The Determinants of the Low COVID-19 Transmission and Mortality Rates in Africa: A Cross-Country Analysis

Abstract

Background: More than 1 year after the beginning of the international spread of coronavirus 2019 (COVID-19), the reasons explaining its apparently lower reported burden in Africa are still to be fully elucidated. Few studies previously investigated the potential reasons explaining this epidemiological observation using data at the level of a few African countries. However, an updated analysis considering the various epidemiological waves and variables across an array of categories, with a focus on African countries might help to better understand the COVID-19 pandemic on the continent. Thus, we investigated the potential reasons for the persistently lower transmission and mortality rates of COVID-19 in Africa.Methods: Data were collected from publicly available and well-known online sources. The cumulative numbers of COVID-19 cases and deaths per 1 million population reported by the African countries up to February 2021 were used to estimate the transmission and mortality rates of COVID-19, respectively. The covariates were collected across several data sources: clinical/diseases data, health system performance, demographic parameters, economic indicators, climatic, pollution, and radiation variables, and use of social media. The collinearities were corrected using variance inflation factor (VIF) and selected variables were fitted to a multiple regression model using the R statistical package.Results: Our model (adjusted R-squared: 0.7) found that the number of COVID-19 tests per 1 million population, GINI index, global health security (GHS) index, and mean body mass index (BMI) were significantly associated (P < 0.05) with COVID-19 cases per 1 million population. No association was found between the median life expectancy, the proportion of the rural population, and Bacillus Calmette–Guérin (BCG) coverage rate. On the other hand, diabetes prevalence, number of nurses, and GHS index were found to be significantly associated with COVID-19 deaths per 1 million population (adjusted R-squared of 0.5). Moreover, the median life expectancy and lower respiratory infections rate showed a trend towards significance. No association was found with the BCG coverage or communicable disease burden.Conclusions: Low health system capacity, together with some clinical and socio-economic factors were the predictors of the reported burden of COVID-19 in Africa. Our results emphasize the need for Africa to strengthen its overall health system capacity to efficiently detect and respond to public health crises.

Development and Validation of a Mortality Prediction Model in Extremely Low Gestational Age Neonates

“…Afterward, we used a backward and forward selection until the remaining predictors: (i) had a p value <5%, (ii) included variables maintained an Akaike information criterion (AIC) that was comparable to the AIC when all variables were used in the model, (iii) had low collinearity (assessed by variance inflation factors), and (iv) encompassed a manageable number of variables that could be easily translated into a clinical tool [18]. Variance inflation factors <4 signify low collinearity, while the AIC is a quantitative estimation used for optimal model selection [19, 20]. The model with the lowest AIC is theoretically the best fitting model [21].…”

The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review

“…T he global pandemic of coronavirus disease 2019 (COVID- 19), caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has disproportionately impacted human health, economy, and security across the continents. Because of weaker health-care systems, existing comorbidities burden (HIV, tuberculosis, and noninfectious chronic conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity of disease and deaths [1][2][3]. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia [3].…”

“…South Africa has recorded the highest cumulative number of COVID-19 cases (3,559,230) followed by Morocco (1,048,653), Tunisia (788,012) and Ethiopia (457,322), together accounting for more than half of the whole confirmed COVID-19 cases in Africa [4]. Several hypotheses have been investigated to understand such varying COVID-19 epidemiology in Africa, including flawed capacity for large scale testing and reporting, weak surveillance and monitoring systems, younger age of population, cross-immunity from other human coronaviruses, climatic factors, low international air flows, as well as experience acquired from the public health response to other epidemics such as Ebola and Lassa fever [1,3,5]. Another crucial gap is that one year after the start of vaccination campaigns against COVID-19 around the world, a profound heterogeneity -and inequality -still characterizes the African continent.…”

Diabetes Mellitus is Associated With Higher COVID-19 Mortality Rates in Sub-Saharan Africa: A Systematic Review and Meta-analysis

“…These meta-analyses pooled studies from around the world, mostly from China, without including African studies [6][7][8][9][10][22][23][24][25]. In addition, an ecological investigation in Africa also reported that diabetic patients had a high risk of death in a population of 1 million Africans [26].…”