Risk factors for long COVID among participants of a population-based study in urban and rural Kenya, 2021

Post-COVID-19 conditions (PCC) or Long COVID, will linger due to continued circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Understanding the burden and risk factors of PCC could guide development of management guidelines for affected persons.

Using Population-Based Infectious Disease Surveillance platforms established in Nairobi and Siaya Counties in Kenya, we followed up participants previously infected with SARS-CoV-2 between 01/05/2020 and 30/09/2021 to evaluate the presence and risk factors for PCC. Interviews were conducted from 13/10/2021 to 22/11/2021 to elicit information on the presence of four primary outcome categories: (i) presence of respiratory symptoms, (ii) self-reported non-recovery after SARS-CoV-2 infection, (iii) psychological distress, and (iv) worsening disability. The latter two were evaluated for persons ≥ 18 years old. Risk factors assessed included participants' demographic and clinical characteristics. Logistic regression models were developed for each outcome adjusted for household-level clustering.

Characteristics of the 832 participants from both sites were as follows; 82.7% were < 50 years, 59.3% were female, 5/511 (1.0%) were vaccinated with ≥ 1 dose of COVID vaccine. For the outcomes, 174/832 (20.9%) had respiratory symptoms, 165/793 (20.8%) reported non-recovery following SARS-CoV-2 infection, 152/511 (29.7%) had psychological distress, while 112/511 (21.9%) had a worsening disability. Females had greater odds of reported non-recovery from COVID-19 illness than males, adjusted odds ratio (aOR) of 1.47 (95%CI, 1.01-2.13). Underlying medical conditions was a significant risk factor for all outcomes: for presence of respiratory symptoms, aOR = 1.82 (95% CI, 1.16-2.87), for reported non-recovery, aOR = 1.93 (95% CI, 1.24-3.02), for psychological distress aOR = 1.87 (95%CI, 1.17-2.99), while for worsening disability aOR = 2.58 (95% CI, 1.54-4.34). Other significant predictors included living in the Asembo site associated with psychological distress (aOR = 2.23; 95% CI, 1.42-3.53), worsening disability (aOR = 2.38; 95% CI, 1.43-3.97), and presence of respiratory illness (aOR = 2.44; 95% CI, 1.67-3.56).

PCC were found in approximately one-fifth to one-third of participants with the presence of underlying medical conditions being a common risk factor in all outcomes. Advocacy for the prioritization of interventions such as vaccination of persons with underlying medical conditions could consequently result in a reduction in the risk of PCC.