Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Feb 7;23(1):79.
doi: 10.1186/s12879-022-07941-y.

A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study

Catherine Anscombe #  1   2 , Samantha Lissauer #  3   4 , Herbert Thole #  1 , Jamie Rylance  1   2 , Dingase Dula  1 , Mavis Menyere  1 , Belson Kutambe  1 , Charlotte van der Veer  1   5 , Tamara Phiri  6 , Ndaziona P Banda  7 , Kwazizira S Mndolo  6 , Kelvin Mponda  6 , Chimota Phiri  6 , Jane Mallewa  7 , Mulinda Nyirenda  7   6 , Grace Katha  6 , Henry Mwandumba  1   2   7 , Stephen B Gordon  1   2 , Kondwani C Jambo  1   2   7 , Jennifer Cornick  1   8 , Nicholas Feasey  1   2 , Kayla G Barnes #  1   8   9   10   11 , Ben Morton #  1   2   12 , Philip M Ashton #  13   14 ; Blantyre COVID-19 Consortium
Collaborators, Affiliations
Observational Study

A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study

Catherine Anscombe et al. BMC Infect Dis. .

Abstract

Background: Compared to the abundance of clinical and genomic information available on patients hospitalised with COVID-19 disease from high-income countries, there is a paucity of data from low-income countries. Our aim was to explore the relationship between viral lineage and patient outcome.

Methods: We enrolled a prospective observational cohort of adult patients hospitalised with PCR-confirmed COVID-19 disease between July 2020 and March 2022 from Blantyre, Malawi, covering four waves of SARS-CoV-2 infections. Clinical and diagnostic data were collected using an adapted ISARIC clinical characterization protocol for COVID-19. SARS-CoV-2 isolates were sequenced using the MinION™ in Blantyre.

Results: We enrolled 314 patients, good quality sequencing data was available for 55 patients. The sequencing data showed that 8 of 11 participants recruited in wave one had B.1 infections, 6/6 in wave two had Beta, 25/26 in wave three had Delta and 11/12 in wave four had Omicron. Patients infected during the Delta and Omicron waves reported fewer underlying chronic conditions and a shorter time to presentation. Significantly fewer patients required oxygen (22.7% [17/75] vs. 58.6% [140/239], p < 0.001) and steroids (38.7% [29/75] vs. 70.3% [167/239], p < 0.001) in the Omicron wave compared with the other waves. Multivariable logistic-regression demonstrated a trend toward increased mortality in the Delta wave (OR 4.99 [95% CI 1.0-25.0 p = 0.05) compared to the first wave of infection.

Conclusions: Our data show that each wave of patients hospitalised with SARS-CoV-2 was infected with a distinct viral variant. The clinical data suggests that patients with severe COVID-19 disease were more likely to die during the Delta wave.

Keywords: Africa; COVID; Delta; ISARIC; LMIC; Malawi; Mortality; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

We have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Relationship between PCR Ct value and the percentage of the SARS-CoV-2 reference genome covered to at least 20 × depth. The number at the top of each column is the number of samples for the two protocols in each bin of the box plot
Fig. 2
Fig. 2
The monthly number of each lineage or VOC identified in patients in our cohort
See this image and copyright information in PMC

Update of

References

    1. Brito AF, Semenova E, Dudas G, et al. Global disparities in SARS-CoV-2 genomic surveillance. medRxiv 2021; :2021.08.21.21262393.
    1. Aborode AT, Hasan MM, Jain S, et al. Impact of poor disease surveillance system on COVID-19 response in africa: time to rethink and rebuilt. Clin Epidemiol Global Health. 2021;12:100841. doi: 10.1016/j.cegh.2021.100841. - DOI - PMC - PubMed
    1. Wolter N, Jassat W, Walaza S, et al. Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: a data linkage study. The Lancet. 2022;399:437–446. doi: 10.1016/S0140-6736(22)00017-4. - DOI - PMC - PubMed
    1. Novel 2019 coronavirus genome—SARS-CoV-2 coronavirus. 2020. Available at: https://virological.org/t/novel-2019-coronavirus-genome/319. Accessed 28 October 2021.
    1. CDC. CDC’s Diagnostic Test for COVID-19 Only and Supplies. 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/virus-requests.html. Accessed 28 October 2021.

Publication types