









































Communication, Society and Media 
ISSN 2576-5388 (Print) ISSN 2576-5396 (Online) 

Vol. 3, No. 4, 2020 
www.scholink.org/ojs/index.php/csm 

85 
 

 

Addressing the Risk Factors Contributing to High COVID-19 

Infection Rates in Africa 
Amb. John O. Kakonge, Ph.D.1* 

1 President of the Association of Former International Civil Servants, Kenya 
* Amb. John O. Kakonge, President of the Association of Former International Civil Servants, Kenya 

 

Received: October 25, 2020    Accepted: November 7, 2020    Online Published: November 21, 2020 

doi:10.22158/csm.v3n4p85                       URL: http://dx.doi.org/10.22158/csm.v3n4p85 

 

Abstract 

This article argues that, to contain COVID-19 in Africa, a number of risk factors must be more 

seriously addressed in the fight against the disease, namely, understanding the interrelationships 

between population density and mass gatherings, sanitation and contaminated water, poverty, climate 

change, insufficient disease-tracking data, leadership style and ability, and corruption. All the above 

factors are intertwined and they need to be addressed in a holistic manner if the continent is to contain 

not only COVID-19, but also future pandemics. Regardless of other factors, as can already be seen 

from the experience of countries such as New Zealand, strong leadership will be critical to addressing 

the identified risks. 

Keywords 

COVID-19, Africa, infection rates, poverty, sanitation, corruption, leadership 

 

1. Introduction 

Since COVID-19 was first detected in December 2019 in Wuhan Province in China, it has spread to 

almost 190 countries in all regions of the world. During the last six months, the approaches to 

containing the COVID-19 pandemic have varied from one country to another. This article explores 

some of the risk factors which have enabled the spread of the novel coronavirus in Africa, namely, 

population density and mass gatherings, sanitation and contaminated water, poverty, climate change, 

insufficient data, the role of political leadership, and corruption. 

 

2. Risk Factors 

2.1 Population Density and Mass Gatherings 

It was thought initially that COVID-19 infections would be more concentrated in densely populated 



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areas of the world. This, however, has not always been the case. While some analysts, such as Barr and 

Tassier (2020), argue that putting too much emphasis on urban density is a mistake, others insist on this 

correlation. Thus, Žmuk and Jošić (2020), in their study of COVID-19 infection in 209 countries, 

conclude that, in some regions of Italy, France and the United Kingdom of Great Britain and Northern 

Ireland, there is a correlation between population density and the spread of COVID-19. Similarly, some 

studies of the spread of higher infection rates in major US cities, compared with outlying residential 

areas, indicate a relationship with congested subways in cities like New York. However, Hamidi et al. 

(2020) find that in many densely populated areas, especially major cities like New York, Los Angeles 

and Chicago, higher infection rates have not occurred. In fact, according to Hamidi et al. (2020), the 

death rates are lower in densely populated counties than in less densely populated counties. They 

contend that densely populated counties in the USA have greater access to healthcare facilities and 

social distancing interventions are better managed (Hamidi et al., 2020). A further contributing factor to 

the apparent anomaly, as noted by Florida (2020), could be that small communities and towns in the 

USA are often characterised by a higher proportion of nursing homes, institutions whose residents are 

more susceptible to the virus due to their age and health. 

The correlation between population density and COVID-19 infection rates has been much clearer in 

developing countries. For example, Bagcchi (2020) notes that the American findings contradict those of 

India and other developing countries. In India, the highest mortality rates have been in densely 

populated slums of the major cities of Mumbai, Delhi and Chennai, and not in the small urban centres. 

Florida (2020) confirms that this applies also in Africa, where infection rates are higher in densely 

populated countries, including Algeria, Egypt, Ethiopia, Morocco and Nigeria, and in certain 

metropolitan centres, such as Abidjan, Cairo, Johannesburg, Kinshasa and Lagos, but notes that, as 

population densities in Africa are lower than in other parts of the world, the incidence of COVID-19 is 

also lower. This is the case in Kenya. Ayah (2020) notes that the densely populated cities of Nairobi and 

Mombasa have had the highest mortality rates in Kenya since the COVID-19 outbreak. Within those 

cities, the worst affected areas are the overcrowded slums. This also is the case in the informal 

settlements (townships) of South Africa. 

