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

Nyasulu, Juliet Charity Yauka; Munthali, Richard Junganiko; Nyondo-Mipando, Alinane Linda; Pandya, Himani; Nyirenda, Laywell; Nyasulu, Peter; Manda, Samuel

INTRODUCTION COVID-19 pandemic in Malawi emerged amidst widespread anti-Government demonstrations and subsequently mass gatherings. This paper describes the incidence and factors associated with the spread of COVID-19 pandemic in Malawi. METHODOLOGY This was a retrospective study on public data analysing geopolitical and immigration activities that occurred between 2 April and 8 September 2020. We used chi-square test of independence to tabulate gender 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 % Confidence Interval 1.11 - 2.22) compared to women. Furthermore, men and women ≥40 years old were 16.1 times and 7.1 times more likely to die of COVID related complications respectively. Men ≥40 years had a 62% increased risk of deaths compared to 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 gathering, repatriation of citizens, and strengthen use of preventive health interventions. Men, the older age groups and urban area should be prioritized with COVID-19 prevention strategies.