The Determinants of the Low COVID-19 Transmission and Mortality Rates in Africa: A Cross-Country Analysis.

Yagai Bouba,Emmanuel Kagning Tsinda,Jude Dzevela Kong,Gideon Sadikiel Mmbando,Maxime Descartes Mbogning Fonkou,Nicola Luigi Bragazzi

doi:10.3389/fpubh.2021.751197

Abstract

Background: More than 1 year after the beginning of the international spread of coronavirus 2019 (COVID-19), the reasons explaining its apparently lower reported burden in Africa are still to be fully elucidated. Few studies previously investigated the potential reasons explaining this epidemiological observation using data at the level of a few African countries. However, an updated analysis considering the various epidemiological waves and variables across an array of categories, with a focus on African countries might help to better understand the COVID-19 pandemic on the continent. Thus, we investigated the potential reasons for the persistently lower transmission and mortality rates of COVID-19 in Africa.Methods: Data were collected from publicly available and well-known online sources. The cumulative numbers of COVID-19 cases and deaths per 1 million population reported by the African countries up to February 2021 were used to estimate the transmission and mortality rates of COVID-19, respectively. The covariates were collected across several data sources: clinical/diseases data, health system performance, demographic parameters, economic indicators, climatic, pollution, and radiation variables, and use of social media. The collinearities were corrected using variance inflation factor (VIF) and selected variables were fitted to a multiple regression model using the R statistical package.Results: Our model (adjusted R-squared: 0.7) found that the number of COVID-19 tests per 1 million population, GINI index, global health security (GHS) index, and mean body mass index (BMI) were significantly associated (P < 0.05) with COVID-19 cases per 1 million population. No association was found between the median life expectancy, the proportion of the rural population, and Bacillus Calmette–Guérin (BCG) coverage rate. On the other hand, diabetes prevalence, number of nurses, and GHS index were found to be significantly associated with COVID-19 deaths per 1 million population (adjusted R-squared of 0.5). Moreover, the median life expectancy and lower respiratory infections rate showed a trend towards significance. No association was found with the BCG coverage or communicable disease burden.Conclusions: Low health system capacity, together with some clinical and socio-economic factors were the predictors of the reported burden of COVID-19 in Africa. Our results emphasize the need for Africa to strengthen its overall health system capacity to efficiently detect and respond to public health crises.

Highlights

The global pandemic of “coronavirus disease 2019” (COVID-19), caused by the “Severe acute respiratory syndrome coronavirus2” (SARS- CoV-2) first emerged in Wuhan City, Hubei Province of China [1,2,3]
There was an agreement among most the predictive models that the new pandemic will be disastrous on the African countries, which have a weaker health system and are already facing huge public health challenges; this would be in terms of transmission, severity, and impact of COVID-19 [9,10,11,12,13,14]
To overcome some of the methodological gaps outlined above, in this analysis focused on Africa, we investigated all the factors potentially related to COVID19 burden, to obtain a comprehensive picture of the plausible reasons for the observed persistently lower transmission and mortality rates of COVID-19 on the African continent, more than a year after the first cases were reported on the continent

Summary

Introduction

The global pandemic of “coronavirus disease 2019” (COVID-19), caused by the “Severe acute respiratory syndrome coronavirus2” (SARS- CoV-2) first emerged in Wuhan City, Hubei Province of China [1,2,3]. The SARS-CoV-2 infection rapidly spread in China and thereafter, was reported in the United States, Europe, and all the other continents [4,5,6,7] Following this international spread and the threat it represents for the world, the DirectorGeneral of the WHO declared COVID-19 a “global pandemic” on 11 March 2020. The epidemic evolved rapidly and as of 15 March 2020, a total of 25 countries reported COVID-19 cases in the WHO AFRO region (https://apps.who.int/iris/bitstream/handle/10665/ 331451/OEW11-0915032020.pdf). In this regard, the WHO has called Africa to “wake up” to the coronavirus threat and prepare for the worst scenario. We investigated the potential reasons for the persistently lower transmission and mortality rates of COVID-19 in Africa

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