Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis

Jean B Nachega; Nadia A Sam-Agudu; Rhoderick N Machekano; Philip J Rosenthal; Sonja Schell; Liesl de Waard; Adrie Bekker; Onesmus W Gachuno; John Kinuthia; Nancy Mwongeli; Samantha Budhram; Valerie Vannevel; Priya Somapillay; Hans W Prozesky; Jantjie Taljaard; Arifa Parker; Elizabeth Agyare; Akwasi Baafuor Opoku; Aminatu Umar Makarfi; Asara M Abdullahi; Chibueze Adirieje; Daniel Katuashi Ishoso; Michel Tshiasuma Pipo; Marc B Tshilanda; Christian Bongo-Pasi Nswe; John Ditekemena; Lovemore Nyasha Sigwadhi; Peter S Nyasulu; Michel P Hermans; Musa Sekikubo; Philippa Musoke; Christopher Nsereko; Evans K Agbeno; Michael Yaw Yeboah; Lawal W Umar; Mukanire Ntakwinja; Denis M Mukwege; Etienne Kajibwami Birindwa; Serge Zigabe Mushamuka; Emily R Smith; Edward J Mills; John Otokoye Otshudiema; Placide Mbala-Kingebeni; Jean-Jacques Muyembe Tamfum; Alimuddin Zumla; Aster Tsegaye; Alfred Mteta; Nelson K Sewankambo; Fatima Suleman; Prisca Adejumo; Jean R Anderson; Emilia V Noormahomed; Richard J Deckelbaum; Jeffrey S A Stringer; Abdon Mukalay; Taha E Taha; Mary Glenn Fowler; Judith N Wasserheit; Refiloe Masekela; John W Mellors; Mark J Siedner; Landon Myer; Andre-Pascal Kengne; Marcel Yotebieng; Lynne M Mofenson; Eduard Langenegger; AFREhealth Research Collaboration on COVID-19 and Pregnancy

doi:10.1093/cid/ciac294

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis

Clin Infect Dis. 2022 Nov 30;75(11):1950-1961. doi: 10.1093/cid/ciac294.

Authors

Jean B Nachega^{1

2

3

4}, Nadia A Sam-Agudu^{5

6

7}, Rhoderick N Machekano⁸, Philip J Rosenthal⁹, Sonja Schell¹⁰, Liesl de Waard¹⁰, Adrie Bekker¹¹, Onesmus W Gachuno¹², John Kinuthia^{12

13}, Nancy Mwongeli¹³, Samantha Budhram¹⁴, Valerie Vannevel¹⁵, Priya Somapillay¹⁶, Hans W Prozesky¹, Jantjie Taljaard¹, Arifa Parker¹, Elizabeth Agyare¹⁷, Akwasi Baafuor Opoku¹⁸, Aminatu Umar Makarfi¹⁹, Asara M Abdullahi²⁰, Chibueze Adirieje⁵, Daniel Katuashi Ishoso²¹, Michel Tshiasuma Pipo²², Marc B Tshilanda²², Christian Bongo-Pasi Nswe^{23

24}, John Ditekemena²¹, Lovemore Nyasha Sigwadhi⁸, Peter S Nyasulu⁸, Michel P Hermans²⁵, Musa Sekikubo²⁶, Philippa Musoke²⁷, Christopher Nsereko²⁸, Evans K Agbeno²⁹, Michael Yaw Yeboah¹⁹, Lawal W Umar³⁰, Mukanire Ntakwinja³¹, Denis M Mukwege³¹, Etienne Kajibwami Birindwa³², Serge Zigabe Mushamuka³², Emily R Smith³³, Edward J Mills³⁴, John Otokoye Otshudiema³⁵, Placide Mbala-Kingebeni³⁶, Jean-Jacques Muyembe Tamfum³⁶, Alimuddin Zumla^{37

38}, Aster Tsegaye³⁹, Alfred Mteta⁴⁰, Nelson K Sewankambo⁴¹, Fatima Suleman⁴², Prisca Adejumo⁴³, Jean R Anderson⁴⁴, Emilia V Noormahomed⁴⁵, Richard J Deckelbaum⁴⁶, Jeffrey S A Stringer⁴⁷, Abdon Mukalay⁴⁸, Taha E Taha³, Mary Glenn Fowler⁴⁹, Judith N Wasserheit⁵⁰, Refiloe Masekela⁵¹, John W Mellors⁵², Mark J Siedner^{53

54}, Landon Myer⁵⁵, Andre-Pascal Kengne⁵⁶, Marcel Yotebieng⁵⁷, Lynne M Mofenson⁵⁸, Eduard Langenegger¹⁰; AFREhealth Research Collaboration on COVID-19 and Pregnancy

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
² Department of Epidemiology, Infectious Diseases, and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁵ International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
⁶ Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.
⁷ Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁸ Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA.
¹⁰ Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹¹ Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹² Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
¹³ Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya.
¹⁴ Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa.
¹⁵ Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa.
¹⁶ Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa.
¹⁷ Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
¹⁸ Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
¹⁹ Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
²⁰ Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
²¹ University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo.
²² Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo.
²³ Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo.
²⁴ Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo.
²⁵ Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium.
²⁶ Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁷ Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda.
²⁸ Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda.
²⁹ Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
³⁰ Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria.
³¹ Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo.
³² Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.
³³ Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
³⁴ Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
³⁵ Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo.
³⁶ Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo.
³⁷ Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom.
³⁸ National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom.
³⁹ Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁴⁰ Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.
⁴¹ School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴² Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁴³ Department of Nursing, University of Ibadan, Ibadan, Nigeria.
⁴⁴ Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
⁴⁵ Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
⁴⁶ Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
⁴⁷ Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA.
⁴⁸ Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
⁴⁹ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵⁰ Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA.
⁵¹ Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
⁵² Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁵³ Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵⁴ Mbarara University of Science and Technology, Mbarara, Uganda.
⁵⁵ Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
⁵⁶ Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁵⁷ Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA.
⁵⁸ Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.

Abstract

Background: Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice.

Methods: We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models.

Results: Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13).

Conclusions: Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.

Keywords: Africa; COVID-19; maternal; neonate; pregnancy.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Africa South of the Sahara / epidemiology
COVID-19 Vaccines
COVID-19* / epidemiology
Cohort Studies
Female
Hospital Mortality
Humans
Infant
Pregnancy
Pregnancy Complications, Infectious*
Retrospective Studies
SARS-CoV-2

Substances

COVID-19 Vaccines

Abstract

Publication types

MeSH terms

Substances

Grants and funding