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Post-COVID-19 conditions and health effects in Africa: a scoping review

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DOI: 10.1136/bmjopen-2024-088983

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 Open access Original research

Post-­COVID-­19 conditions and health

BMJ Open: first published as 10.1136/bmjopen-2024-088983 on 7 January 2025. Downloaded from http://bmjopen.bmj.com/ on January 8, 2025 by guest. Protected by copyright.
effects in Africa: a scoping review
Edward W Ansah,1 Promise Kwame Salu ‍ ‍,1 Martin S Daanko,1
David N Banaaleh,1 Mustapha Amoadu ‍ ‍2

To cite: Ansah EW, Salu PK, ABSTRACT

Daanko MS, et al. Post-­ Introduction The SARS-­CoV-­2 pandemic has caused STRENGTHS AND LIMITATIONS OF THIS STUDY
COVID-­19 conditions and global devastations in social, economic and health systems ⇒ This scoping review provides a comprehensive
health effects in Africa: a synthesis of existing evidence on post-­COVID-­19
of every nation, but disproportionately of nations in Africa.
scoping review. BMJ Open conditions in Africa, which may inform healthcare
In addition to its grave effects on the global systems,
2025;15:e088983. doi:10.1136/
there is continuation or development of new symptoms strategies and interventions and public health plan-
bmjopen-2024-088983
among individuals who have contracted the virus, with ning in the continent, and further draws attention to
► Prepublication history the potential to further stress the health systems on the the areas of needed research.
and additional supplemental continent. Therefore, the aim of this scoping review was ⇒ The consultation with diverse stakeholders, includ-
material for this paper are ing medical professionals and individuals experi-
to collate and summarise the existing research evidence
available online. To view these encing post-­ COVID complications, enhances the
on the prevalence and health effects of post–COVID-­19
files, please visit the journal
conditions in Africa. validity and relevance of our findings.
online (https://doi.org/10.1136/​
bmjopen-2024-088983). Methods and analysis Five main databases were ⇒ By including both peer-­reviewed articles and grey
thoroughly searched from 1 September 2023 to 10 May literature, the study offers a broad overview of the
Received 21 May 2024 2024 for eligible articles based on the pre-­established prevalence and health effects of post-­ COVID-­19
Accepted 09 December 2024 inclusion and exclusion criteria. These databases included conditions in Africa.
PubMed, Central, Scopus, Dimensions AI and JSTOR. ⇒ Quality appraisal of included studies was not con-
A total of 17 papers were included in the review. The ducted, which potentially limits the robustness of
protocol for this review is already published in BMJ Open; our findings.
doi:10.1136/bmjopen-­2023-­082519. ⇒ The review included studies published in English,
Results The prevalence of post–COVID-­19 conditions potentially excluding relevant literature published in
in Africa ranged from 2% to as high as 94.7%. Fatigue, other languages.
dyspnoea and brain fog were among the commonly
reported symptoms of post–COVID-­19 conditions. Reduced
worldwide from an estimated 800 million
functional status as well as physical and psychosocial
confirmed infections as of September 2023.3
disorders were the main health effects reported by the
In Africa alone, there were around 10 million
studies reviewed, but no study yet reported the effects of
post–COVID-­19 conditions on the health systems in Africa.
confirmed cases and 175 496 deaths as of 16
Conclusions There is an evidence of high prevalence of
February 2024.3
post–COVID-­19 conditions in the African setting. However,
Recent global evidence indicates that many
there is limited evidence of the health effects of the post–
individuals infected with COVID-­19 continue
COVID-­19 conditions on patients and health systems in
to experience symptoms or develop new ones
Africa.
beyond the acute phase of the disease.1 Post-­
Ethics and dissemination This scoping review involved
COVID-­ 19 condition, also known as long
analysis of secondary data; therefore, no ethical approval
COVID, is characterised by the persistence or
was needed. Dissemination of the result is being done
© Author(s) (or their emergence of physiological health symptoms
employer(s)) 2025. Re-­use
through international journals and may also be presented
permitted under CC BY-­NC. No at available research conferences. 3 months into the initial infection, lasting for
commercial re-­use. See rights 2 months or more with no other underlying
and permissions. Published by cause apart from the COVID-­19 infection.4
BMJ Group. INTRODUCTION Symptoms of post-­ COVID-­ 19 conditions
1
Department of Health, Physical The coronavirus disease 2019 (COVID-­ include fatigue, malaise, altered sense of
Education and Recreation,
University of Cape Coast, Cape
19) pandemic has altered global dynamics, smell and taste, breathlessness and cognitive
Coast, Ghana affecting both individual and societal well-­ impairments.5–7 In some cases, organ damage
2
Biomedical and Clinical being since its outbreak in late 2019 in has also been reported.8
Research Centre, University of Wuhan, China.1 The COVID-­ 19 pandemic Globally, the prevalence of post-­COVID-­19
Cape Coast, Cape Coast, Ghana has posed significant challenges and conditions is estimated at 0.43%.2 In the USA,
Correspondence to continues to impact the global healthcare reports indicate that by 2022, 6.9% of adults
Promise Kwame Salu; system profoundly.2 The disease has tragi- had experienced post-­COVID-­19 conditions,
​promise.​salu@s​ tu.​ucc.e​ du.​gh cally led to approximately 7 million deaths with 3.4% still living with these symptoms.9 In

