• Juliet Charity Yauka Nyasulu, Richard Junganiko Munthali, Alinane Linda Nyondo-Mipando, Himani Pandya, Laywell Nyirenda, Peter Suwirakwenda Nyasulu, and Samuel Manda.
• Division of Community Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; AFRIQUIP Health, Department of Systems Strengthening, Johannesburg, South Africa. Electronic address: Juliet.nyasulu@wits.ac.za.
• Int. J. Infect. Dis. 2021 May 1; 106: 269-275.

IntroductionThe COVID-19 pandemic in Malawi emerged amidst widespread anti-government demonstrations and subsequent mass gatherings. This paper describes the incidence and factors associated with the spread of the COVID-19 pandemic in Malawi.MethodologyThis was a retrospective study of public data analysing geopolitical and immigration activities that occurred between 02 April and 08 September 2020. The Chi-square test of independence was used to tabulate sex and age-related fatality ratios among deaths due to COVID-19-related complications.ResultsThe drivers for COVID-19 spread were mass gatherings secondary to the country's political landscape and repatriation of citizens from high-risk areas coupled with minimum use of public health interventions. The prevalence was higher in people aged 50-59 years, males and in urban areas. Men had an increased risk of COVID-19-related deaths (Case Fatality Ratio: 1.58 (95% CI 1.11-2.22) compared with women. Furthermore, men and women aged ≥40 years were 16.1 times and 7.1 times more likely to die of COVID-related complications, respectively. Men aged ≥40 years had a 62% increased risk of deaths compared with women of the same age group.ConclusionMass political gatherings and cross-border immigration from high-risk areas were drivers for infection. Males, older age and urban residence were associated with increased COVID-19 morbidity and mortality. To control the spread of COVID-19 there is a need to regulate mass gatherings and repatriation of citizens, and strengthen the use of preventive health interventions. Men, the older age groups and urban areas should be prioritised for COVID-19 prevention strategies.Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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