Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Lancet Glob Health. 2023 Nov;11(11):e1713-e1724. doi: 10.1016/S2214-109X(23)00384-4.
An improved estimation of the clinical sequelae of SARS-CoV-2 infection is crucial in African countries, where the subject has received little attention despite more than 12 million reported cases and evidence that many more people were infected. We reviewed the evidence on prevalence, associated risk factors for long COVID, and systemic or sociocultural determinants of reporting long COVID.
We conducted a systematic review, searching PubMed, the Living OVerview of Evidence platform, and grey literature sources for publications from Dec 1, 2019, to Nov 23, 2022. We included articles published in English, French, Spanish, or Portuguese that reported on any study type in Africa with participants of any age who had symptoms for 4 weeks or more after an acute SARS-CoV-2 infection. We excluded secondary research, comments, and correspondence. Screening and data extraction were performed by two reviewers. Summary estimates were extracted, including sociodemographic factors, medical history, prevalence of persistent symptoms, and symptoms and associated factors. Results were analysed descriptively. The study was registered on the Open Science Framework platform.
Our search yielded 294 articles, of which 24 peer-reviewed manuscripts were included, reporting on 9712 patients from eight African countries. Only one study exclusively recruited children, and one other study included children as part of their study population. Studies indicated moderate to low risk of bias. Prevalence of long COVID varied widely, from 2% in Ghana to 86% in Egypt. Long COVID was positively associated with female sex, older age, non-Black ethnicity, low level of education, and the severity of acute infection and underlying comorbidity. HIV and tuberculosis were not identified as risk factors. Factors influencing reporting included absence of awareness, inadequate clinical data and diagnostics, and little access to health-care services.
In Africa, research on long COVID is scarce, particularly among children, who represent the majority of the population. However, existing studies show a substantial prevalence across settings, emphasising the importance of vaccination and other prevention strategies to avert the effects of long COVID on individual wellbeing, the increased strain on health systems, and the potential negative effects on economically vulnerable populations. At a global level, including African countries, tools for research on long COVID need to be harmonised to maximise the usefulness of the data collected.
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在非洲国家，改进对 SARS-CoV-2 感染临床后果的估计至关重要，尽管报告了超过 1200 万例病例，并有证据表明还有更多人感染，但该主题在这些国家几乎没有受到关注。我们回顾了关于长期 COVID 的流行率、相关风险因素以及报告长期 COVID 的系统或社会文化决定因素的证据。
我们进行了系统综述，在 2019 年 12 月 1 日至 2022 年 11 月 23 日期间，在 PubMed、Living OVerview of Evidence 平台和灰色文献来源中搜索了出版物。我们纳入了以任何年龄的参与者为对象、在急性 SARS-CoV-2 感染后 4 周或更长时间出现症状的任何研究类型的英文、法文、西班牙文或葡萄牙文发表的文章。我们排除了二次研究、评论和通信。由两名评审员进行筛选和数据提取。提取了包括社会人口因素、病史、持续性症状的流行率以及症状和相关因素在内的综合估计数。结果进行了描述性分析。该研究在 Open Science Framework 平台上注册。
我们的搜索产生了 294 篇文章，其中 24 篇同行评议的手稿被纳入，报告了来自 8 个非洲国家的 9712 名患者。只有一项研究专门招募了儿童，另一项研究则将儿童作为其研究人群的一部分。研究表明，偏倚风险为中低。长期 COVID 的流行率差异很大，从加纳的 2%到埃及的 86%。长期 COVID 与女性、年龄较大、非黑人种族、教育程度较低以及急性感染的严重程度和潜在合并症呈正相关。HIV 和结核病未被确定为危险因素。影响报告的因素包括缺乏意识、临床数据和诊断不足以及很少获得医疗保健服务。
在非洲，长期 COVID 的研究很少，尤其是在儿童中，而儿童占人口的大多数。然而，现有研究表明，在各种环境中都存在着相当大的流行率，这强调了接种疫苗和其他预防策略的重要性，以避免长期 COVID 对个人健康、医疗系统压力增加以及对经济弱势群体的潜在负面影响。在全球范围内，包括非洲国家在内，需要协调长期 COVID 研究工具，以最大限度地提高所收集数据的有用性。
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