Ansah EW, et al. BMJ Open 2025;15:e088983. doi:10.1136/bmjopen-2024-088983 1

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the UK, as of February 2023, 2 million people (3.1% of METHOD AND ANALYSIS
the population) reported post-­COVID-­19 conditions.10 In This review adhered to the scoping review method-
Africa, approximately 41% of individuals diagnosed with ology outlined by Arksey and O’Malley,16 which includes
COVID-­ 19 continue with post-­ COVID-­ 19 conditions.11 defining research questions; identifying relevant studies,
However, these figures may not fully capture the reality selecting studies, data extraction, summarising and synthe-
in Africa, where under-­reporting is likely due to chal- sising results and incorporating consultation. The Arksey
lenges in testing and diagnosis, especially in low-­resource and O’Malley framework was chosen for its emphasis on
settings. This under-­ reporting complicates efforts to consultation, a crucial component in enhancing the rigour
fully understand and appreciate the long-­term impact of a scoping review.16 Additionally, findings were reported
of COVID-­19 on individuals across the continent. Conse- following the Preferred Reporting Items for Systematic
quently, African health systems may find it challenging Reviews and Meta-­Analyses extension for Scoping Reviews
to plan and manage the healthcare demands posed by (PRISMA-­ScR).17 The protocol for this review is available
post-­COVID-­19 conditions effectively. The persistence of at doi:10.1136/bmjopen-­2023-­082519.18
post-­COVID-­19 conditions could exacerbate the strain on
Africa’s already burdened healthcare systems, potentially Patient and public involvement
impeding socioeconomic and health development across This study is a scoping review, and as such, there was no
the continent. This scenario underscores the importance patient or public involvement in its design and conduct,
of improving diagnostic capacity and support structures reporting and dissemination. We rather collated existing
for those experiencing post-­ COVID-­ 19 symptoms to evidence into one stop shop, providing a strong evidence.
address the broader implications for public health in the
Research question(s)
continent of Africa.
Two research questions guided this review
Several reviews have explored the risk factors, prev-
1. What is the prevalence of post–COVID-­19 conditions
alence and burden of post–COVID-­ 19 conditions in
in Africa?
Africa.11–14 However, these reviews often fall short of
2. What are the health effects of post–COVID-­19 condi-
addressing how post–COVID-­19 conditions could further
tions on patients in Africa?
strain Africa’s already overburdened healthcare systems.
Although these reviews aim to provide updated evidence Identification of relevant literature
on the prevalence of post–COVID-­19 conditions, their Search for the literature started from 1 September 2023
comprehensiveness may be limited. Methods, such as and continued until 10 May 2024 in five main databases,
systematic reviews and meta-­ analyses,15 include quality including PubMed, Central, Scopus, Dimensions AI and
appraisals that may exclude relevant records, potentially JSTOR. Additional search was conducted in Google
narrowing the findings. Additionally, given the evolving Scholar, Google, ProQuest, WHO library and univer-
nature of post–COVID-­ 19 conditions, the evidence sity online repositories. In consultation with a profes-
provided in these previous reviews11–14 may already be sional librarian at the Sam Jonah Library, University of
outdated, limiting their ability to capture recent trends Cape Coast, Medical Subject Headings terms together
in Africa. It remains essential to understand the common with controlled vocabularies were identified and used
post–COVID-­ 19 symptoms, their critical impact on to conduct an initial search in PubMed. These search
patients and their broader implications for health systems terms were modified to suit searches in the other data-
in Africa. Access to accurate, up-­ to-­date information bases (see online supplemental file 1 for details). More-
would enable African health systems to respond effec- over, all identified records were saved into the Mendeley
tively to these challenges, allowing for improved manage- software where they were merged (to remove duplicates)
ment in a region with limited healthcare resources. for further screening. See table 1 for the search strategy
The challenge is that post–COVID-­19 conditions could conducted in PubMed. A librarian at the Sam Jonah
raise the dependency ratio because of the long-­ term Library, University of Cape Coast, was also consulted
health effects including the various forms of disabilities. throughout the literature search process. Table 2 presents
Therefore, there is the need for evidence-­based policy, the eligibility criteria for the review.
health system restructuring and re-­orientation to meet
such increasing health demands. Thus, a more compre- Selection of relevant studies
hensive review like a scoping review is needed to map The selection of articles went through a two-­ stage
available evidence on the prevalence, common symp- screening process. The screening of titles and abstracts
toms, and health effects of long COVID and provide how was carried out after the duplicate records were identi-
they affect the health system in Africa. Furthermore, the fied and merged using the Mendeley software. Titles
evidence could improve patients’ well-­being and health- and abstracts were screened by 15 graduate students
care outcomes and form the bases for future studies, under the guidance of authors PKS, MSD and DNB.
including systematic reviews. This scoping review aimed Five students formed a group (three groups), and these
at providing critical insights into the prevalence of post– students independently screened the retrieved records.
COVID-­19 conditions, health effects on patients and the There was cross-­ over screening, where a group cross-­
implications for the health system in Africa. checked the screening done by another group. Any

