COVID-19 pandemic in Malawi: Did public sociopolitical events gatherings contribute to its first-wave local transmission?

Introduction: The COVID-19 pandemic in Malawi emerged amidst widespread anti-government demonstrations and subsequent mass gatherings. This paper describes the incidence and factors associated with the spread of the COVID-19 pandemic in Malawi. Methodology: This was a retrospective study of public data analysing geopolitical and immigration activities that occurred between 02 April and 08 September 2020. The Chi-square test of independence was used to tabulate sex and age-related fatality ratios among deaths due to COVID-19-related complications. Results: The drivers for COVID-19 spread were mass gatherings secondary to the country's political landscape and repatriation of citizens from high-risk areas coupled with minimum use of public health interventions. The prevalence was higher in people aged 50-59 years, males and in urban areas. Men had an increased risk of COVID-19-related deaths (Case Fatality Ratio: 1.58 (95% CI 1.11-2.22) compared with women. Furthermore, men and women aged >40 years were 16.1 times and 7.1 times more likely to die of COVID-related complications, respectively. Men aged >40 years had a 62% increased risk of deaths compared with women of the same age group. Conclusion: Mass political gatherings and cross-border immigration from high-risk areas were drivers for infection. Males, older age and urban residence were associated with increased COVID-19 morbidity and mortality. To control the spread of COVID-19 there is a need to regulate mass gatherings and repatriation of citizens, and strengthen the use of preventive health interventions. Men, the older age groups and urban areas should be prioritised for COVID-19 prevention strategies. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/).

Automated summary

The spread of COVID-19 in Malawi was driven by mass political gatherings, cross-border immigration from high-risk areas, and inadequate public health interventions. The prevalence of COVID-19 was higher in the 50-59 age group, males, and urban areas. Men had a higher risk of COVID-19-related deaths, with men over 40 years old being 16.1 times more likely to die of COVID-related complications. Men aged over 40 had a 62% increased risk of death compared to women in the same age group.