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The epidemiology of COVID-19 in Africa

March 10, 2022
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for the coronavirus disease of 2019 (COVID-19), continues to spread across Africa, thus impacting mortality and morbidity rates on this continent. In fact, all 55 African Union (AU) Member States (MS) have reported COVID-19 cases, along with cases due to new SARS-CoV-2 variants, which have limited the efficacy of efforts to contain the pandemic.

However, since the majority of SARS-CoV-2 infections are either asymptomatic or mild, the true number of infections, along with age and sex distribution of infections, have not been fully determined yet in the context of Africa.

Background

The number of confirmed COVID-19 cases that were detected and reported in each AU MS have been influenced by several factors such as the capacity for COVID-19 testing, case definition, access to and utilization of healthcare services, the manifestation of symptomatic illness among infected individuals, and community health-seeking behaviors.

National estimates of seroprevalence are considered to be important in understanding current or prior exposure to SARS-CoV-2 across populations, as well as to provide country-specific information for the development of guidelines for current and future control of epidemics. These estimates also help elucidate the true extent of the pandemic and provide insight into the factors that might have influenced transmission. Although previous seroprevalence studies have been carried out in Africa, they mostly focused on high-risk groups.

A new Preprints with The Lancet / SSRN First study Look* used the Africa Centres for Disease Control and Prevention (Africa CDC) generic protocol for obtaining COVID-19 seroprevalence data from Ethiopia, Uganda, Togo, Sierra Leone, and Zimbabwe to understand the spread and epidemiology of SARS-CoV-2 to help in response activities and guiding policies.

About the study

The current study recruited participants who filled out a questionnaire on pre-existing conditions, COVID-19 symptomology, basic demographics, pregnancy status, household information, hospitalization information, missed work or school, vaccination status, and treatments received. The survey varied in different countries and was conducted for varying durations from two weeks to two months between November 2020 and June 2021.

Blood samples were collected from the recruited participants and assessed for the presence of both immunoglobulin M (IgM) and IgG SARS-CoV-2 specific antibodies. Participants who showed the presence of either IgM, IgG, or both IgM and IgG were considered to be seropositive.

Study findings

Out of the 31,707 individuals surveyed across the five AU MSs, the majority were female. The participants from Sierra Leone, Togo, and Uganda were five years and older, whereas the cohort in Zimbabwe consisted of participants who were one year and older, and in Ethiopia, study participants were ten years and older. The majority of participants were reported to be between 20 to 39 years old.

Most participants in Ethiopia and Sierra Leone lived in large households, while in Uganda and Zimbabwe the majority of participants lived in smaller households. Taken together, most of the participants resided in rural areas.

The highest overall weighted seroprevalence of SARS-CoV-2 antibodies was observed in Uganda, followed by Togo, while the lowest was observed in Sierra Leone. The risk of seropositivity also appeared to increase with age.

Seroprevalence was also found to be affected by several factors such as sex, occupation, and demographics, while symptoms, pre-existing medical conditions, and household size were not found to influence seroprevalence.

The current study determined that seroprevalence studies were important in providing public health leaders with important information for action against SARS-CoV-2. Variations in results from these five AU MSs suggest the need to regularly conduct serosurveys for better monitoring of the pandemic.

Limitations

Some of the limitations of the current study included issues regarding inconsistent response options, missing data, and different sampling designs. Furthermore, the results were limited to the comparable variables, rather than the entire population. The observed levels of infection were also affected, as each MS implemented its survey according to local logistic factors.

Sources: https://www.news-medical.net/

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There’s been a global trend in the reduction of aid to Africa since 2018. Donors are shifting their funding priorities in response to domestic and international agendas. Germany, France and Norway, for instance, have all reduced their aid to Africa in the past five years. And, in 2020, the UK government reduced its Overseas Development Aid from 0.7% of gross national income to 0.5%. Many health services across the African continent rely heavily on overseas aid to provide essential care. International funding supports everything from vaccines and HIV treatment to maternal health programmes. Cuts to aid, particularly unilateral ones, can have widespread implications. For instance, about 72 million people missed out on treatment for neglected tropical diseases between 2021 and 2022 due to UK aid cuts. The freeze of US aid to Africa in January 2025 is the latest in this trend. It’s already having significant and wide-ranging impacts across the African continent. For example, vaccination campaigns for polio eradication and HIV/Aids treatment through the President’s Emergency Plan for AIDS Relief (Pepfar) have been stopped. This puts millions of lives at risk. In South Africa alone, the cut of Pepfar’s US$400 million a year to HIV programmes risks patients defaulting on treatment, infection rates going up and eventually a rise in deaths. President Donald Trump’s actions have highlighted Africa’s reliance on foreign aid for health funding. I’m a global health expert who sits on various funding and advisory boards, including those of the World Health Organization (WHO), the UK government and boards of global resource mobilisation organisations. I am well aware of the competing funding priorities for international funders and have long advocated for local, sustainable health funding mechanisms. Long-term strategies to reduce aid dependency are critical. Breaking away from this current funding status requires concerted efforts building on proven best practice. Country-leadership and ownership African countries currently face the unique challenge of simultaneously dealing with high rates of communicable diseases, such as malaria and HIV/Aids, and rising levels of non-communicable diseases, such as cardiovascular diseases and diabetes. But Africa’s health systems are not sufficiently resourced. They’re not able to provide appropriate, accessible and affordable healthcare to address these challenges. African governments spend less than 10% of their GDP on health, amounting to capital expenditure of US$4.5 billion. This falls short of the estimated US$26 billion annual investment needed to meet evolving health needs. Aid goes towards filling this funding gap. For example, in 2021, half of sub-Saharan African countries relied on external financing, such as grants and loans, for more than one-third of their health expenditures. 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For instance, tobacco taxes which are currently underutilised in Africa. Zimbabwe offers a successful example. It has bridged donor resource gaps through its 3% Aids levy (started in 1999). Imposed on both individual and corporate incomes, it funds domestic HIV/Aids prevention, care and treatment programmes. Nigeria’s another country that’s taken initiative, prioritising domestic budget allocation to health. It recently absorbed the 28,000 healthworkers formerly paid by USAid. This demonstrates that domestic health financing in Africa is possible. 2.) More private-public partnerships. Formed between local and international philanthropies or institutions, these can bridge financing gaps. One successful example is the 2015 health service provision partnership between the Kenyan government and GE Healthcare. GE Healthcare provides radiography equipment and services which the government pays for over time. 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