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Table 1 Search strategy for search in PubMed
Items Search
#1 Search to identify “Prevalence [MeSH Terms)” OR “Rate [MeSH Terms)” OR “epidemiology” OR “Percentage”
prevalence
#2 Search to identify “Long COVID-­19” [MeSH Terms] OR “COVID-­19 Syndrome, Post-­Acute” OR “Post-­Acute COVID-­19
post COVID-­19 Syndromes” OR “Long Haul COVID-­19” OR “COVID-­19, Long Haul” OR “Long Haul COVID-­19” OR “Long
conditions Haul COVID-­19s” OR “Post Acute COVID-­19 Syndrome” OR “Post Acute COVID-­19 Syndrome” OR “Long
COVID” OR “Post-­Acute Sequelae of SARS-­CoV-­2 Infection” OR “Post Acute Sequelae of SARS CoV 2
Infection” OR “Post-­COVID Conditions” OR “Post COVID Conditions” OR “Post-­COVID Condition” OR “Long-­
Haul COVID” OR “COVID, Long-­Haul” OR “Long Haul COVID” OR “Long-­Haul COVIDs” OR “post covid”
#3 Search to identify “Health effects” [MeSH Terms] OR “Respiratory issues” OR “Cardiovascular problems” OR “Neurological
health effect of post complications” OR “Mental health concerns” OR “Chronic fatigue” OR “Muscle weakness” OR “Ongoing
COVID-­19 organ damage” OR “Immune system dysregulation” OR “Changes in taste and smell” OR “Skin problems”
#4 Search to identify “Africa(MeSH Term)” OR “sub-­Saharan Africa” [MeSH Terms] OR “Algeria” OR “Angola” OR “Benin” OR
countries in Africa “Botswana” OR “Burkina Faso” OR “Burundi” OR “Cape Verde” OR “Cameroon” OR “Central African
Republic” OR “Chad” OR “Comoros” OR “Congo (Congo-­Brazzaville)” OR “Democratic Republic of the
Congo” OR “Djibouti” OR “Egypt” OR “Equatorial Guinea” OR “Eritrea” OR “Eswatini” OR “Ethiopia” OR
“Gabon” OR “Gambia” OR “Ghana” OR “Guinea” OR “Guinea-­Bissau” OR “Ivory Coast” OR “Kenya” OR
“Lesotho” OR “Liberia” OR “Libya” OR “Madagascar” OR “Malawi” OR “Mali” OR “Mauritania” OR “Mauritius”
OR “Morocco” OR “Mozambique” OR “Namibia” OR “Niger” OR “Nigeria” OR “Rwanda” OR “Sao Tome and
Principe” OR “Senegal” OR “Seychelles” OR “Sierra Leone” OR “Somalia” OR “South Africa” OR “South
Sudan” OR “Sudan” OR “Tanzania” OR “Togo” OR “Tunisia” OR “Uganda” OR “Zambia” OR “Zimbabwe” OR
‘‘Ivory Coast’’(tw), and ‘‘Western Sahara’’(tw] OR Zaire(tw)
Overall search #1 AND #2 AND #4 Not animal* #3 AND #2 AND #4 Not animal*
strategy Filters that will be activated (01/01/2020 to date)

