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New study challenges understanding of pandemic preparedness and resilience in Africa

Countries in Africa assessed as being least weak to an epidemic have been the worst affected by Covid-19, new analysis suggests.

Nations with extra city populations and robust worldwide journey hyperlinks have been worst affected by the pandemic, the study reveals.

Mortality charges and ranges of restrictions — comparable to lockdowns and journey bans — have been discovered to be lowest in international locations beforehand considered at biggest danger from Covid-19.

A group of researchers from the NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) from the University of Edinburgh labored with the World Health Organization (WHO) African Region to establish elements affecting mortality charges throughout Africa’s first two Covid-19 waves and the timing of the primary reported instances.

Professor Mark Woolhouse, TIBA Director, who co-led the study, stated: “Our study reveals very clearly that a number of elements affect the extent to which African international locations are affected by Covid-19. These findings problem our understanding of vulnerability to pandemics.

“Our outcomes present that we should always not equate excessive ranges of preparedness and resilience with low vulnerability.

“That seemingly well-prepared, resilient countries have fared worst during the pandemic is not only true in Africa; the result is consistent with a global trend that more developed countries have often been particularly hard hit by Covid-19.”

Among 44 international locations of the WHO African Region with obtainable information, South Africa had the very best mortality price through the first wave between May and August 2020, at 33.3 deaths recorded per 100,000 individuals. Cape Verde and Eswatini had the subsequent highest charges at 17.5 and 8.6 deaths per 100,000, respectively. At 0.26 deaths recorded per 100,000, the bottom mortality price was in Uganda.

South Africa additionally recorded the very best mortality price through the second wave between December 2020 and February 2021, at 55.4 deaths per 100,000. Eswatini and Botswana recorded charges of 39.8 and 17.7 deaths per 100,000, respectively. The lowest price was in Mauritius, which recorded no deaths through the second wave.

“The early models which predicted how Covid-19 would lead to a massive number of cases in Africa were largely the work of institutions not from our continent. This collaboration between researchers in Africa and Europe underlines the importance of anchoring analysis on Africa’s epidemics firmly here,” stated Dr. Matshidiso Moeti, WHO Regional Director for Africa and co-author. We can now not focus our understanding of illness transmission purely on the traits of a virus — Covid-19 operates inside a social context which has a significant impression on its unfold.”

As effectively as these with massive city populations and robust worldwide journey hyperlinks, international locations with excessive charges of HIV have been additionally extra prone to have increased mortality charges. This could also be as a result of individuals with HIV typically produce other well being circumstances that put them at larger danger from Covid-19, the group suggests.

The weak hyperlink between mortality price and the timing or severity of government-imposed restrictions on day-to-day actions is reveals the impression of the big selection of software and enforcement of these restrictions throughout the area, making a constant impression sample troublesome to discern. Restrictions throughout peaks of an infection are effectively documented to have interrupted transmission in the area.

The findings present that the earliest recorded instances of Covid-19 have been in counties the place most individuals stay in city areas, with robust worldwide journey hyperlinks and larger testing capability. Algeria was the primary of 47 African international locations to report a case, on 25 February 2020. Most international locations had recorded instances by late March 2020, with Lesotho the final to report one, on 14 May 2020.

Researchers doc increased deaths through the second wave, as in comparison with the primary. The peak of infections through the second wave was additionally increased, with 675 deaths throughout the continent on 18 January 2021 in contrast with 323 through the first wave peak on 5 August 2020. Potential under-reporting was accounted for in the evaluation.

Dr Sarah Puddicombe, NIHR’s Assistant Director for Global Health Research, stated: “This study offers compelling results which challenge accepted views of epidemic preparedness and resilience in Africa. It is one of a series of important contributions that the TIBA partnership, working with governments and the WHO Regional Office has made to inform local, national and pan-African responses to the Covid-19 pandemic.”

The study, revealed in the journal Nature Medicine, was supported by the UK National Institute for Health Research and the Darwin Trust of Edinburgh. It additionally concerned researchers from the Universities of Nairobi, Ghana and Hong Kong.

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