Before the Covid-19 pandemic, Kizito Zua, a farmer living in Arua, a city in northern Uganda, had earned his way selling his produce at the local market.
In 2020, when lockdown rules were enforced in his area, he was no longer able to tend to his land. Left without a source of income, Kizito had little choice but to continue travelling to his fields to work. He was caught by the police and was placed in prison. The detention room he was in was full of other people, Kizito says — and this is where he believes he contracted Covid-19.
When he came home, he became feverish. Eventually, he became so ill that his family took him to hospital, where the Covid-19 infection was confirmed and he was put on oxygen. He ended up spending three months in hospital. “I was close to death,” he recalls.
Eventually, Kizito became well enough to leave hospital, but he was not quite the same as he was before. For about nine months following his encounter with the virus, Kizito was plagued by a range of symptoms, including dizziness, fatigue, and low libido.
To this day, although his condition has improved, it affects his ability to make money. “My body is weak; I can no longer dig, he says.
Kizito is not alone. As the Covid-19 virus spread globally, it left in its wake a trail of patients who have not fully recovered. This phenomenon, known as Long Covid, is defined as a chronic condition that persists beyond three months after the initial Covid-19 infection.
While it slowly became better documented as the pandemic progressed, it is still poorly understood today. In low-income countries, a lack of capacity and tools to track long-term symptoms and a focus on treating urgent cases has exacerbated the lack of awareness and knowledge. That means people like Kizito have been less likely to receive the help they need to get better.
Recognising this knowledge gap, researchers at Malaria Consortium set out to understand the prevalence of the condition in African populations. I led the research team that conducted a large case-control study to document the condition in sub-Saharan Africa, which had previously been difficult to do because of the lack of standardised diagnostic approaches. The research also looked at whether a previous Covid-19 infection could increase the risk of malaria infection.
Kizito was part of this long-term study.
Equitable access to healthcare remains one of the most pressing challenges of our time, and the Covid-19 pandemic served as a stark reminder of how fragile and uneven health systems can be, exposing long-standing deficiencies in infrastructure, workforce preparedness, and care delivery. Shining a light on this lingering aftermath of the pandemic is the aim of a series at allAfrica about Long Covid. In an interview with allAfrica, I had the opportunity to discuss the Malaria Consortium’s research , and how it’s helping to inform policy today.
The research conducted in Ethiopia and Uganda enrolled about 2,000 participants and found that as many as two-thirds of patients remained unwell after they had fallen ill with Covid-19, with some remaining ill for up to three years after their initial infection. On top of that, many reported more frequent episodes of febrile illnesses following their Covid-19 infection.
One participant from Uganda reported that since contracting Covid-19, at least every three to four months, they are “experiencing malaria constantly”.
Our team found that these individuals had struggled to receive adequate medical care for their condition. Healthcare workers interviewed for the research study said they were not adequately trained in how to recognise or treat the condition.
Malaria Consortium is working with the Ministries of Health to ensure the findings inform guidelines that are being drawn up. In Uganda, health officials are developing community-based guidelines for Long Covid care.
In an earlier allAfrica report, Professor Resia Pretorius from Stellenbosch University was interviewed, and spoke about her research, which showed that inflammatory microclots can linger in blood long after an initial Covid infection, potentially explaining the persistent symptoms — which can last months or even years — that characterise Long Covid. Pretorius said governments all over the world must address this debilitating condition by funding more research, setting up holistic Long Covid clinics, and preparing healthcare systems for rising economic and social burdens tied to chronic illness.
Indeed, Long Covid sufferers across Africa are still struggling to access even the most basic medical services, often due to a shortage of trained health workers equipped to diagnose and manage this complex condition. And it isn’t just a matter of workforce. The infrastructure itself is often fragmented; these individuals are often forced to navigate a maze of specialists, many of whom are located far from home. For some, the cost of multiple consultations — or the sheer distance required to reach them — is prohibitive.
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Many participants in our research reported feeling as though they had been left behind and forgotten about as the immediate threat of the pandemic receded and the world moved on. Malaria Consortium’s work is aiming to get these individuals, like Kizito, the help they need to return to normal and reduce the health inequities they face.
Dr Achan oversees and drives Malaria Consortium’s research agenda and programmes across 11 countries in Africa and South East Asia. Previously, the doctor was the Malaria Research Coordinator at the Medical Research Council Unit in The Gambia. These roles provided extensive experience with several trials on mass drug administration of several antimalarial drugs, including dihydroartemisinin-piperaquine and ivermectin, studies on reactive self-administered treatment against asymptomatic malaria, and multiple individually randomized antimalarial therapeutic trials. Most recently, Dr Achan evaluated potential interactions between Covid-19 and malaria, and is exploring the role of innovative mass drug administration strategies for malaria burden reduction in special risk populations in high-burden settings.