unresolved discrepancies were dealt with by authors EWA screening and selection process using the PRISMA-­ScR
and MA. This ensured that all relevant full-­text records flow diagram.
have been selected into the review. The screening of the
titles and abstracts were conducted to select eligible full-­ Data extraction
text records. In addition, the reference lists of full-­text Data extraction form was designed, tested and used for
eligible records were searched for additional relevant the charting of the data. Extracted data include author
records. Finally, full-­text records were screened by PKS, and date, purpose of the study, country of the study,
MSD and DNB against the eligibility criteria to select rele- design and sample size used, study population and find-
vant studies into the review. Figure 1 presents the search, ings on the prevalence of post-­ COVID-­ 19 conditions,
common symptoms of post-­COVID-­19 and health effects.
The included studies were critically searched, and data
Table 2 Eligibility criteria for screening search results and
full-­text records were extracted on the stated implications of COVID-­19
conditions and their health effects on the health systems
Inclusion ► Full-­text peer-­reviewed articles and grey in Africa. Two authors (MSD and DNB) performed the
criteria literature
data extraction independently. Then, the other two
► studies conducted in any African country
► Studies published in the English Language authors PKS and MA reviewed the data extracted by MSD
► Studies on prevalence or health effects of post-­ and DNB. The data extraction process ensured that we
COVID-­19 symptoms/conditions captured relevant information that are needed to answer
► Studies on the effects of post-­COVID-­19 on the the stated research questions. Author EWA led the study
health systems in Africa and helped to resolve any challenge that ensued during
► Studies published between 1 January 2020, and
10 May 2024
the data extraction phase.
► Studies published online and available
Exclusion ► Studies conducted in other continent other than Data summary and synthesis of results
criteria Africa Thematic analysis was employed in reporting the results
► Full-­text articles that are not freely available of this scoping review. The process include systematic
► Studies that did not provide a report on either
the prevalence or health effects of post-­
coding of the extracted data to identify recurring themes
COVID-­19 symptoms/conditions which were then organised and interpreted according to
► Case reports, case series, editorials, letters to the stated research questions. At the initial stage, authors
editors, expert opinions, reviews familiarised themselves with the data through reading.
► Abstract without full text This was followed up by the generation of initial codes
► Studies written and published in other language to identify specific themes. Subsequently, themes were
other than the English Language
grouped based on similarities and relationships and

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Figure 1 Preferred Reporting Items for Systematic Reviews and Meta-­analyses Extension for Scoping Reviews flow diagram.

were then reviewed and refined iteratively to ensure Africa,25–28 12% (2) in Ghana29 30 and 5.8% (1) each in
accuracy and coherence. Each theme was defined and Ethiopia,31 Tunisia,32 Nigeria33 and Libya.34 Addition-
named descriptively to reflect its content and relevance ally, one study (5.8%) was a multicountry investigation
to the research questions. Thereafter, narrative report that involved Cameroon, Egypt, Nigeria and Somalia³⁴.
was generated to present the synthesised themes in a The designs used in these studies varied, with nine
coherent manner. The approach allowed for a compre- cross-­sectional studies,19 20 24 26 29 31 32 34 35 two prospective
hensive exploration of the prevalence and health effects studies21 27 four retrospective studies22 26 30 33 and two case-­
of post–COVID-­19 conditions on health systems in Africa, control studies.23 25 In total, the studies sampled 14 328
which provided valuable insights into the topic under participants. The majority of these studies were published
investigation. in 2022 (n=7), followed by 2023 (n=6), 2021 (n=3), and
one in 2024.
Only three of the studies received funding support, with
RESULTS one funded by a government agency and two by private
Search results entities. Furthermore, most articles were published in
A total of 17 550 records were retrieved from the five main international journals such as The Lancet Global Health,
databases, including PubMed=45, CENTRAL=14 848, BMC Public Health, BMC Health Services Research and
Scopus=778, Dimmensions AI=1824 and JSTOR=55. Addi-
BMC Infectious Diseases, with only five studies published
tional 23 records were retrieved from Google, Google
in African journals.20 21 24 26 30 Online supplemental table
Scholar and the other sites; thus, 17 573 records were
1 provides detailed characteristics of the included studies.
retrieved and screened. A total of 371 duplicates were
merged, and 17 202 records were screened for eligibility.
Thus, 17 full-­text records were selected for this review. Prevalence of post-COVID-19 conditions and follow-up
See figure 1 for details. periods
The prevalence of post–COVID-­19 condition was anal-
Characteristics of included studies ysed under two themes, namely, prevalence and common
The 17 studies included in the review comprised 16 quan- symptoms of post–COVID-­ 19 conditions. Reviewed
titative studies and one qualitative study. Of these, 35% (6 studies reported post–COVID-­19 conditions prevalence
studies) were conducted in Egypt,19–24 24% (4) in South between 2%29 and 94.7%.34 Table 3 presents information

