key: cord-0903406-jdqqvxxc authors: Olumade, Testimony Jesupamilerin; Uzairue, Leonard Ighodalo title: Clinical characteristics of 4499 COVID‐19 patients in Africa: A meta‐analysis date: 2021-02-12 journal: J Med Virol DOI: 10.1002/jmv.26848 sha: cad101ca487b353e4cd3f763c2e254027a670112 doc_id: 903406 cord_uid: jdqqvxxc The novel coronavirus disease‐2019 (COVID‐19) pandemic that started in December 2019 has affected over 95 million people and killed over 2 million people as of January 19, 2021. While more studies are published to help us understand the virus, there is a dearth of studies on the clinical characteristics and associated outcomes of the severe acute respiratory syndrome coronavirus 2 on the African continent. We evaluated evidence from previous studies in Africa available in six databases between January 1 and October 6, 2020. Meta‐analysis was then performed using Open‐Meta Analyst and Jamovi software. A total of seven studies, including 4499 COVID‐19 patients, were included. The result of the meta‐analysis showed that 68.8% of infected patients were male. Common symptoms presented (with their incidences) were fever (42.8%), cough (33.3%), headache (11.3%), and breathing problems (16.8%). Other minor occurring symptoms included diarrhea (7.5%) and rhinorrhea (9.4%). Fatality rate was 5.6%. There was no publication bias in the study. This study presents the first description and analysis of the clinical characteristics of COVID‐19 patients in Africa. The most common symptoms are fever, cough, and breathing problems. A disease that was first reported in early December 2019 1 has led to a pandemic in 2020 that has resulted in about 95 million people and killed over 2 million people as of January 19, 2021. 2 Nearly every continent of the earth, except Antarctica, has felt the impact of the novel coronavirus disease 2019 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 3, 4 It was predicted that Africa would be the worst hit with the pandemic, having no less than 223 million cases and more than 150,000 fatalities. 3 Nevertheless, to improve our understanding and management of this novel disease, it remains pertinent to define and analyze the clinical characteristics and outcomes of the disease in patients. 7 Several studies have described the clinical and epidemiological characteristics, risk factors, case management, and associated outcomes of different patient cohorts with COVID-19 globally. 1, [7] [8] [9] [10] [11] [12] [13] [14] [15] Clinical features, diagnosis, and treatment of COVID-19 have also been reviewed elsewhere. 16 However, there is limited information on the clinical characteristics of COVID-19 in patients in Africa. In this study, we describe a meta-analysis of the clinical characteristics of COVID-19 patients in Africa. Leone" OR "Togo" OR "Burundi" OR "Eritrea" OR "Ethiopia" OR "Kenya" OR "Mozambique" OR "Rwanda" OR "Somalia" OR "Tanzania" OR "Uganda" OR "Zambia" OR "Zimbabwe" OR "Angola" OR "Algeria" OR "Egypt" OR "Tunisia" OR "Namibia" OR "South Africa" OR "Gambia" OR "Liberia" OR "Mali" OR "Nigeria" AND English [lang] . Figure 1 shows the flow chart of the literature screening process. The inclusion criteria were as follows: (1) cohort studies, casecontrol studies, and case series studies; (2) the study population Two reviewers, using the inclusion and exclusion criteria, independently selected the literature and extracted data to an Excel database, and any disagreement was resolved by consensus. Data extraction included the first author's surname and the date of publication of the article, study region/country, study design, sample size, age, and outcome measurement data such as clinical symptoms. The included studies of these meta-analyses were observational case series studies, so the British National Institute for Clinical Excellence (BNICE) was used to evaluate the study quality by the independent reviewers. The evaluation included eight items and the total score was 8. Studies with a score greater than 4 were seen as high-quality. All the meta-analyses were performed by using Open-Meta Analyst 27 and Jamovi software. A single-arm meta-analysis was carried out. The heterogeneity was quantified using the I 2 statistic. The random model was utilized for statistical heterogeneity between the results of each study. A total of 1065 records were identified during literature retrieval from databases. A total of seven studies involving 4499 COVID-19 patients were included in this meta-analysis 8, 9, 15, 15, [17] [18] [19] [20] (Figure 1 and Table 1 ). All studies included in this meta-analysis were conducted in African countries. The characteristics of the studies included in this metaanalysis were published between June 1, 2020 to October 2, 2020. The quality score of the included studies ranged from 5 to 7 on a maximum scale of quality score of 8 using the NICE criteria 28 (Table 1 ). The random-effect model was used in the meta-analysis. Gender distribution showed that the proportion of male was 68.8% (95% CI, 64.6%-72.9%) with significant heterogeneity I 2 = 65.16%, p = .014 ( Figure 3) , while the proportion of females in the study was 41.1% (31.8%-50.4%) with significant heterogeneity (I 2 = 94.28%), p = .001 ( Figure 5 ). The incidence of commonly encountered symptoms was as follows: The fatality rate in the 4490 patients included in the meta-analysis was 5.6% (95% CI, 2.7%-8.6%) with significant heterogeneity (I 2 = 85.9%, p ≤ .001) (Figure 4 ). F I G U R E 2 Evaluation of publication bias using a funnel plot based on the proportion of males Our findings of fever, cough, and breathing problems as clinical symptoms of COVID-19 were in tandem with the findings of other studies, with up to 99% of patients experiencing fever. 22 However, the proportion of patients who developed a fever in our analysis was lower than that reported from meta-analysis done in China and other countries, where over 80% of the patients examined had fever. 10, 12, 24 Our study also reported a low proportion in cough and breathing problems as compared with studies done outside Africa, 11, 12 this could be attributed to the number of studies that has reported pool clinical presentation in Africa as compared to those reported in other continents and probable missed cases that might have been attributed to malaria cases and other illnesses that Clinical characteristics of coronavirus disease 2019 in China WHO Coronavirus Disease (COVID-19) Dashboard The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model COVID-19: the new threat Africa in the path of COVID-19 What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control Characteristics, risk factors and outcomes among the first consecutive 1096 patients diagnosed with COVID-19 in Kuwait Clinical presentation, case management and outcomes for the first 32 COVID-19 patients in Nigeria Clinical characteristics and outcomes of COVID-19 infection in nine pregnant women: a report from a Sub-Saharan African country Clinical characteristics of 3062 COVID-19 patients: a meta-analysis Clinicopathological characteristics of 8697 patients with COVID-19 in China: a meta-analysis Clinical characteristics and morbidity associated with coronavirus disease 2019 in a series of patients in metropolitan Detroit The clinical characteristics and prognosis factors of mild-moderate patients with COVID-19 in a mobile cabin hospital: a retrospective, single-center study Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Clinical and demographic characteristics of COVID-19 patients in COVID-19): a review of clinical features, diagnosis, and treatment The epidemiological and clinical profile of covid-19 in children: Moroccan experience of the cheikh khalifa university center Clinical characteristics and outcomes of patients hospitalized for COVID-19 in Africa: early insights from the Democratic Republic of the Congo Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda Descriptive epidemiology of coronavirus disease 2019 in Nigeria Severe acute respiratory syndrome: historical, epidemiologic, and clinical features From SARS and MERS to COVID-19: a brief summary and comparison of severe acute respiratory infections caused by three highly pathogenic human coronaviruses Clinical features, pathogenesis and immunobiology of severe acute respiratory syndrome Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: a single arm metaanalysis Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice