Disruptions from COVID-19 in sub-Saharan Africa will have substantial health consequences

For immediate release: Wednesday, June 23, 2021

Boston, MA—Early in the COVID-19 pandemic, many African leaders implemented prevention measures such as lockdowns, travel bans, border closures, and school closures. While these efforts may have helped slow the spread of the virus on the continent and continue to be important for its containment, they inadvertently disrupted livelihoods and food systems and curtailed access to critical nutrition, health, and education services. A new series of studies by researchers from Harvard T.H. Chan School of Public Health and colleagues from the Africa Research, Implementation Science and Education (ARISE) Network finds that these disruptions may have serious consequences for nutrition and health and exacerbate existing inequities—key areas for policymakers to address as the pandemic continues.

The six studies were published online in The American Journal of Tropical Medicine and Hygiene on June 23, 2021. Policy briefs on the studies were published online by the Harvard University Center for African Studies.

Few studies have documented and quantified the pandemic’s direct and indirect health and socioeconomic impacts in sub-Saharan Africa. With COVID-19 cases on the rise in many African countries and vaccine access lagging behind, these new studies help address knowledge gaps regarding the direct and indirect impacts of COVID-19 on various population groups in both rural and urban areas, and across three countries in sub-Saharan Africa: Burkina Faso, Ethiopia, and Nigeria. These sites were selected to leverage the partnerships and infrastructure of the ARISE Network, which brings together 21 member institutions from nine sub-Saharan African countries and researchers from Harvard Chan School to advance training and research capacity in the region.

The researchers analyzed data from the ARISE multi-country surveys, which were conducted using mobile telephone survey platforms from July to November 2020. Participants included 900 health care workers, 1,797 adults, and 1,795 adolescents.

In addition to the immediate risk of infection and mortality from COVID-19, the researchers found that the pandemic posed substantial indirect threats due to existing challenges around health infrastructure, food insecurity, and a high prevalence of other infectious diseases such as HIV.

Key findings from the studies detailed these threats:

  • COVID-19 restrictions impacted food systems, resulting in reported price increases for staples and grains, pulses (lentils, chickpeas, and beans), fruits, vegetables, and animal-source foods, and decreased consumption of diverse and quality diets.
  • Schooling was disrupted for most adolescents surveyed, with many not accessing education remotely or through other formats during the height of the pandemic in 2020.
  • Health care providers reported that more than half (56%) of essential health care services—including child and maternal nutrition and health services, HIV treatment, and surgeries—were disrupted due to COVID-19 restrictions.
  • Knowledge about COVID-19 was high among adults and health workers (although lower in nurses compared to doctors). However, among adults (not including health workers), misconceptions about COVID-19 transmission were prevalent and adherence to recommended prevention measures was low.
  • At least 18% of health care providers and 20% of adults reported mild or higher levels of psychological distress during the pandemic.

“In the coming months, additional preventive measures may be necessary to slow the spread of the virus in African countries,” said senior author and principal investigator Wafaie Fawzi, Richard Saltonstall Professor of Population Sciences, and professor of nutrition, epidemiology, and global health at Harvard Chan School. “Our findings highlight key areas for policymakers to consider when crafting interventions in order to reduce indirect risks to their populations.”

“These results indicate that the COVID-19 pandemic has had serious consequences for education, nutrition, and food security in sub-Saharan Africa,” said Isabel Madzorera, a lead author and postdoctoral research fellow in the Department of Global Health and Population at Harvard Chan School. “Interventions are needed to address observed increases in food prices, the reduction in diet quality and diversity, and educational opportunities lost, particularly for poor and vulnerable households during this pandemic—and to prevent these challenges in future disease outbreaks.”

Elena Hemler, a lead author and senior project coordinator of the Nutrition and Global Health Program in the Department of Global Health and Population at Harvard Chan School, said, “These studies can inform and aid the development of evidence-based strategies and public policy to mitigate against health, social, and economic impacts of COVID-19 in these countries and beyond.”

The ARISE Network is planning a follow-up survey that will include additional sites in Ghana and Tanzania and questions regarding vaccines.

Other Harvard Chan School authors included Till Bärnighausen, Phyllis Kanki, Michelle Korte, Josiemer Mattei, Dongqing Wang, and Tara Young. Additional collaborating institutions involved in the first survey round include the Harvard Center for African Studies, Addis Continental Institute of Public Health (Ethiopia), Haramaya University (Ethiopia), Nouna Health Research Center (Burkina Faso), University of Ouagadougou (Burkina Faso), and University of Ibadan (Nigeria).

