ObjectiveThe aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa.DesignA systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa.Data sourcesData were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv.Eligibility criteriaStudies 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 synthesisWe 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.ResultsFifteen 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.ConclusionsDemographic, 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.

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Objective To determine individual‐ and country‐level determinants of utilization of key maternal health services in sub‐Saharan Africa (SSA). Study Setting We used the most recent standard demographic and health survey data from the period of 2005 to 2015 for 34 SSA countries. Predictors of key maternal health service indicators were determined using a sample of 245 178 women who had at least one live birth 5 years preceding the survey. Study Design We used a two‐level hierarchical model, considering individual predictors at level one and country factors at level two of the hierarchy. Principal Findings While the skilled birth attendance (SBA) utilization rate reached 53 percent during the study period, the recommended four or more antenatal care (ANC) coverage was commonly low with less significant differences among different groups of women and countries. Being in a middle‐income country increased the individual‐level association between ANC and SBA (OR = 2.34, 95% CI: 1.24, 4.44). Less privileged women with lower education level were less likely to receive maternal health services. Conclusions This study reveals the existence of wide gaps between ANC and SBA coverage in SSA. Urgent policy attention is required to improve access, utilization, and quality of maternal health services.

The region showed improvement in both indicators across time. Regional disparity in ANC narrowed down while that of SBA remained high. These were mainly associated with economic class and cluster of countries.

Introduction: The Millennium Development Goals include a focus on Reproductive Health (RH) indicators which are of substantial importance in low and middle income countries. However, little has been reported of the time-trend in these indicators in Ethiopia. This study aims to describe trends in RH indicators in Ethiopia from 2000-2014. Methods: This study is a time-trend analysis of RH indicators. We used 15-years of RH indicator data sourced mainly from Federal Ministry of Health and Demographic and Health Survey. Maternal mortality ratio, antenatal care coverage, skilled birth attendance coverage, postnatal care coverage, contraceptive prevalence rate and total fertility rate were selected and analysed using numerical and graphic summaries. We used coefficient of determination (R 2 ) for the Federal Ministry of Health facility based data to examine the variation in annual progress explained by the regression model. Confidence intervals were used in the Demographic and Health Survey data to indicate the period when significant difference was observed. Trends of indicators from both data sources were also compared. Results: During the 15-years study period, antenatal care coverage increased from 29% to 98% (R 2 = 95%). It increased more rapidly than skilled birth attendance which remained low at 41% in 2014. Postnatal care coverage increased from 5% to 64% (R 2 = 96%). Modern contraceptive prevalence rate among the married women improved from 6.3% (5.8%, 6.8%) to 40% (38.7%, 41.3%) within the 15-year period. Maternal mortality ratio decreased from 990 in 2000 to 420 in 2013. The total fertility rate decreased from 5.5 to 4.1 children per woman. With lowest performance in 2000, Ethiopia demonstrated better improvement compared to selected sub-Saharan African countries. Variations in the trends were observed when data from both sources were compared. Conclusions: RH service coverages have shown remarkable improvement while maternal mortality ratio, although reduced, remained high. There was a significant gap in the continuum of maternal health services.