Effect of SARS-CoV-2 Infection in Pregnancy on Maternal and Neonatal Outcomes in Africa: An AFREhealth Call for Evidence through Multicountry Research Collaboration

Nachega, Jean B.; Sam-Agudu, Nadia A.; Budhram, Samantha; Taha, Taha E.; Vannevel, Valerie; Somapillay, Priya; Ishoso, Daniel Katuashi; Tshiasuma Pipo, Michel; Bongo-Pasi Nswe, Christian; Ditekemena, John; Ayele, Birhanu T.; Machekano, Rhoderick N.; Gachuno, Onesmus W.; Kinuthia, John; Mwongeli, Nancy; Sekikubo, Musa; Musoke, Philippa; Agbeno, Evans Kofi; Umar, Lawal W.; Ntakwinja, Mukanire; Mukwege, Denis M.; Smith, Emily R.; Mills, Eduard J.; Otshudiema, John Otokoye; Mbala-Kingebeni, Placide; Kayembe, Jean-Marie N.; Mavungu Landu, Don Jethro; Muyembe Tamfum, Jean-Jacques; Zumla, Alimuddin; Langenegger, Eduard J.; Mofenson, Lynne M.

In the African context, there is a paucity of data on SARS-CoV-2 infection and associated COVID-19 in pregnancy. Given the endemicity of infections such as malaria, HIV, and tuberculosis (TB) in sub-Saharan Africa (SSA), it is important to evaluate coinfections with SARS-CoV-2 and their impact on maternal/infant outcomes. Robust research is critically needed to evaluate the effects of the added burden of COVID-19 in pregnancy, to help develop evidence-based policies toward improving maternal and infant outcomes. In this perspective, we briefly review current knowledge on the clinical features of COVID-19 in pregnancy; the risks of preterm birth and cesarean delivery secondary to comorbid severity; the effects of maternal SARS-CoV-2 infection on the fetus/neonate; and in utero mother-to-child SARS-CoV-2 transmission. We further highlight the need to conduct multicountry surveillance as well as retrospective and prospective cohort studies across SSA. This will enable assessments of SARS-CoV-2 burden among pregnant African women and improve the understanding of the spectrum of COVID-19 manifestations in this population, which may be living with or without HIV, TB, and/or other coinfections/comorbidities. In addition, multicountry studies will allow a better understanding of risk factors and outcomes to be compared across countries and subregions. Such an approach will encourage and strengthen much-needed intra-African, south-to-south multidisciplinary and interprofessional research collaborations. The African Forum for Research and Education in Health’s COVID-19 Research Working Group has embarked upon such a collaboration across Western, Central, Eastern and Southern Africa.