Mass gatherings of people, including religious services, weddings and funerals, political gatherings and 

open markets, attract greater risks of coronavirus transmission. An exemplary handling of containing 

such transmission comes from the Republic of Korea, where the government demanded that the 

Shincheonji church turn over its full membership list to enable the Ministry of Health to screen the 

worshippers for COVID-19. All the members identified as positive were ordered to self-isolate. In the 

city of Daegu, everyone was tested for the virus and individuals with the most serious cases of 

COVID-19 were hospitalized, while those with milder cases were checked into isolation centres 

(Thompson, 2020). Thompson confirmed that the initial Korean outbreak was contained within one 



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month.  

An example of poor management of potential transmission is a biotechnology leadership conference 

held in Boston, USA, in February 2020, attended by 175 executives from all over the world 

(Aschwanden, 2020). During the two days, participants shook hands, did not maintain social distancing 

protocols, and shared meals. Thereafter, a number of people were infected with COVID-19 

(Aschwanden, 2020). Similar examples abound and make it clear that proper protocols as 

recommended by the World Health Organization (WHO) should be respected.  

In should be remembered that WHO (2015) recommends that whenever there are disease outbreaks in 

crowded areas, the responsible governments should address the problem through the use of risk 

assessment approaches. 

2.2 Sanitation and Contaminated Water 

Another contributing factor to COVID-19 infection rates is provided by polluted water, poor hygiene, 

and lack of sanitation. Before COVID-19, regular hand-washing practices were not observed by many 

people, especially in rural areas and urban slums in Africa and other developing countries. Most poor 

neighbourhoods within major cities in developing countries lack clean water and adequate sanitation. 

People cannot afford to wash their hands regularly and, in most cases, they share toilets and washing 

areas, which are environmentally sub-standard. Poor hygiene increases the risk of contracting 

gastroenteritis, food poisoning, hepatitis A, influenza, the common cold, giardiasis, roundworm and 

threadworm. In short, improved sanitation could help many slum dwellers to avoid the possible risks 

associated with poor hygiene and polluted water and provide access to running water to enable regular 

hand-washing. 

The importance of hygiene and the need for water has increased since the outbreak of COVID-19. For 

example, since March 2020, NGOs, charity organizations and the county government of Nairobi have 

been helping slum communities with clean potable water. Even so, Yusuf (2020) describes a slum 

where a landslide destroyed the single water pipe, making frequent hand washing for coronavirus 

prevention a challenge. 

Unfortunately, people living in informal settlements and slums of major cities in Africa and elsewhere 

have little means to access affordable clean water. According to UN News (2020), it is recommended 

that African governments and partners should provide subsidized water for the duration of the 

COVID-19 crisis to people who are poverty stricken and those affected by economic hardship. 

2.3 Poverty 

Most people who are classified as being of low socioeconomic status live in overcrowded conditions. 

Crowded living conditions reduce compliance with social distancing requirements. Poverty is one of 

the risk factors for lower respiratory tract infections. Many poor people lack medical insurance and 

suffer from underlying illnesses such as diabetes, obesity, hypertension, and cardiovascular diseases.  



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Studies such as those in the USA indicate that poor and working poor Americans are most vulnerable to 

COVID-19 (Rogers, 2020). This is because they work in jobs with high exposure risks, such as home 

health aides, grocery clerks, and housekeepers, which put them in close contact with the public. 

In Africa, the poor are the ones who have been hardest hit by the pandemic. Protests have occurred in 

some African countries. For example, in the Sudan, people protested over the measures implemented to 

contain the spread of the coronavirus which left people with a choice between death by virus or death 

by starvation (Ostergard, 2020). This was also the case in Morocco. According to Ostergard (2020), in 

impoverished South African townships, the government had to use the military and police to enforce 

pandemic policies. Levison (2020) stated that by 22 June 2020, the Cape Town area, the country’s 

second-most populated city, was the epicentre of the COVID-19 outbreak, with about 53% of the 

national cumulative cases, followed by Gauteng (Johannesburg and Pretoria) at 21%. One of the 

lessons from COVID-19 is that the South African government now plans to reduce the density of the 

poverty-stricken overcrowded informal settlements. Nonetheless, for the proposed measures to work, 

they should be implemented with the support of communities in those areas. 

