The SARS-CoV-2 pandemic scenario in Africa - What should be done to
address pregnant women needs? A commentary.
Charles M’poca Charles 1,2,*† ; Emefa Modey
Amoah 3†; Kadidiatou Raissa Kourouma4; Luis Guilhermo Bahamondes2 ; José Guilherme Cecatti2 ; Nafissa Bique Osman 5,6,;
Philip Govule 7; Abdou Karim Diallo8; Jahit Sacarlal 9 ; Rodolfo
de Carvalho Pacagnella 2.
1 Provincial Health Administration - DPS Manica,
Manica Province, Mozambique.
2 University of Campinas, School of Medicine,
Department of Obstetrics and Gynecology, 101 Alexander Fleming st,
Campinas, São Paulo, Zip code: 13083-970, Brazil.
3 University of Ghana, Department of Population Family
and Reproductive Health, Accra, Ghana.
4 National Institute of Public Health of Côte
d’Ivoire, Abidjan, Côte d’Ivoire.
5 Eduardo Mondlane University, Faculty of Medicine,
Department of Obstetrics and Gynecology, 706 Salvador Allende st,
Maputo, Mozambique.
6 Maputo Central Hospital, Department of Obstetrics
and Gynecology, Agostinho Neto st, Maputo, Mozambique.
7 University of Ghana, School of Public Health,
Department of Epidemiology and Disease control, Accra, Ghana.
8 Clinique Gynécologique et Obstétricale de l’Hôpital
Aristide Le Dantec, Dakar, Senegal.
9 Eduardo Mondlane University, Faculty of Medicine,
Department of Microbiology, 706 Salvador Allende st, Maputo, Mozambique.
† Co-First authorship
*Corresponding author:
Charles M’poca Charles, Provincial Health Administration - DPS Manica,
Manica Province, Mozambique.
Email: cmpoca@gmail.com
Phone number: +258 825483741 / +55 19 98198-7713
Shortened running title: The SARS-CoV-2 pandemic in Africa & pregnant
women.
Keywords: SARS-CoV-2, COVID-19, Africa, Low and middle-income
countries, network, severe maternal morbidity.
The SARS-Cov-2 (COVID-19) virus causes an infectious and multisystem
disease first diagnosed in China in December 2019.1Having evolved rapidly with an exponential increase in the number of
cases and deaths worldwide, COVID-19 was declared a pandemic by the WHO
in mid-March 2020. Although in most Sub-Saharan African countries the
pandemic is in its initial phase, as of 8 September 2020, the cumulative
total cases of COVID-19 in the African Region exceeded one million and
it is now at 1 315 073 confirmed cases with 31 725
deaths.2
The advent of the pandemic has exhibited the weaknesses of health
systems in different settings, testing capacity and strategy being more
evident in low and middle-income countries (LMICs).3The growing number of COVID-19 cases has forced many countries to
reorganise existing health services and reassign available healthcare
professionals to combat COVID-19. In this regard, a number of service
delivery points were closed due to the lack of healthcare providers.
In response to the COVID-19 pandemic, many countries enforced lockdown
restrictions that closed down schools, businesses, restaurants, markets,
religious gatherings, and limited mass gatherings and border entry. The
lockdowns in some contexts, led to the disruption or suspension of many
essential health services including sexual and reproductive health (SRH)
services, thus placing women of reproductive age under conditions of
greater vulnerability and at risk of suffering devastating effects from
COVID-19.4, 5
In LMIC countries, the disruption in SRH services such as family
planning, prevention and treatment of sexual transmitted infection
(STI), safe abortion services, antenatal and postnatal consultations
pose risks to women of reproductive age. The disruptions were generally
associated with low coverage of the health network, weak diagnostic
capacity for SARS-CoV-2 detection, shortage of trained healthcare
personnel and reduced demand for services in the available health
facilities due to stigma and fear of acquiring SARS-COV-2 infection.
This situation has the potential to contribute negatively to the
incidence of high risk pregnancy, near miss, maternal and perinatal
deaths in these LMIC countries, with the consequent compromise of
objective 3.1 of the WHO Sustainable Development Goals, 2030
agenda.6
Although information on the clinical course of the disease and the
consequences on maternal and perinatal health are still scarce, there is
evidence that SARS-CoV-2 infection during pregnancy is associated with
an increased risk of perinatal complications, including foetal distress,
premature birth, perinatal death 7 and increased rate
of admission to the intensive care unit and need for mechanical
ventilation. 8, 9
The risk of maternal and perinatal complications may be increased in
pregnant women with underlying medical conditions, black pregnant women,
and pregnant women from a disadvantaged social class and, in contexts
with limited access to adequate healthcare services for COVID-19
management. 10, 11
Although, the impact of COVID-19 on pregnant women was considered a
secondary priority (12), studies involving pregnant women with
respiratory diseases caused by other respiratory viruses in addition to
recent data from studies of pregnant women with SARS-CoV-2 infection in
middle and high-income countries, highlight the need to pay special
attention to this group of women, especially in settings where
healthcare services are strained.
While global maternal deaths gradually declined between 2000 and 2017,
disparities in patterns of mortality still exist with Sub-Saharan Africa
region alone accounting for approximately 66% of deaths in the
continent.13 Due to the increasing number of reported
maternal death cases related to the COVID-19, mostly from LMIC, and
deficiencies in reporting cases in those countries, the need for
prospective monitoring of COVID-19 cases among pregnant women in the
context of LMIC is needed now more than ever.
As SARS COV-2 is a novel virus, knowledge of its impact on sexual and
reproductive health (SRH) is now emerging. 14Therefore, to understand the dynamics of SARS-CoV-2 infection in its
broad spectrum in the obstetric population of LMIC countries and to
minimize the effects of the pandemic on maternal and perinatal health,
it is essential to join forces among African researchers to generate
evidence to better elucidate the magnitude of the problem. For this, the
adoption of interinstitutional and multinational strategies is essential
to optimize the allocation of scarce resources to fight the pandemic.
In response to the SARS-COV-2 pandemic in sub Saharan Africa, domestic
and regional level efforts have been undertaken by various partners in
multiple sectors.15, 16 A critical component to
complement these strategies is the setting up of multi-centre
collaborative networks of African researchers to undertake surveillance
studies of conditions related to maternal and neonatal morbidity
associated with COVID-19 and interinstitutional support for the creation
and implementation of care protocols. The building of a collaborative
network to study the impact of COVID-19 on the obstetric population in
Africa (African Network for fighting COVID-19 in pregnancy- ANCOVID-19)
would enable a broad understanding of the pattern of disease evolution
in different countries and different contexts, enabling a better
understanding of the role of context-specific determinants in the
evolution of infection by SARS-CoV-2 and strengthen measure to ensure
access to essential reproductive health services during pandemics,
lockdowns and easing of restrictions.
Likewise, the implementation of robust surveillance systems and support
to weaker systems by the stronger partnerships may favour the collection
of standardised information on related maternal and perinatal morbidity.
Continuous monitoring of the impact of the disease on maternal and
perinatal health including strategies for remote monitoring of pregnant
women through telephone calls and/or digital tools where available
coupled with the sharing of clinical information will contribute to a
better understanding of the dynamics of infection in this population and
the moment of greatest vulnerability for the maternal and newborn
health.
Thus, we call on all researchers in Africa to join in a continental
effort to combat COVID-19 and reduce its impacts on maternal and
perinatal health in Africa. This would encourage the provision of
routine maternal and newborn services during and post pandemic in
Sub-Saharan Africa.