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Table 3 Prevalence of post-­COVID-­19 conditions
Prevalence Study Follow-­up Prevalence
category reference period Study population percentage (%) Country
0% and 10% 29 4 weeks COVID-­19 patients who survived 2 Ghana
31% and 40% 19 2 months COVID-­19 survivors (≥18 years old) 36.5 Egypt
21 1.5 months Patients with COVID-­19 (≥18 years old) 38.8 Egypt
28 6 months Hospitalised and nonhospitalised adults 18 years 38.5 South Africa
and older who had COVID-­19
30 2 weeks All COVID-­19 patients who were discharged 32 Ghana
41% and 50% 32 Not reported All Individuals who were infected with COVID-­19 46.5 Tunisia
33 2 weeks COVID-­19 survivors aged 10 years and above 40.9 Nigeria
51% and 60% 26 2 months Adults ≥18 years diagnosed with mild COVID-­19 60 South Africa
24 3 months Patients previously diagnosed of COVID-­19 with 55.3 Egypt
persistent health problems
35 3 months Healthcare workers who had COVID-­19 58.8 Cameroon,
Egypt, Nigeria
& Somalia
61% and 70% 27 3 months Previously hospitalised COVID-­19 survivors aged 66.7 South Africa
(≥18 years old)
81% and 90% 20 Not reported Patients who had confirmed/presumed COVID-­19 86 Egypt
infection
91%–100% 34 6 months Patients who had confirmed/presumed COVID-­19 94.7 Libya
infection

on the prevalence of post–COVID-­19 conditions and the impacting the health systems in Africa, a gap that need
respective country for each study. urgent research attention.
Where available, we also report follow-­up periods for
some of the reviewed studies. Time to follow-­up ranged
from 2 weeks30 33 to 6 months and over.34 See table 3 for DISCUSSION
details of the follow-­up periods. Summary of findings
Our review indicates that the prevalence of post–
Common symptoms of post-COVID-19 conditions COVID-­ 19 conditions in Africa ranged from 2% in
Fatigue, dyspnoea or breathlessness, brain fog (charac- Ghana to 94.7% in Libya. Fatigue, dyspnoea, brain fog,
terised by memory problems, lack of concentration or headache, insomnia, arthralgia and anosmia were the
cognitive impairments), headache, insomnia, anosmia, commonly reported symptoms of post–COVID-­19 condi-
arthralgia, chest pain, depression, and ageusia, among tions. Reduced functional status as well as physical and
others, were the commonly reported symptoms of post– psychosocial disorders were the main patents’ health
COVID-­19 conditions. Table 4 presents the pooled preva- effects reported by the studies reviewed.
lence of symptoms, and the studies reporting them.
Prevalence of post-COVID-19 conditions
Health effects of post-COVID-19 conditions Our study found that the prevalence of post-­COVID-­19
Two reviewed studies22 32 reported on the health effects conditions ranged from 2% to 94.7%. This wide variation
of post–COVID-­19 conditions on patients, highlighting likely reflects differences in definitions of post-­COVID-­19
reduced functional status²¹ and various physical and conditions, as well as diverse methodological approaches
psychosocial impacts.32 Reduced functional status ranged used by the studies reviewed in this scoping review. Similar
from 1.2% to 35.3%: 31% of patients reported negli- variability has been reported, with Muller et al13 docu-
gible limitations, 24.1% light limitations, 8.8% moderate menting a prevalence range of 2% to 86% in their system-
limitations and 1.2% severe limitations.22 Physical effects atic review. Most studies in our review reported prevalence
included itching, facial discolouration, coughing that between 31% and 40%, aligning closely with the pooled
made speaking difficult, forgetfulness, hand tremors, global prevalence of 45% documented by O’Mahoney
inability to perform daily activities and olfactory dysfunc- et al.36 These findings also align with the prevalence of
tion.32 Psychosocial effects included suicidal ideation and 48.6% and 41% from previous systematic reviews focused
social isolation.32 Unfortunately, none of the included on Africa.11 14 This consistency across studies suggests a
studies addressed how post–COVID-­ 19 conditions are convergent understanding of post-­COVID-­19 prevalence

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Table 4 Symptoms of post-­COVID-­19 condition
Symptom Study Pooled prevalence Range of reported prevalence
Fatigue 19 21 22 24–26 28 31 32 34 35 45.4% 12.8% to 63.7%
Dyspnoea 20 22 24–28 31 24.5% 15.6%28 to 33.3%22
Brain fog 19 25 27 28 31 32 24.2%. 9.9%28 to 49.1%32
Headache 20 24 27 28 30 31 33 18% 10.3%28 to 58.4%
Insomnia 19 20 23 24 31 32 36% 9.8%33 to 76%23
Anosmia 19 22 24 26 31 34 35 26.2%. 18%26 to 42.6%20
Arthralgia 20 21 24 25 31 32 35.8% 10%26 to 57.2%20
Chest pain 20 24 30–32 22.2% 6.5%24 to 32.6%20
Ageusia 19 24 26 34 35 30% 10.4%19 to 43%34
Anxiety/irritability 19 23 24 32 10.6% 14.3%19 to 36%32
Cough 20 22 30 31 41% 29.3%20 to 6430
Depression 23 24 31 32 35.7% 24.6%19 to 36.3%32
Myalgia 23 24 31 32 45.2% 21.835 to 60%20
Fever 22 31 34 48% 44%34 to 57.5%22
Mood swings 24 35 32.3% 8.6%35 to 40.532
Dizziness 19 24 16.3% 14.119 to 27%24
24
Abdominal pain 24 31 14.6% N/A
24
Rash 24 31 4.8% N/A
Palpitation 24 31 6.5%24 N/A
Restriction of activities 20 57% N/A
Anorexia 32 11% N/A
Gastritis 20 32.3% N/A
Hair Loss 32 47.6% N/A
Nervousness 20 53% N/A
Diarrhoea 19 27.5% N/A
Neuropathic pain 19 13% N/A

N/A, Not Applicable.

despite methodological differences, lending reliability no other explanation, with which they reported a lower
to the findings and underscoring the importance of prevalence, of 66.7%. These variations in definition and
addressing post-­COVID-­19 conditions in clinical practice study design likely accounted for the disparities in prev-
with relevant public health strategies. alence observed across the studies. Thus, we define post-­
Several studies reported exceptionally high prevalence COVID-­19 condition as the persistence or manifestation
of post-­COVID-­19 conditions20 26 27 34 which may result of new physiological and psychological health symptoms
from methodological differences such as study design, after the initial infection(s) beyond the initial successful
follow-­
up period, sample size and definitions of post-­ diagnosis and treatment, with no other underlying cause
COVID-­19 symptoms. For example, both Buzgia et al34 apart from the COVID-­ 19 infection. This definition
and Galal et al21 used a cross-­sectional design with 323 and encompasses post-­COVID-­19 condition to include both
430 participants, they reported prevalence of 94.7% and physiological and psychological health symptoms.
86%, respectively. In contrast, Dryden et al27 employed a Beyond our current definition, we further recommend
prospective observational cohort design and reported a a more standardised approach to defining post-­COVID-­19
prevalence of 66.7%. The definition of post-­COVID-­19 conditions in future research, such as the WHO’s defi-
conditions also appear to play a significant role. Galal et nition.4 Standardising definitions would facilitate more
al,21 with a prevalence of 86%, defined post-­COVID-­19 consistent measurement across studies and improve
conditions broadly to include symptoms affecting various comparability of findings. The variations in the prevalence
bodily systems following recovery from acute COVID-­19. underscore the importance of clear, uniform criteria for
Dryden et al,27 however, defined post-­COVID-­19 condi- understanding the burden of post-­COVID-­19 conditions,
tions as symptoms persisting for at least 3 months after aiding healthcare systems in identifying and managing
COVID-­19 onset and lasting for at least 2 months, with these conditions effectively. Establishing consistent