2.4 Climate Change 

There is a direct relationship between climate change and coronavirus infections. For instance, WHO 

(2015) maintains that climate change affects the social and environmental determinants of health, 

namely clean air, safe drinking water, sufficient food and secure shelter. Lustgarten (2020) argues that 

climate change is demolishing the natural defence systems that have kept many viruses away from 

people. Climate change is also a factor in the catastrophic loss of biodiversity caused by reckless 

deforestation and aggressive conversion of wildland for economic development, which, in turn, is 

pushing farms and people closer to the wild and opening the doors for the spread of disease. In this 

context, climate change therefore affects disease transmission by shifting the vectors’ geographical 

range and by shortening the pathogens’ incubation period. The consequences of climate change can 

thus fuel the spread of the coronavirus. For example, it is the poorest people who have suffered the 

most loss and damage resulting from climate change, including coping with the coronavirus disease 

pandemic during the recent floods of the Nile in the Sudan. The two crises, floods and coronavirus, are 

interdependent. There are concerns also that changing climate will bring more viral disease outbreaks. 

On the other hand, some people contend that although outbreaks of viral diseases may become more 

frequent, science may well be in a better position to deal with them (Kingsland, 2020). 

According to Lone and Ahmad (2020), the high burden of infectious diseases and the arrival of the 

winter flu season in southern Africa were some of the major factors which rendered the continent 

particularly vulnerable to the pandemic. They further point out that non-communicable diseases, such 

as cardiovascular conditions, cancers, chronic respiratory diseases and diabetes, are common in Africa 

and these conditions, in turn, compromise the body’s immune system and affect the severity of the 



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effects of COVID-19. Indeed, the majority of COVID-19 infections in Africa and other developing 

countries are found in combination with the above diseases. 

Onyango (2020) holds that the evidence linking COVID-19 to climate change is still in the initial 

stages, but there is consensus that respiratory viruses such as influenza are influenced by temperature 

and humidity and can survive longer at lower temperatures and low humidity. Accordingly, it can be 

argued that climate change may influence the spread of a novel viral disease such as COVID-19.  

Regardless of the differing perspectives on the role of climate change and the spread of the coronavirus, 

COVID-19 has taken the world by surprise and we should be prepared to face possible pandemics in 

the future that could be triggered by climate change (Momaneh, 2020). 

2.5 Insufficient Data for Tracking COVID-19 

Having credible data remains critical to the containment of COVID-19. According to Houreld and 

Lewis (2020), a month after the coronavirus emerged in Tanzania in April, President Magufuli declared 

the country free of COVID-19. Since then, there has been no update or data on the spread of the disease 

in Tanzania (Houreld & Lewis, 2020). Inadequate data in many African countries make it difficult to 

determine the extent and impact of the disease. As explained by Houreld and Lewis (2020), some 

African governments do not wish to publicize the poor state of their health services or accept that they 

face epidemics. There is no question that sharing information has several advantages including for 

planning and management purposes, and mobilizing funding, among others. 

Some governments have gone to great lengths to prevent information about the status of infections 

from becoming known, even if that has meant them missing out on donor funding (Houreld & Lewis, 

2020). In Africa, a lack of credible coronavirus data raises fears of a “silent epidemic” (Houreld & 

Lewis, 2020). BBC reporter Ann Soy, quoting the African Union’s Africa Centres for Disease Control 

and Prevention (Africa CDC), confirmed that, as at 27 May 2020, in a continent of 1.3 billion people, 

only 1.3 million had been tested. 

Based on the data available, it also appears that there are huge differences in actual cases of people 

affected by COVID-19 and other determinants among African countries. For example, the majority of 

the tested and confirmed cases in Eswatini, Malawi, Nigeria and South Africa are people in their 30s 

(Olamijuwon et al., 2020). Moreover, a significant number of the people tested and confirmed positive 

in South Africa are women, while more men have tested positive in Nigeria and Kenya. 

There is a lack of complete and quality registration and statistics, in particular on the causes of death of 

people. This is a big limitation for many African countries. Many high-income countries can at least 

quantify the actual number of deaths from COVID-19 (Olamijuwon et al., 2020). African countries 

need to standardize and detail the data collected as part of their national COVID-19 containment 

strategy. 

