Predictors of COVID-19 epidemics in countries of the World Health Organization African Region

Abstract

Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning.

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“…However, other factors may also be at play, such as demographics, geography, past experiences with epidemics, level of urbanization and connectivity, which been explored as arguments for explaining the comparatively and unexpectedly low Covid-19 cases numbers in most African countries (e.g. Nguimkeu and Tadadjeu, 2021 ; Zhang et al, 2021 ). As of early November 2021, the number of confirmed COVID-19 cases across the globe reached over 249 million and over 4.9 million deaths had been reported since the start of the pandemic ( WHO, 2021b ).…”

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“… 30 It is important to take note that public health interventions implemented in several African countries to lessen the gaps and control disease outbreaks, such as Ebola, may have strengthened the response in containing the current pandemic. 31 Zhang et al 32 explored the association between health care preparedness and the government response during the first and second COVID-19 waves that rolled through the African region. Initial cases were first detected in countries with urban populations, greater international travel, and those with better capability in diagnostic testing equipment.…”