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methodologies in research on post-­COVID-­19 conditions services is limited, these symptoms may be further inten-
would enhance the reliability of data and inform strate- sified.40 Factors like disrupted routines, limited access
gies for clinical and public health interventions. to mental health support and COVID-­19-­related stigma
could also increase psychological distress, explaining the
Common symptoms of post-COVID-19 conditions high prevalence of neuropsychiatric symptoms observed
Similar to findings from other reviews in Africa,11–14 our in our review, consistent with global trends.39 Therefore,
review identified fatigue, dyspnoea, brain fog, headache, COVID-­ 19 patients would benefit from psychological
insomnia, arthralgia and anosmia as the most common interventions, yet such resources remain scarce in Africa,
post-­COVID-­19 symptoms. Fatigue emerged as the most compounding the pandemic’s mental health burden in
frequently reported symptom, aligning with previous the continent.42
African studies.11–14 It is crucial for clinical investiga-
tions to explore the factors and dynamics contributing to Health effects of post-COVID-19 conditions
fatigue in post-­COVID-­19 patients, as it may result from The reduced functional status identified in this review
a range of causes, including potential organ damage.37 may be influenced by the duration and severity of post-­
Likewise, neurological symptoms such as headache, brain COVID-­19 infection, as well as pre-­existing health condi-
fog and anosmia were commonly reported, mirroring tions in patients.21 For instance, persistent symptoms
findings in other African reviews.11–13 Multiple factors such as fatigue, dyspnoea and cognitive impairment can
may underlie these neurological symptoms, including significantly hinder patients’ ability to perform daily
direct viral effects on the nervous system, neuroinflamma- activities, limiting their participation in social and occu-
tion from the immune response, cerebrovascular compli- pational roles.37 Additionally, underlying conditions like
cations, hypoxia-­induced brain injury and psychological obesity, diabetes, cardiovascular diseases and respiratory
stress.37 Individual variations, such as immune response disorders may further impair functional capacity, as these
differences, genetic predispositions, pre-­existing health comorbidities can exacerbate the effects of COVID-­19 on
conditions and the severity of the initial COVID-­19 infec- multiple organ systems, prolonging recovery and intensi-
tion, might further contribute to the prevalence of neuro- fying functional limitations.22 The psychological impacts
logical symptoms.38 of COVID-­19, including anxiety, depression and PTSD,
Although COVID-­19 was initially identified as a respira- may also contribute to reduced motivation, diminished
tory pathogen,37 it can impact various systems throughout self-­efficacy and limited engagement in rehabilitation, all
the body, including the nervous system. While the virus of which impede functional recovery.39 40 These factors
may not directly invade brain cells extensively, neurolog- together highlight the importance of addressing both
ical effects likely arise from immune activation, neuroin- physical and psychological aspects in managing post-­
flammation and cerebral blood vessel impairment.39 COVID-­19 recovery.
This highlights the importance of examining cytokine Physical effects such as facial discolouration, speech
networks in post–COVID-­ 19 patients, as the cytokine difficulties, hand tremors and olfactory dysfunction,
storm experienced during the acute phase of infection as observed in this review, align with findings by Wang
might persist and contribute to these lasting symptoms.22 et al41 from China. These symptoms are likely to result
Addressing these issues may be particularly challenging from the systemic inflammatory response induced by the
in many African countries, where diagnostic and treat- virus, leading to tissue damage and functional impair-
ment options for complex conditions such as cytokine ments across various organ systems in African COVID-­19
dysregulation are limited, potentially exacerbating the patients.41 The diverse presentations of COVID-­ 19—
complications linked to post–COVID-­19. ranging from mild respiratory symptoms to severe multi-
Neuropsychiatric disorders, including insomnia, organ dysfunction—illustrate the broad spectrum of
depression and anxiety, were the second most frequently clinical sequelae that can manifest during both acute and
symptom reported in our review. This aligns with global postacute phases of the disease.41 This diversity under-
trends, where the prevalence of anxiety and depression scores the need for healthcare providers to remain vigi-
increased by 25% in the first year of the pandemic.40 lant and responsive to a wide array of post-­COVID-­19
Our findings are also consistent with prior African symptoms, enabling timely recognition, treatment, and
reviews.11 13 14 Stressors like isolation, social distancing rehabilitation of affected individuals.
and stigma associated with COVID-­ 19 may contribute Such comprehensive attention to post–COVID-­ 19
to depression and anxiety among survivors.40 In addi- conditions can bolster patients’ confidence in the African
tion, the virus’s neurotropic effects and the associated healthcare systems, encouraging healthcare-­ seeking
neuroinflammation could disrupt mood regulation and behaviours and improving health outcomes.41 Acknowl-
sleep patterns.39 The pandemic’s broader psychological edging and addressing the extensive impact of post–
impact—including fear of infection, social isolation, COVID-­ 19 conditions through early intervention and
economic instability and grief from loss of loved ones— holistic management will not only aid patients’ recovery
may exacerbate pre-­ existing mental health conditions but also reinforce trust in the healthcare infrastructure
or induce new ones among patients in Africa.40 41 In across the continent, contributing to better long-­ term
low-­resource countries, where access to mental health public health outcomes.

Ansah EW, et al. BMJ Open 2025;15:e088983. doi:10.1136/bmjopen-2024-088983 7

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Implications for health systems in Africa on patients’ functional status. That is, future studies
Healthcare systems across Africa face a complex array should assess the effects of post–COVID-­19 conditions
of challenges, spanning across institutional, human on functional status of patients and the health systems
resource, financial, technological and political domains. in Africa. It is also recommended that gendered analysis
Many African countries struggle to meet the basic of the prevalence and health effects of post–COVID-­19
requirements for building robust healthcare systems.43 conditions be conducted in future studies.
As a result, the additional burden of managing post–
COVID-­ 19 conditions could significantly disrupt the Conclusion
provision of quality healthcare services, exacerbating This review has highlighted a relatively high prevalence
health inequalities in the continent.29 The healthcare of post–COVID-­ 19 conditions in Africa, with reported
workforce may see declines in productivity due to post– rates ranging from 2% to 94.7%, though most studies
COVID-­19 conditions affecting healthcare workers who reported prevalence between 31% and 40%. Frequent
previously contracted COVID-­19, while the demands of symptoms identified included fatigue, dyspnoea, brain
managing post–COVID-­19 cases with limited diagnostic fog, headache, insomnia, arthralgia and anosmia, with
and treatment knowledge will likely add to workforce neurological symptoms being particularly prevalent. Key
stress.44 health impacts included reduced functional status and
Given that post–COVID-­19 conditions present over 200 psychological effects like suicidal ideation. However,
different symptoms, the capacity of the health workforce a significant limitation in the existing literature is the
must be strengthened for accurate diagnosis and manage- lack of focus on the health system implications of post–
ment. Health services will need to adapt at primary, COVID-­19 conditions, leaving a gap in understanding
secondary and tertiary care levels to support post– how these conditions may further burden the already
COVID-­19 patients effectively. This may necessitate the strained healthcare resources in Africa. This study’s find-
establishment or adaptation of specialised health facilities ings suggest that post–COVID-­19 conditions will likely
dedicated to treating these conditions.44 Furthermore, impose additional financial and operational pressures on
health technology for diagnosing post–COVID-­19 condi- African health systems, necessitating reorientation and
tions and essential medicines to treat them must be made restructuring to meet these emerging demands. Never-
readily available and accessible. Establishing protocols theless, this review also has limitations, including the
for data collection on post–COVID-­19 conditions is also exclusion of non-­English language studies, which may
essential to enhance monitoring and management. These limit the comprehensiveness of our findings. Further
protocols should ensure equitable access and support primary research across diverse African settings is essen-
broader research efforts to understand and address these tial to capture more detailed picture of the health and
emerging health challenges comprehensively.44 systemic impacts of post–COVID-­19 conditions. Addition-
Increased financial resources will be critical to enable ally, greater investment in research funding for African
African health systems to meet the demands posed by scholars is crucial to develop context-­specific strategies to
post–COVID-­ 19 conditions effectively. Managing this address this ongoing health challenge effectively.
responsibility will require strategic policy frameworks,
Acknowledgements We acknowledge the tremendous assistance rendered to us
effective oversight, and coalition-­building from leader- by Dr Diana Atuase of the Sam Jonah Library University of Cape Coast throughout
ship to ensure that financial and human resources are the review process. We also thank our postgraduate students who helped in
allocated and use judiciously. Such coordinated action screening the papers.
would support improved health service delivery to Contributors EWA conceptualised the study, PKS, MSD, DNB and MA designed,
patients across the continent, enabling a more resilient collected and analyse data and wrote the draft report of the study. EWA led and
response to the growing healthcare demands in Africa.44 supervised the team throughout the review process, is responsible for the overall
content as guarantor.
Funding The authors have not declared a specific grant for this research from any
Limitations and recommendations for future research
funding agency in the public, commercial or not-­for-­profit sectors.
This review included only studies published in English
Competing interests None declared.
language; thus, there may be useful studies published
in other languages that were not included in our review. Patient and public involvement Patients and/or the public were not involved in
the design, or conduct, or reporting, or dissemination plans of this research.
Moreover, we acknowledge that the inherent biases in
Patient consent for publication Not applicable.
the included studies may affect our findings. In addition,
gendered analysis of the prevalence and health effects Ethics approval Not applicable.
of post–COVID-­ 19 conditions was not conducted in Provenance and peer review Not commissioned; externally peer reviewed.
this review because only one study, out of the 17 studies Data availability statement Data are available upon reasonable request.
reviewed, did gender-­based analysis. Irrespective of these Supplemental material This content has been supplied by the author(s). It has
limitations, the authors collated relevant studies from five not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been
major databases and two online sources. The authors also peer-­reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
consulted a professional librarian in search of relevant responsibility arising from any reliance placed on the content. Where the content
studies on post–COVID-­19 conditions in Africa. Only one includes any translated material, BMJ does not warrant the accuracy and reliability
study assessed the effects of post–COVID-­19 conditions of the translations (including but not limited to local regulations, clinical guidelines,

8 Ansah EW, et al. BMJ Open 2025;15:e088983. doi:10.1136/bmjopen-2024-088983

 Open access

BMJ Open: first published as 10.1136/bmjopen-2024-088983 on 7 January 2025. Downloaded from http://bmjopen.bmj.com/ on January 8, 2025 by guest. Protected by copyright.
terminology, drug names and drug dosages), and is not responsible for any error 22 Tawfik HM, Shaaban HM, Tawfik AM. Post-­COVID-­19 Syndrome
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