COVID-19 pandemic in Malawi: Did public sociopolitical events gatherings contribute to its first-wave local transmission?

Abstract

Introduction: The COVID-19 pandemic in Malawi emerged amidst widespread anti-government demonstrations and subsequent mass gatherings. This paper describes the incidence and factors associated with the spread of the COVID-19 pandemic in Malawi.

Methodology: This was a retrospective study of public data analysing geopolitical and immigration activities that occurred between 02 April and 08 September 2020. The Chi-square test of independence was used to tabulate sex and age-related fatality ratios among deaths due to COVID-19-related complications.

Results: The drivers for COVID-19 spread were mass gatherings secondary to the country's political landscape and repatriation of citizens from high-risk areas coupled with minimum use of public health interventions. The prevalence was higher in people aged 50-59 years, males and in urban areas. Men had an increased risk of COVID-19-related deaths (Case Fatality Ratio: 1.58 (95% CI 1.11-2.22) compared with women. Furthermore, men and women aged ≥40 years were 16.1 times and 7.1 times more likely to die of COVID-related complications, respectively. Men aged ≥40 years had a 62% increased risk of deaths compared with women of the same age group.

Conclusion: Mass political gatherings and cross-border immigration from high-risk areas were drivers for infection. Males, older age and urban residence were associated with increased COVID-19 morbidity and mortality. To control the spread of COVID-19 there is a need to regulate mass gatherings and repatriation of citizens, and strengthen the use of preventive health interventions. Men, the older age groups and urban areas should be prioritised for COVID-19 prevention strategies.

Keywords: COVID19; Incidence; Malawi; Political events; Public and social events.

Figure 1

COVID-19 infections and deaths by sex and age with 40-year cut-off point.

Figure 2

Heat map for national distribution of COVID-19 a) distribution of cases, b) deaths and c) recoveries.

Figure 3

Daily cumulative local and imported COVID-19 cases up to 08 September 2020.

Figure 4

Case positivity rate, case fatality rate and recovery rate per week up to 08 September 2020.

Figure 5

COVID-19 cases and major related events up to 08 September 2020.

Figure 6

Dr Lazarus Chakwera (centre on pick-up truck), presidential candidate for the then opposition Tonse Alliance and his running candidate, Dr Saulos Klaus Chilima (right), with their supporters on the submission of nomination papers to the MEC at Mount Soche Hotel, Blantyre, 06 May 2020 (Masina, 2020c).