Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration

Abstract

. In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health’s COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.

Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV

“…Unfortunately, the spread of the disease elsewhere in Africa has been less well characterised, with only a few small observational studies documenting the effect of COVID-19 on African pregnant women. [28] Etti et al [5] plan to address some of these knowledge gaps by screening >50 000 pregnant women from five sub-Saharan countries, which will provide more information on the burden of COVID-19 in pregnant women on the continent.…”

Clinical features and predictors of mortality among hospitalized patients with COVID-19 in Niger

“…HIV-infection and/or tuberculosis independently predicted the hazard of death in South Africa [ 12 ] and of severity in Ethiopia [ 27 ], but not in studies from the USA [ 15 , 28 ]. As such, the call by The African Forum for Research and Education in Health [ 6 , 7 ] to pool COVID-19 data from African countries very necessary to enhance COVID-19 epidemiology in Africa to ensure an adaptive response at both hospital and community levels.…”

“…Although the literature on COVID-19 is growing at an exponential pace, there is still a shortage of observational studies from several African countries. However, local epidemiology is essential to enable the adaptation of the evidence-based response of COVID-19 at local levels as well as national and regional levels, once pooled [ 6 , 7 ]. For example, in typical resource constrained settings, not every facility would have adequate intensive care beds, access to ventilators, continuous oxygen, CT scanners, or even basic biological testing kits.…”

Opportunities and Challenges in North-South and South-South Global Health Collaborations During the COVID-19 Pandemic: The AFREhealth-CUGH Experience (as Reported at the CUGH 2021 Satellite Meeting)

“…As is now apparent, many aspects of research and teaching can be continued quite effectively via virtual platforms like Zoom and others. A successful example of the leverage of virtual video platforms for research collaborations is demonstrated by AFREhealth's multi-country, South-South COVID-19 research project among pregnant women and children [7,8]. While deficiencies and concerns in education (especially clinical teaching and training) remain, several have been quite effectively addressed in some form through video-enhanced platforms like Lecturio, Osmosis, and Scholar-X [6].…”

“…Such initiatives will also strengthen Southto-South multi-disciplinary and interprofessional research collaborations. AFREhealth's COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern, and Southern Africa [7,8].…”