Long COVID presents considerable health challenges in Africa

While most people recover from COVID-19 within weeks, the World Health Organization (WHO) says that 10–20% of those with the disease will develop long COVID and experience symptoms for much longer. The most common symptoms of long COVID include fatigue, shortness of breath, brain fog, chest pain, depression or anxiety, and difficulty sleeping. It can lead to more severe complications such as lung fibrosis and respiratory failure.

A systematic review published in The Lancet Global Health analysed 24 articles including 9,712 patients who had COVID-19 in eight African countries and found varying prevalence rates for long COVID ranging from 2% in a patient group in Ghana to 86% in a study of 430 patients in Egypt. Half of the studies had prevalence rates that were over 40%.

The review profiled symptoms of long COVID cited in the studies and the characteristics of those with symptoms. It showed that long COVID was positively associated with women, older age, a low level of education, non-black ethnicity, the severity of acute infection and underlying comorbidities. HIV and tuberculosis were found to not have an association with long COVID.

The researchers suggested that long COVID is widely under-reported in Africa because of a lack of awareness of the condition, inadequate clinical data and diagnostics, and limited access to health care.

The review used articles published in English, French and Spanish from December 2019 to November 2022 that focused on patients who presented with symptoms for four weeks or more after having a severe case of COVID-19. It included studies from Egypt, Ghana, South Africa, Morocco, Tunisia, Ethiopia, Uganda and Zambia. Although children make up 40% of the African population, they were only included in two of the studies.

The review highlighted the lack of research on long COVID in Africa. Sophie Alice Müller, principal investigator and researcher at the Center for International Health Protection at the Robert Koch Institut, Berlin, says there is an urgent need for research evidence from longitudinal studies involving vulnerable populations, especially children and rural communities across the continent.

Islam Anan, lecturer in pharmacoeconomics and health policy at Ain Shams University in Egypt, says the review shows the overwhelming health burden caused by long COVID in Africa, highlighting the importance of health strategies to avoid straining health systems and negatively affecting welfare, especially among people on low incomes. He has called for further investment from WHO to investigate the implications of the disease.

Müller, S.A. et al. Prevalence and risk factors for long COVID and post-COVID-19 condition in Africa: a systematic review. Lancet Glob Health 2023; 11: e1713–24

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