lancet-header

Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.

Predictors of COVID-19 Epidemics in Countries of the World Health Organisation African Region

28 Pages Posted: 30 Apr 2021

See all articles by Feifei Zhang

Feifei Zhang

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Humphrey Karamagi

World Health Organization (WHO) - Regional Office for Africa

Ngoy Nsenga

World Health Organization (WHO) - Regional Office for Africa

Miriam Nanyunja

World Health Organization (WHO) - Regional Office for Africa

Miriam Karinja

University of Nairobi - Institute of Tropical and Infectious Diseases

Seth Amanfo

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Margo Chase-Topping

University of Edinburgh - School of Biological Sciences

Giles Calder-Gerver

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Miles McGibbon

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Alexandra Huber

University of Edinburgh - Usher Institute

Tara Wagner-Gamble

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Chuan-Guo Guo

University of Hong Kong - Department of Medicine

Samuel Haynes

University of Edinburgh - School of Biological Sciences

Alistair Morrison

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Miranda Ferguson

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Gordon Awandare

University of Ghana - West African Centre for Cell Biology of Infectious Pathogens

Francisca Mutapi

University of Edinburgh - School of Biological Sciences

Zabulon Yoti

World Health Organization (WHO) - Regional Office for Africa

Joseph Cabore

World Health Organization (WHO) - Regional Office for Africa

Matshidiso Moeti

World Health Organization (WHO) - Regional Office for Africa

Mark Woolhouse

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

More...

Abstract

Background: WHO African Region countries have experienced very different COVID-19 epidemics. This study aimed to identify predictors for the timing of the first COVID-19 case and the per capita mortality rate during the first and second pandemic wave in the region, and to test for any impact of countermeasures.

Methods: We performed a region-wide, country-based observational study. Data on COVID-19 cases and deaths for all 47 countries in the WHO African Region were obtained from the WHO COVID-19 Dashboard. A set of predictors classified to nine categories were collected and used as explanatory variables. We applied Cox proportional hazards regression models, generalized linear mixed models and multinomial logistic regression models as appropriate.

Findings: Predictors for an earlier first case were a more urban population, high volume of international air travel and more land borders, and better COVID-19 test capacity. Predictors for a high per capita mortality rate during the first wave were a more urban population, more pre-pandemic international air travel and higher prevalence of HIV. The stringency and timing of government restrictions on behaviour were not associated with a lower per capita mortality rate in the first wave. A more urban population and a higher infectious disease resilience score were associated with more stringent restrictions and/or a higher per capita mortality rate in the first wave. The predictor set for the second wave was similar, and first wave per capita mortality predicted that in the second wave. These results were not altered when measures of national testing effort were included in the models.

Interpretation: COVID-19 in Africa arrived earlier and caused greater mortality in countries with more international travel and a more urban population. Mortality was exacerbated by high HIV prevalence; it is not clear whether this is a direct or indirect effect. Countries that were better prepared and judged to have more resilient health systems were worst affected, both by the disease and by the imposition of restrictions. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa.

Funding Statement: National Institute for Health Research, Darwin Trust of Edinburgh

Declaration of Interests: The authors disclose no conflicts of interest.

Suggested Citation

Zhang, Feifei and Karamagi, Humphrey and Nsenga, Ngoy and Nanyunja, Miriam and Karinja, Miriam and Amanfo, Seth and Chase-Topping, Margo and Calder-Gerver, Giles and McGibbon, Miles and Huber, Alexandra and Wagner-Gamble, Tara and Guo, Chuan-Guo and Haynes, Samuel and Morrison, Alistair and Ferguson, Miranda and Awandare, Gordon and Mutapi, Francisca and Yoti, Zabulon and Cabore, Joseph and Moeti, Matshidiso and Woolhouse, Mark, Predictors of COVID-19 Epidemics in Countries of the World Health Organisation African Region. Available at SSRN: https://ssrn.com/abstract=3831121 or http://dx.doi.org/10.2139/ssrn.3831121

Feifei Zhang (Contact Author)

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Humphrey Karamagi

World Health Organization (WHO) - Regional Office for Africa ( email )

Congo, Democratic Republic of the (Zaire)

Ngoy Nsenga

World Health Organization (WHO) - Regional Office for Africa ( email )

Brazzaville
Congo, Republic of

Miriam Nanyunja

World Health Organization (WHO) - Regional Office for Africa ( email )

Brazzaville
Congo, Republic of

Miriam Karinja

University of Nairobi - Institute of Tropical and Infectious Diseases

4139-40200
Nairobi, 40200
Kenya

Seth Amanfo

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Margo Chase-Topping

University of Edinburgh - School of Biological Sciences ( email )

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Giles Calder-Gerver

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Miles McGibbon

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Alexandra Huber

University of Edinburgh - Usher Institute

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Tara Wagner-Gamble

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Chuan-Guo Guo

University of Hong Kong - Department of Medicine

Pokfulam Road
Hong Kong, Pokfulam HK
China

Samuel Haynes

University of Edinburgh - School of Biological Sciences

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Alistair Morrison

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Miranda Ferguson

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics ( email )

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Gordon Awandare

University of Ghana - West African Centre for Cell Biology of Infectious Pathogens

PO Box 25
Legon, LG
Ghana

Francisca Mutapi

University of Edinburgh - School of Biological Sciences

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Zabulon Yoti

World Health Organization (WHO) - Regional Office for Africa

Congo, Democratic Republic of the (Zaire)

Joseph Cabore

World Health Organization (WHO) - Regional Office for Africa

Congo, Democratic Republic of the (Zaire)

Matshidiso Moeti

World Health Organization (WHO) - Regional Office for Africa

Congo, Democratic Republic of the (Zaire)

Mark Woolhouse

University of Edinburgh - Usher Institute of Population Health Sciences and Informatics

Teviot Place
Edinburgh, EH8 9AG
United Kingdom

Click here to go to TheLancet.com

Paper statistics

Abstract Views
548
Downloads
66
PlumX Metrics