PT - JOURNAL ARTICLE AU - James, Ananthu AU - Dalal, Jyoti AU - Kousi, Timokleia AU - Vivacqua, Daniela AU - Câmara, Daniel Cardoso Portela AU - Dos Reis, Izabel Cristina AU - Botero Mesa, Sara AU - Ng’ambi, Wignston AU - Ansobi, Papy AU - Bianchi, Lucas M AU - Lee, Theresa M AU - Ogundiran, Opeayo AU - Stoll, Beat AU - Chimbetete, Cleophas AU - Mboussou, Franck AU - Impouma, Benido AU - Hofer, Cristina Barroso AU - Coelho, Flávio Codeço AU - Keiser, Olivia AU - Abbate, Jessica Lee TI - An in-depth statistical analysis of the COVID-19 pandemic’s initial spread in the WHO African region AID - 10.1136/bmjgh-2021-007295 DP - 2022 Apr 01 TA - BMJ Global Health PG - e007295 VI - 7 IP - 4 4099 - http://gh.bmj.com/content/7/4/e007295.short 4100 - http://gh.bmj.com/content/7/4/e007295.full SO - BMJ Global Health2022 Apr 01; 7 AB - During the first wave of the COVID-19 pandemic, sub-Saharan African countries experienced comparatively lower rates of SARS-CoV-2 infections and related deaths than in other parts of the world, the reasons for which remain unclear. Yet, there was also considerable variation between countries. Here, we explored potential drivers of this variation among 46 of the 47 WHO African region Member States in a cross-sectional study. We described five indicators of early COVID-19 spread and severity for each country as of 29 November 2020: delay in detection of the first case, length of the early epidemic growth period, cumulative and peak attack rates and crude case fatality ratio (CFR). We tested the influence of 13 pre-pandemic and pandemic response predictor variables on the country-level variation in the spread and severity indicators using multivariate statistics and regression analysis. We found that wealthier African countries, with larger tourism industries and older populations, had higher peak (p<0.001) and cumulative (p<0.001) attack rates, and lower CFRs (p=0.021). More urbanised countries also had higher attack rates (p<0.001 for both indicators). Countries applying more stringent early control policies experienced greater delay in detection of the first case (p<0.001), but the initial propagation of the virus was slower in relatively wealthy, touristic African countries (p=0.023). Careful and early implementation of strict government policies were likely pivotal to delaying the initial phase of the pandemic, but did not have much impact on other indicators of spread and severity. An over-reliance on disruptive containment measures in more resource-limited contexts is neither effective nor sustainable. We thus urge decision-makers to prioritise the reduction of resource-based health disparities, and surveillance and response capacities in particular, to ensure global resilience against future threats to public health and economic stability.The script for the statistical analyses described in this article as well as the assocated datafile can be found here: https://github.com/Ananthu89/James-Dalal-Kousi-et-al-BJMGH-2022. COVID-19 data used in this manuscript is available at https://github.com/JyotiDalal93/COVID-19_SSA/blob/main/Data_sub_saharan_Africa.zip.