 



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2.6 Lack of Leadership 

Based on the available information, leadership style can pose another risk to the containment of 

COVID-19. For example, some leaders have successfully taken in hand their country’s entire 

containment process, such as Prime Minister Jacinda Ardern of New Zealand and Chancellor Angela 

Merkel of Germany. As the coronavirus disease spread all over Africa, Pierre Nkurunziza, the late 

President of Burundi, refused to apply lockdown and continued with business as usual. Furthermore, he 

expelled the WHO representative and three experts on the subject. He insisted that the country would 

be spared through the Christian faith (Solomon, 2020). His sudden death just before the end of his 

presidency is widely attributed to COVID-19, offering a salutary lesson to other COVID-deniers. The 

Tanzanian President decided to take a different approach, criticizing the public health experts and 

international community, thereby shutting off debate and discussion about the disease. 

In contrast, the Africa countries that have made progress with COVID-19 are the ones where the 

leaders have been proactive in instituting testing and contact tracing, such as Ghana, Kenya, Senegal 

and South Africa (Solomon, 2020). In Uganda, President Museveni, echoing what his scientists had 

learned from dealing with Ebola and AIDS, said that dealing with the most common means of 

transmission was the key and declared that everyone should wear masks in public as part of the fight 

against COVID-19 (Solomon, 2020). 

In the opinion of Johnson-Sirleaf (2020), credit should be given to some African women who have 

outdone themselves in fighting the coronavirus. For example, the mayor of Freetown, Yvonne 

Aki-Sawyer, has been mobilizing support across the city of Freetown to deliver behaviour change 

messages, such as the importance of wearing masks for all citizens. In Rwanda, Clare Akamanzi, 

working under the direct leadership of the President, has coordinated a massive Ministry of Health 

effort to combat the COVID-19 pandemic through organized isolation centres, the sourcing of personal 

protective equipment (PPE) and testing kits, and by developing plans for the post-virus recovery of the 

economy (Johnson-Sirleaf, 2020). 

In short, there are a few things which African leaders could still do concerning COVID-19:  

(a) During the current outbreak, African Presidents or Prime Ministers should help to organize the 

national response and not leave citizens to struggle on their own. Moreover, for government to respond 

adequately to the crisis, there should be clear guidance from the national leadership and the process 

should not be politicized as has happened in such countries as Brazil, Burundi, the USA, Mexico, and 

Tanzania, with unfortunate consequences. 

(b) Ideally, African leaders should fight the COVID-19 pandemic collectively rather than as individual 

countries. It is necessary for all stakeholders to join hands together in order to successfully fight the 

pandemic. 

 



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2.7 Corruption 

Since the COVID-19 outbreak began in March 2020, a significant challenge faced by some African 

countries has been the procurement of high-quality PPE and other essential medical equipment at 

affordable prices. Almost all African countries were unprepared for the pandemic, and there was 

competition among them and other countries, including those from Europe, to procure PPE. Given the 

financial challenges faced by most African countries, a number of their development partners and 

donors have come to their aid. Unfortunately, the procurement of COVID-19 medical supplies has been 

marred by corruption in many African countries. In particular, Igunza (2020) notes that the Kenya 

Medical Supplies Authority (KEMSA) misused US$ 7.8 million destined for the purchase of 

emergency PPE for hospitals and health workers throughout Kenya. The Kenya Anti-Corruption 

Commission discovered that procurement laws had been broken by KEMSA officials to award tenders 

to their friends or influential people. The investigation is ongoing, and chances are that those concerned 

will be arrested. Every Kenyan has condemned KEMSA and the parent Ministry of Health for allowing 

the misappropriation of funds donated to fight COVID-19. In fact, WHO (2020) has described 

corruption in the procurement of COVID-19 PPE as unacceptable and likened it to murder (Omboki, 

2020). 

Other examples include South Africa, whose COVID-19 response has also been marred by allegations 

of corruption surrounding its historic US$ 26 billion economic relief package (Magome, 2020). 

President Ramaphosa has launched an investigation targeting unscrupulous officials and private 

companies which have been involved in looting the government coffers. Interestingly, PPE was being 

offered for sale at four times the regular price and sanitizers were being charged at US$ 5 for a 

half-litre bottle, almost twice the original price (Magome, 2020). In Zimbabwe, the Heath Minister was 

sacked in July for unlawfully procuring medical equipment valued at US$ 75 million (Africa Briefing, 

2020). Ministers have been implicated for embezzling COVID-19 funds in Malawi and the Democratic 

Republic of the Congo (Africa Briefing, 2020). COVID-19 scandals also have caused government 

officials to lose their jobs in Botswana, Somalia and Uganda. 

