Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

doi:10.1136/bmjopen-2020-044618

. 2021 Feb 18;11(2):e044618.

doi: 10.1136/bmjopen-2020-044618.

Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

Hailay Abrha Gesesew^{1

2}, Digsu Negese Koye³, Dagnachew Muluye Fetene⁴, Mulu Woldegiorgis⁴, Yohannes Kinfu^{5

6}, Ayele Bali Geleto^{7

8}, Yohannes Adama Melaku⁹, Hassen Mohammed^{10

11}, Kefyalew Addis Alene^{12

13

14}, Mamaru Ayenew Awoke¹⁵, Mulugeta Molla Birhanu^{16

17}, Amanuel Tesfay Gebremedhin^{12

13}, Yalemzewod Assefa Gelaw^{14

18}, Desalegn Markos Shifti^{17

19}, Muluken Dessalegn Muluneh^{20

21}, Teketo Kassaw Tegegne^{19

22}, Solomon Abrha^{5

23}, Atsede Fantahun Aregay^{24

25}, Mohammed Biset Ayalew^{26

27}, Abadi Kahsu Gebre^{28

29}, Kidane Tadesse Gebremariam^{2

30

31}, Tesfaye Gebremedhin³², Lemlem Gebremichael^{23

33}, Cheru Tesema Leshargie^{22

34}, Getiye Dejenu Kibret^{22

35}, Maereg Wagnew Meazaw⁷, Alemayehu Berhane Mekonnen^{36

37}, Dejen Yemane Tekle^{2

38}, Azeb Gebresilassie Tesema^{2

38}, Fisaha Haile Tesfay^{2

39}, Wubshet Tesfaye⁴⁰, Befikadu Legesse Wubishet⁷, Berihun Assefa Dachew^#^{12

41}, Akilew Awoke Adane^#^{41

42}

Affiliations

¹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia hailushepi@gmail.com.
² Scool of Public Health, Mekelle University, Mekelle, Ethiopia.
³ Department of Medicine at Royal Melbourne Hospital and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Burnet Institute, Melbourne, Victoria, Australia.
⁵ Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
⁶ College of Medicine, Doha, Qatar.
⁷ Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia.
⁸ School of Public Health, Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia.
⁹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
¹⁰ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹¹ Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
¹² School of Population Health, Curtin University, Perth, Western Australia, Australia.
¹³ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.
¹⁴ Institute of Public Health, University of Gondar, Gondar, Ethiopia.
¹⁵ School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
¹⁶ Department of Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁷ Saint Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia.
¹⁸ Population Child Health Research Group, School of Women's & Children's Health, UNSW, Sydney, New South Wales, Australia.
¹⁹ Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.
²⁰ School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia.
²¹ Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia.
²² College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
²³ Department of Pharmacology, Mekelle University, Mekelle, Ethiopia.
²⁴ School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
²⁵ School of Nursing, Mekelle University, Mekelle, Ethiopia.
²⁶ Department of Pharmacy, University of New England, Armidale, New South Wales, Australia.
²⁷ Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia.
²⁸ School of Pharmacy, Mekelle University, Mekelle, Ethiopia.
²⁹ School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
³⁰ School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
³¹ Lifelong Health, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia.
³² Canberra School of Politics, University of Canberra, Canberra, Australian Capital Territory, Australia.
³³ Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
³⁴ School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia.
³⁵ Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
³⁶ Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
³⁷ School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
³⁸ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
³⁹ School of Health and Social development, Deakin University, Melbourne, Victoria, Australia.
⁴⁰ Health research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia.
⁴¹ Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia.
⁴² Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.

^# Contributed equally.

PMID: 33602714
PMCID: PMC7896374
DOI: 10.1136/bmjopen-2020-044618

Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

Hailay Abrha Gesesew et al. BMJ Open. 2021.

. 2021 Feb 18;11(2):e044618.

doi: 10.1136/bmjopen-2020-044618.

Authors

Affiliations

¹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia hailushepi@gmail.com.
² Scool of Public Health, Mekelle University, Mekelle, Ethiopia.
³ Department of Medicine at Royal Melbourne Hospital and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Burnet Institute, Melbourne, Victoria, Australia.
⁵ Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.
⁶ College of Medicine, Doha, Qatar.
⁷ Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia.
⁸ School of Public Health, Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia.
⁹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
¹⁰ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹¹ Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
¹² School of Population Health, Curtin University, Perth, Western Australia, Australia.
¹³ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.
¹⁴ Institute of Public Health, University of Gondar, Gondar, Ethiopia.
¹⁵ School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
¹⁶ Department of Medicine, Monash University, Melbourne, Victoria, Australia.
¹⁷ Saint Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia.
¹⁸ Population Child Health Research Group, School of Women's & Children's Health, UNSW, Sydney, New South Wales, Australia.
¹⁹ Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.
²⁰ School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia.
²¹ Amref Health Africa in Ethiopia, Addis Ababa, Ethiopia.
²² College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
²³ Department of Pharmacology, Mekelle University, Mekelle, Ethiopia.
²⁴ School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
²⁵ School of Nursing, Mekelle University, Mekelle, Ethiopia.
²⁶ Department of Pharmacy, University of New England, Armidale, New South Wales, Australia.
²⁷ Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia.
²⁸ School of Pharmacy, Mekelle University, Mekelle, Ethiopia.
²⁹ School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
³⁰ School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
³¹ Lifelong Health, South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia.
³² Canberra School of Politics, University of Canberra, Canberra, Australian Capital Territory, Australia.
³³ Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
³⁴ School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia.
³⁵ Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
³⁶ Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.
³⁷ School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
³⁸ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
³⁹ School of Health and Social development, Deakin University, Melbourne, Victoria, Australia.
⁴⁰ Health research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia.
⁴¹ Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia.
⁴² Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.

^# Contributed equally.

PMID: 33602714
PMCID: PMC7896374
DOI: 10.1136/bmjopen-2020-044618

Abstract

Objective: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa.

Design: A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa.

Data sources: Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv.

Eligibility criteria: Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020.

Data extraction and synthesis: We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form.

Results: Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and individuals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths.

Conclusions: Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies.

Keywords: epidemiology; public health; respiratory medicine (see thoracic medicine).

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
PRISMA flow diagram. Figure 1 describes the flow diagram of the search strategy. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

See this image and copyright information in PMC

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[1] He F, Deng Y, Li W. Coronavirus disease 2019: what we know? J Med Virol 2020;92:719–25. 10.1002/jmv.25766 - DOI - PMC - PubMed

[2] He F, Deng Y, Li W. Coronavirus disease 2019: what we know? J Med Virol 2020;92:719–25. 10.1002/jmv.25766 - DOI - PMC - PubMed

[3] WHO Coronavirus disease (COVID-2019) situation reports. Geneva: World Health Organization, 2020.

[4] WHO Coronavirus disease (COVID-2019) situation reports. Geneva: World Health Organization, 2020.

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[9] Mackenzie JS, Smith DW. COVID-19: a novel zoonotic disease caused by a coronavirus from China: what we know and what we don't. Microbiol Aust 2020:45–MA13. 10.1071/MA20013 - DOI - PMC - PubMed

[10] Mackenzie JS, Smith DW. COVID-19: a novel zoonotic disease caused by a coronavirus from China: what we know and what we don't. Microbiol Aust 2020:45–MA13. 10.1071/MA20013 - DOI - PMC - PubMed

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Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

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Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

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Conflict of interest statement

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