Full text


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.



Cite as

Zhang, F., Karamagi, H., Nsenga, N., Nanyunja, M., Karinja, M., Amanfo, S., Chase-Topping, M., Calder-Gerver, G., McGibbon, M., Huber, A., Wagner-Gamble, T., Guo, C., Haynes, S., Morrison, A., Ferguson, M., Awandare, G., Mutapi, F., Yoti, Z., Cabore, J., Moeti, M. & Woolhouse, M. 2021, 'Predictors of COVID-19 epidemics in countries of the World Health Organization African Region'Zhang, F , Karamagi , H , Nsenga , N , Nanyunja , M , Karinja , M , Amanfo , S , Chase-Topping , M , Calder-Gerver , G , McGibbon , M , Huber , A , Wagner-Gamble , T , Guo , C-G , Haynes , S , Morrison , A , Ferguson , M , Awandare , G A , Mutapi , F , Yoti , Z , Cabore , J , Moeti , M R & Woolhouse , M E J 2021 , ' Predictors of COVID-19 epidemics in countries of the World Health Organization African Region ' , Nature Medicine . https://doi.org/10.1038/s41591-021-01491-7. https://publichealthscotland.scot/id/45175

Downloadable citations

Download HTML citationHTML Download BIB citationBIB Download RIS citationRIS
Last updated: 16 June 2022
Was this page helpful?