Allegations of mismanagement of COVID-19 funds do not centre on Africa only; other countries have 

also fallen foul in this regard, such as Poland, whose Health Minister was forced to step down in 

August (Africa Briefing, 2020). The Africa Briefing (2020) article goes on to quote Liz David-Barrett 

of the University of Sussex, who notes that “The difficult part about a crisis, is that it is much harder to 

differentiate corrupt behaviour from the results of genuine mistakes and rushed decisions”. 

Whatever the case, the entrenched African culture will not change overnight, health crisis or no health 

crisis. 

 

 



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3. Summary 

Clearly, there are no simple solutions to tackling the risks discussed above that can exacerbate the 

spread and severity of COVID-19. As noted, in some countries, residents of densely populated areas or 

cities appear to be at less risk from COVID-19 than people living in less densely populated areas. This 

is not the case in Africa, however. The report of the Africa Centres for Strategic Studies of April 2020 

acknowledged that densely populated slums or informal settlements created conditions where 

coronavirus could spread quickly and undetected. African governments should, therefore, in the 

medium to long term, upgrade and modernize the slums in their major urban areas in order to prevent 

future pandemics. African governments should also consider de-urbanization, or at least encourage the 

expansion of smaller towns, especially in countries which have invested in devolution. 

Very large crowds, such as those which gather in churches, political gatherings, open markets, 

weddings and funerals, create greater risks of transmission. The WHO (2015) recommends that all 

countries should use risk assessments and risk management to guide the planning and facilitation of 

mass gatherings. For now, large crowds should be avoided, or certainly discouraged, until African 

countries are able to contain COVID-19. 

The issues of clean water and sanitation have been neglected across Africa, particularly in the densely 

populated urban slums. As part of a sustainable response to COVID-19, Ndaw (2020) maintains that 

African governments should prioritize water supply, sanitation, and hygiene services. The lessons to 

date from COVID-19 indicate that investment in the water and sanitation sector has been dismal. 

As regards poverty, Rodriguez (2020) convincingly demonstrates the vicious circle created by disease 

outbreaks and poverty, resulting in a widespread decline in economic status which, in turn, leads to 

more disease and more poverty. Epidemics worsen inequality and this, in turn, raises the cost of living, 

making it difficult for ordinary people to survive. 

Climate change has been identified as a “pandemic enabler, a pandemic accelerant and a multi-pathway 

crisis engine” (Cadham, 2020). Therefore, countries should invest in the mitigation of climate change. 

Another factor further exacerbating the risks of COVID-19 is the lack of data and information on the 

virus and its transmission pathways. An enormous amount of research undoubtedly has been 

undertaken on the novel coronavirus, but unfortunately this lacks consistency across different African 

countries, greatly limiting its usefulness (Henderson, 2020). Moreover, as Vestal (2020) notes, in some 

countries where very little testing is available, few cases are reported. Consequently, this may make 

people believe that they are not at risk, when in fact they are. The Director of the Africa CDC, John 

Nkengasong, warns that, even with good intentions, collecting quality data from African countries is 

not easy because experts are already stretched so thin; when this constraint is compounded by the 

additional burden imposed by COVID-19, their task becomes even more difficult. Much still remains 

unknown about this pandemic. 



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By and large, the pandemic has shown that Africa is able to solve its own problems. The region has 

resolved to produce its own PPE and other related medical supplies, rather than remain dependent on 

outside sources. According to Devermont (2020), many of the region’s leaders have listened to their 

health professionals, communicated effectively and frequently with their public, and drawn on best 

practices from the campaigns against Ebola, HIV/AIDS and tuberculosis. 

The COVID-19 pandemic provides an opportunity for African countries to strengthen their 

anti-corruption programmes and to integrate them into the fibre of society as part of improving 

governance effectiveness. This, in turn, will ensure that the limited funds are not stolen or misused. 

In short, all these risks are intertwined, and they need to be addressed together in a holistic manner with 

regard not just to COVID-19, but also to future pandemics. Africa has been lucky so far: many experts, 

including the BBC news reporter Andrew Harding, had predicted that by now many people in Africa 

would have died from COVID-19. This has not been the case. Lessons from Europe, the Americas and 

other regions indicate that there is a need for regionally coordinated strategies that are highly 

responsive to the specific requirements of individual nations. 

 

Disclaimer 

The views and opinions expressed in this article are solely those of the author and not necessarily 

associated with AFICS-Kenya. 

 

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