Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review
Kefyalew Addis Alene,
Akilew Awoke Adane,
Digsu Negese Koye,
Berihun Assefa Dachew,
Abadi Kahsu Gebre,
Mohammed Biset Ayalew,
Yohannes Kinfu,
Yohannes Adama Melaku,
Mulugeta Molla Birhanu,
Hassen Mohammed,
Teketo Kassaw Tegegne,
Yalemzewod Assefa Gelaw,
Dagnachew Muluye Fetene,
Muluken Dessalegn Muluneh,
Solomon Abrha,
Kidane Tadesse Gebremariam,
Tesfaye Gebremedhin,
Amanuel Tesfay Gebremedhin,
Lemlem Gebremichael,
Ayele Bali Geleto,
Getiye Dejenu Kibret,
Cheru Tesema Leshargie,
Azeb Gebresilassie Tesema,
Fisaha Haile Tesfay,
Befikadu Legesse Wubishet,
Hailay Abrha Gesesew,
Mulu Woldegiorgis,
Mamaru Ayenew Awoke,
Desalegn Markos Shifti,
Atsede Fantahun Aregay,
Maereg Wagnew Meazaw,
Alemayehu Berhane Mekonnen,
Dejen Yemane Tekle,
Wubshet Tesfaye
Affiliations
Kefyalew Addis Alene
Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
Akilew Awoke Adane
1 Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Digsu Negese Koye
1 Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
Berihun Assefa Dachew
School of Population Health, Curtin University, Perth, Western Australia, Australia
Abadi Kahsu Gebre
1 Nutrition and Health Innovation Research Institute,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
Mohammed Biset Ayalew
12 Department of Pharmacy, University of New England, Armidale, New South Wales, Australia
Yohannes Kinfu
3 University of Canberra, Canberra, Australian Capital Territory, Australia
Yohannes Adama Melaku
1 Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
Mulugeta Molla Birhanu
Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
Hassen Mohammed
37 Vaccinology and Immunology Research Trials Unit, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
Teketo Kassaw Tegegne
Public Health, Debre Markos University, Debre Markos, Amhara, Ethiopia
Yalemzewod Assefa Gelaw
5 Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
Dagnachew Muluye Fetene
Burnet Institute, Melbourne, Victoria, Australia
Muluken Dessalegn Muluneh
Western Sydney University, Penrith South, New South Wales, Australia
Solomon Abrha
Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
Kidane Tadesse Gebremariam
7 School of Public Health, Mekelle University, Mekelle, Ethiopia
Tesfaye Gebremedhin
University of Canberra, Canberra, Australian Capital Territory, Australia
Amanuel Tesfay Gebremedhin
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
Lemlem Gebremichael
Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
Ayele Bali Geleto
Haramaya University, Dire Dawa, Ethiopia
Getiye Dejenu Kibret
28 Public Health, Debre Markos University, Debre Markos, Ethiopia
Cheru Tesema Leshargie
Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
Azeb Gebresilassie Tesema
The George Institute for Global Health, Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia
Fisaha Haile Tesfay
School of Public Health, Mekelle University, Mekelle University College of Health Sciences, Mekelle, Ethiopia
Befikadu Legesse Wubishet
School of Pharmacy, Mekelle University, Mekelle, Ethiopia
Hailay Abrha Gesesew
Research Centre for Public Health, Equity and Human Flourishing (PHEHF), Torrens University Australia, Adelaide, South Australia, Australia
Mulu Woldegiorgis
Burnet Institute, Melbourne, Victoria, Australia
Mamaru Ayenew Awoke
School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
Desalegn Markos Shifti
Child Health Research Centre, The University of Queensland School of Medicine Royal Brisbane Clinical Unit, Herston, Queensland, Australia
Atsede Fantahun Aregay
10 Monash University, Clayton, Victoria, Australia
Maereg Wagnew Meazaw
Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
Alemayehu Berhane Mekonnen
Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
Dejen Yemane Tekle
6 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
Wubshet Tesfaye
Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
Objective The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa.Design A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa.Data sources Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv.Eligibility criteria Studies 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 synthesis We 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.Results Fifteen 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.Conclusions Demographic, 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.
