O ne year into the coronavirus disease 2019 pandemic, the African continent still seems to be spared from the devastating effects the disease had in other continents. Africa's COVID-19 seems to be of a milder nature both in adults and children. However, lack of data from Africa is significant, and more studies are needed to validate the disease status, clinical manifestations, and future implications for Africa. In this study, we report pediatric COVID-19 features in Africa represented by 8 countries.We conducted a systematic literature review (March 2020 to November 2021) using the terms COVID-19 Africa, COVID-19 Africa Pediatrics, and COVID-19 Africa Children. Case characteristics (10 studies in 8 countries, 294 patients positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] by polymerase chain reaction; Table 1 Q1 Supplementary Table 1) are described. Symptoms and comorbidities were combined, compared, and analyzed by weighted analysis methods. SPSS version 26 was used for this analysis.Ethiopian patients were the oldest. The mean age of our cohort was 11.4 years with a minimum of 5.75 years and a maximum of 15 years. Patients from Ethiopia (Table 1, Supplementary Figure 1) were on average 15 years old followed by Morocco, at 13 years old. The youngest patients were from Sierra Leone, at 5.75 years old. Female patients made 55% of our cohort, but gender distribution was not uniform. The Tunisian cohort was 87.5% males, whereas the South African cohort was 73.9% females. No deaths were reported in the overall cohort.Fever was the most common symptom, found in 24.6% of the cohort. Its distribution was 19.9% in the Moroccan cohort, 5.6% in Ethiopia, and up to 100% in South African and Tunisian cohorts. Cough was present in 20% of our African cohort, ranging from 2.2% in Sierra Leone to 22.5% in the Nigerian cohort. Dyspnea was present in 8.5% (25% in Cameroon cohort) and myalgia in 60.8%. Interestingly, there were 63% asymptomatic cases. The Egyptian cohort had 100% asymptomatic cases, whereas Nigeria and Sierra Leone reported 33% and 22%, respectively.Diarrhea and abdominal pain were frequent. Our cohort had an 18.4% diarrhea prevalence, with the highest prevalence in Tunisia (87.5%) and the lowest in Morocco (6.7%). Abdominal pain was present in 16.7%, with a prevalence of 100% in Tunisia and 1.3% in Morocco. Nausea was present in 8% and vomiting in 4.9%. Nausea was noted in 50% in the Tunisian cohort, whereas 4.4% and 5.7% had vomiting in Ethiopia and Nigeria, respectively. The least common symptom was anosmia at 4.3%, with the highest prevalence of 5.8% in Morocco (Table 1, Supplementary Figure 2).Studies from South Africa and Tunisia had more reported symptoms, some of which were highly prevalent. Cumulatively, conjunctivitis was present in 64.5% of these 2 countries' cohorts. More specifically, it was reported in 65.2% in South Africa and 62.5% in Tunisia. Rash followed a similar profile, although at much higher cumulative Q4
