Predictors of COVID-19 epidemics in countries of the World Health Organization African Region

Feifei Zhang,Joseph Cabore,Matshidiso Moeti ,Humphrey Karamagi,Ngoy Nsenga,Gordon A Awandare,Zabulon Yoti,Alistair Morrison,Chuan‐Guo Guo ,Margo Chase-Topping,Samuel Haynes,Alexandra C Huber ,Giles Calder-Gerver,Miles Mcgibbon,Miriam N Karinja ,Francisca Mutapi,Miranda Ferguson,Miriam Nanyunja,Seth Amanfo,Tara Wagner-Gamble,Mark Woolhouse

doi:10.1038/s41591-021-01491-7

Abstract

Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning.

Highlights

The direct and indirect effects of the COVID-19 pandemic have been highly heterogeneous across Africa
Using the data for COVID-19 cases and deaths from the World Health Organization (WHO) COVID-19 Dashboard, this study aimed to identify predictors of the timing of the first case and the per capita mortality rate in the first and second COVID-19 pandemic waves in the WHO African Region and to test for any effect of intervention measures on COVID-19-related deaths
On 25 February 2020, Algeria was the first country in the WHO African Region to report COVID-19 cases (Fig. 1a)

Summary

Introduction

The direct and indirect effects of the COVID-19 pandemic have been highly heterogeneous across Africa. It is important to establish whether this variation is primarily driven by differences in intrinsic socio-ecological characteristics, responses to the pandemic or an artifact of differences in reporting. Main findings and This observational study confirmed that early onsets of national COVID-19 epidemics were partly driven by international limitations connectivity, whereas high urbanization, international connectivity and HIV/AIDS prevalence predicted high first wave mortality rate, which, in turn, was a predictor of high second wave mortality rate. Varied levels of data availability and quality of reporting still remain a concern, the mortality data gaps in some countries excluded from this analysis

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