This work was supported by the Bill & Melinda Gates Foundation grant OPP1179606.

“Design and Field Methods of the ARISE Network COVID-19 Rapid Monitoring Survey,” Elena C. Hemler, Michelle L. Korte, Bruno Lankoande, Ourohiré Millogo, Nega Assefa, Angela Chukwu, Firehiwot Workneh, Amani Tinkasimile, Isaac Lyatuu, Abdramane Soura, Dongqing Wang, Isabel Madzorera, Said Vuai, Till Bärnighausen, Mary Mwanyika Sando, Japhet Killewo, Ayoade Oduola, Ali Sié, Yemane Berhane, Wafaie Fawzi, The American Journal of Tropical Medicine and Hygiene, online June 23, 2021, DOI: https://doi.org/10.4269/ajtmh.20-1618.

“Reported Barriers to Healthcare Access and Service Disruptions Caused by COVID-19 in Burkina Faso, Ethiopia, and Nigeria: A Telephone Survey,” Nega Assefa, Ali Sié, Dongqing Wang, Michelle L. Korte, Elena C. Hemler, Yasir Y. Abdullahi, Bruno Lankoande, Ourohiré Millogo, Angela Chukwu, Firehiwot Workneh, Phyllis Kanki, Till Bärnighausen, Yemane Berhane, Wafaie Fawzi, Ayoade Oduola, The American Journal of Tropical Medicine and Hygiene, online June 23, 2021, DOI: https://doi.org/10.4269/ajtmh.20-1619.

“COVID-19 Knowledge, Perception, Preventive Measures, Stigma and Mental Health Among Healthcare Workers in Three Sub-Saharan African Countries: A Phone Survey,” Nega Assefa, Abdramane Soura, Elena C. Hemler, Michelle L. Korte, Dongqing Wang, Yasir Y. Abdullahi, Bruno Lankoande, Ourohiré Millogo, Angela Chukwu, Firehiwot Workneh, Ali Sié, Yemane Berhane, Till Bärnighausen, Ayoade Oduola, Wafaie Fawzi, The American Journal of Tropical Medicine and Hygiene, online June 23, 2021, DOI: https://doi.org/10.4269/ajtmh.20-1621.

“Impact of COVID-19 on Nutrition, Food Security, and Dietary Diversity and Quality in Burkina Faso, Ethiopia, and Nigeria,” Isabel Madzorera, Abbas Ismail, Elena C. Hemler, Michelle L. Korte, Adedokun A. Olufemi, Dongqing Wang, Nega Assefa, Firehiwot Workneh, Bruno Lankoande, Ourohiré Millogo, Josiemer Mattei, Abdramane Soura, Yemane Berhane, Ali Sié, Ayoade Oduola, Wafaie Fawzi, The American Journal of Tropical Medicine and Hygiene, online June 23, 2021, DOI: https://doi.org/10.4269/ajtmh.20-1617.

“The COVID-19 Pandemic and Adolescents’ Experience in Sub-Saharan Africa: A Cross-Country Study Using a Telephone Survey,” Dongqing Wang, Angela Chukwu, Ourohiré Millogo, Nega Assefa, Christabel James, Tara Young, Bruno Lankoande, Firehiwot Workneh, Elena C. Hemler, Michelle L. Korte, Josiemer Mattei, Abdramane Soura, Ali Sié, Ayoade Oduola, Yemane Berhane, Wafaie Fawzi, The American Journal of Tropical Medicine and Hygiene, online June 23, 2021, DOI: https://doi.org/10.4269/ajtmh.20-1620.

“Knowledge and Practice Related to COVID-19 and Mental Health among Adults in Sub-Saharan Africa,” Firehiwot Workneh, Dongqing Wang, Ourohiré Millogo, Alemayehu Worku, Angela Chukwu, Bruno Lankoande, Nega Assefa, Elena C. Hemler, Michelle L. Korte, Abdramane Soura, Ayoade Oduola, Ali Sié, Wafaie Fawzi, Yemane Berhane, The American Journal of Tropical Medicine and Hygiene, online June 23, 2021, DOI: https://doi.org/10.4269/ajtmh.21-0219.

Photo: Sipa USA via AP

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