COVID-19. Results: There were 1.7 million confirmed COVID-19 cases and 29,685 deaths in the 46 sub-Saharan African countries during the investigated time period. The median CFR was between 1% and 2%. A higher human development index (RR = 0.80; 95%CI: 0.63-1.02), higher political stability index (RR = 0.94; 95%CI: 0.90-1.00), higher number of hospital beds (RR = 0.84; 95%CI: 0.73-0.97), and higher population density (RR = 0.85; 95%CI: 0.71-1.01) resulted in a lower CFR. Elevated prevalence of diabetes mellitus (RR = 1.56; 95%CI: 0.99-2.45) and cardiovascular disease mortality (RR = 1.51; 95%CI: 1.04-2.20) were associated with higher CFR. Chronic respiratory disease and handwashing facilities presented little to no effects on COVID-19 CFR.