Examining the Role of Social Determinants of Health and COVID-19 Risk in 28 African Countries

While the impact of the pandemic has varied between and within countries, there are few published data on the relationship between social determinants of health (SDoH) and COVID-19 in Africa. This ecological cross-sectional study examines the relationship between COVID-19 risk and SDoH among 28 African countries. Included were countries with a recent demographic and health survey (years 2010 to 2018). The response variables were COVID-19 case rates and death rates (reported as of 15 August 2020); and the covariates comprised eight broad topics common to multiple SDoH frameworks aggregated to the country level: geography (urban residence), wealth index, education, employment, crowding, and access to information. A negative binomial regression was used to assess the association between aspects of SDoH and COVID-19 outcomes. Our analysis indicated that 1 in 4 (25.1%) households in study countries are without safe and clean water and a space for handwashing. The odds of COVID-19 morbidity and deaths were higher in countries with a high proportion of households without access to safe and clean water. Having a high proportional of educated women (1.003: 95% CI, 1.001-1.005) and living in a less crowded home (0.959: 95% CI, 0.920-1.000) were negatively associated with COVID-19 deaths, while being insured and owning a mobile phone predicted illness. Overall, aspects of SDoH contribute either negatively or positively to COVID-19 outcomes. Thus, addressing economic and environmental SDoH is critical for mitigating the spread of COVID-19 and re-emerging diseases on the African continent.