The impact of COVID-19 on pregnant and recently pregnant women in Malawi: A national facility-based cohort
Authors: Chapuma Chikondi , Mndala Leonard , Gadama Luis , Kachale Fannie , Likaka Andrew , Bilesi Rosemary , Mbewe Malangizo , Maseko Bertha , Ndamala Chifundo , Makuluni Regina , Kuyeri Annie , Munthali Laura , Phiri Deborah A. , Masesa Clemens , Henrion Marc Y.R , Kumwenda Moses , Lissauer David 
Published: March 2022

ABSTRACTObjectiveTo describe the demographic characteristics, clinical manifestations, and clinical outcomes of hospitalised pregnant and recently pregnant women with COVID-19 in Malawi, a low-income country in Sub-Saharan Africa. This study responds to a critical gap in the global COVID-19 data.MethodsA national surveillance platform was established in Malawi by the Ministry of Health to record the impact of COVID-19 on pregnant and recently pregnant women and provide real-time data for decision making. We report this facility-based cohort that includes all pregnant and recently pregnant hospitalised women in Malawi suspected of having COVID-19 between 2nd June 2020 and 1st December 2021.Results398 women were admitted to hospital with suspected COVID-19 based on presenting symptoms and were tested; 246 (62%) were confirmed to have COVID-19. In women with COVID-19, the mean age was 27 ± 7 years.The most common presenting symptoms were cough (74%), breathlessness (45%), Fever (42%), headache (17%), and joint pain (10%). 53% of the women had COVID-19 symptoms severe enough to warrant admission.31% (76/246) of women admitted with COVID-19 suffered a severe maternal outcome, 47/246 (19%) died, and 29/246 (12%) had a near-miss event. 9/111 (8%) of recorded births were stillbirths, and 12/101 (12%) of the live births resulted in early neonatal death.ConclusionA national electronic platform providing real-time information on the characteristics and outcomes of pregnant and recently pregnant women with COVID-19 admitted to Malawian government hospitals. These women had much higher rates of adverse outcomes than those suggested in the current global data. These findings may reflect the differences in the severity of disease required for women to present and be admitted to Malawian hospitals, limited access to intensive care and the pandemic’s disruption to the health system.SUMMARY BOXWhat is already known?In pregnant and recently pregnant women, COVID-19 is associated with increased complications such as admission to an intensive care unit, invasive ventilation, and maternal death.In pregnant women with confirmed COVID-19, the current global estimate of all-cause mortality is 0.02%.Most countries in Africa rely on paper-based systems to collect key maternal health indicators such as maternal deaths and severe morbidity, which does not enable timely actions.What are the new findings?Maternal mortality and adverse perinatal outcomes are alarmingly high in a cohort of pregnant and recently pregnant women admitted to Malawian healthcare facilities located in a low-income country in Africa.A national facility-based maternal surveillance platform can be implemented during a pandemic and provide real-time data to aid policymakers in understanding its impacts on this key population.What do the new findings imply?In low-income countries in Sub-Saharan Africa, pregnant and recently pregnant women with COVID-19 admitted to hospital require enhanced care and a renewed focus on their needs to avert these adverse health outcomes.Global and national surveillance systems must specifically record outcomes for pregnant, recently pregnant women and their infants to understand the impact of public health emergencies on these groups, as they may be disproportionately affected and may require special considerations.