Clara Sambani, Victor Chikwapulo, Regina Mankhamba, Tonny Muwonge, Mavuto Thomas, Baxter Salatiel, Edna Mandala, Leah Mbabazi, Suzan Nakasendwa, Rodgers R Ayebare, Collins Mitambo, Matthew Kagoli, Mabvuto Chiwaula, Dzinkambani Kambalame, Triza Chirwa, Liness Chinyamunyamu, Tamrat Shaweno, Nebiyu Dereje, Tajudeen Raji, Francis Kakooza, Mosoka P Fallah, Evelyn C Banda, Abigail Kazembe, Mitch Matoga
{"title":"马拉维COVID-19严重程度和疫苗有效性：一项检测阴性的病例对照研究","authors":"Clara Sambani, Victor Chikwapulo, Regina Mankhamba, Tonny Muwonge, Mavuto Thomas, Baxter Salatiel, Edna Mandala, Leah Mbabazi, Suzan Nakasendwa, Rodgers R Ayebare, Collins Mitambo, Matthew Kagoli, Mabvuto Chiwaula, Dzinkambani Kambalame, Triza Chirwa, Liness Chinyamunyamu, Tamrat Shaweno, Nebiyu Dereje, Tajudeen Raji, Francis Kakooza, Mosoka P Fallah, Evelyn C Banda, Abigail Kazembe, Mitch Matoga","doi":"10.4102/jphia.v16i1.758","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>COVID-19 vaccines were administered globally, and Malawi commenced vaccination on 11 March 2021.</p><p><strong>Aim: </strong>This study assessed the real-world effectiveness of COVID-19 vaccines and factors associated with disease severity and mortality in Malawi.</p><p><strong>Setting: </strong>A facility-based case-control study within the largest referral hospitals.</p><p><strong>Methods: </strong>Cases (COVID-19 positive) were matched 1:1 with controls based on age, sex and testing date. Interviews via phone focused on COVID-19 testing and vaccination, underlying conditions and disease outcomes. Analysed using STATA 17, the exposure of interest was vaccination status. For vaccine effectiveness (VE), conditional logistic regression modelling was used, while disease severity and management were analysed using binary logistic regression.</p><p><strong>Results: </strong>The unvaccinated were at 53.3%, and 35.8% were fully vaccinated and/or received a booster. The VE among the fully and partially vaccinated was 10% (95% CI: -26.2, 35.81) and 31.8% (95% CI: -9.91, 57.72), respectively compared to the unvaccinated. Most of the COVID-19 patients (87.8%) were not hospitalised. Underlying chronic conditions and a previous positive COVID-19 test were associated with severe disease (aOR: 3.54, 95% CI: 1.65, 7.61 and aOR: 2.73, 95% CI: 1.13, 7.61, respectively); however, these odds were not different by vaccination status.</p><p><strong>Conclusion: </strong>The VE was low and severe disease was linked with chronic illnesses and previous positive COVID-19 tests. Efforts to promote vaccination through education and access should be enhanced, particularly for those with underlying chronic conditions.</p><p><strong>Contribution: </strong>The findings can inform strategies on prioritisation for disease vaccination and improving patient outcomes.</p>","PeriodicalId":44723,"journal":{"name":"Journal of Public Health in Africa","volume":"16 1","pages":"758"},"PeriodicalIF":0.6000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067548/pdf/","citationCount":"0","resultStr":"{\"title\":\"COVID-19 severity and vaccine effectiveness in Malawi: A test-negative case-control study.\",\"authors\":\"Clara Sambani, Victor Chikwapulo, Regina Mankhamba, Tonny Muwonge, Mavuto Thomas, Baxter Salatiel, Edna Mandala, Leah Mbabazi, Suzan Nakasendwa, Rodgers R Ayebare, Collins Mitambo, Matthew Kagoli, Mabvuto Chiwaula, Dzinkambani Kambalame, Triza Chirwa, Liness Chinyamunyamu, Tamrat Shaweno, Nebiyu Dereje, Tajudeen Raji, Francis Kakooza, Mosoka P Fallah, Evelyn C Banda, Abigail Kazembe, Mitch Matoga\",\"doi\":\"10.4102/jphia.v16i1.758\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>COVID-19 vaccines were administered globally, and Malawi commenced vaccination on 11 March 2021.</p><p><strong>Aim: </strong>This study assessed the real-world effectiveness of COVID-19 vaccines and factors associated with disease severity and mortality in Malawi.</p><p><strong>Setting: </strong>A facility-based case-control study within the largest referral hospitals.</p><p><strong>Methods: </strong>Cases (COVID-19 positive) were matched 1:1 with controls based on age, sex and testing date. Interviews via phone focused on COVID-19 testing and vaccination, underlying conditions and disease outcomes. Analysed using STATA 17, the exposure of interest was vaccination status. For vaccine effectiveness (VE), conditional logistic regression modelling was used, while disease severity and management were analysed using binary logistic regression.</p><p><strong>Results: </strong>The unvaccinated were at 53.3%, and 35.8% were fully vaccinated and/or received a booster. The VE among the fully and partially vaccinated was 10% (95% CI: -26.2, 35.81) and 31.8% (95% CI: -9.91, 57.72), respectively compared to the unvaccinated. Most of the COVID-19 patients (87.8%) were not hospitalised. Underlying chronic conditions and a previous positive COVID-19 test were associated with severe disease (aOR: 3.54, 95% CI: 1.65, 7.61 and aOR: 2.73, 95% CI: 1.13, 7.61, respectively); however, these odds were not different by vaccination status.</p><p><strong>Conclusion: </strong>The VE was low and severe disease was linked with chronic illnesses and previous positive COVID-19 tests. Efforts to promote vaccination through education and access should be enhanced, particularly for those with underlying chronic conditions.</p><p><strong>Contribution: </strong>The findings can inform strategies on prioritisation for disease vaccination and improving patient outcomes.</p>\",\"PeriodicalId\":44723,\"journal\":{\"name\":\"Journal of Public Health in Africa\",\"volume\":\"16 1\",\"pages\":\"758\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2025-04-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067548/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Public Health in Africa\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4102/jphia.v16i1.758\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Public Health in Africa","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4102/jphia.v16i1.758","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
COVID-19 severity and vaccine effectiveness in Malawi: A test-negative case-control study.
Background: COVID-19 vaccines were administered globally, and Malawi commenced vaccination on 11 March 2021.
Aim: This study assessed the real-world effectiveness of COVID-19 vaccines and factors associated with disease severity and mortality in Malawi.
Setting: A facility-based case-control study within the largest referral hospitals.
Methods: Cases (COVID-19 positive) were matched 1:1 with controls based on age, sex and testing date. Interviews via phone focused on COVID-19 testing and vaccination, underlying conditions and disease outcomes. Analysed using STATA 17, the exposure of interest was vaccination status. For vaccine effectiveness (VE), conditional logistic regression modelling was used, while disease severity and management were analysed using binary logistic regression.
Results: The unvaccinated were at 53.3%, and 35.8% were fully vaccinated and/or received a booster. The VE among the fully and partially vaccinated was 10% (95% CI: -26.2, 35.81) and 31.8% (95% CI: -9.91, 57.72), respectively compared to the unvaccinated. Most of the COVID-19 patients (87.8%) were not hospitalised. Underlying chronic conditions and a previous positive COVID-19 test were associated with severe disease (aOR: 3.54, 95% CI: 1.65, 7.61 and aOR: 2.73, 95% CI: 1.13, 7.61, respectively); however, these odds were not different by vaccination status.
Conclusion: The VE was low and severe disease was linked with chronic illnesses and previous positive COVID-19 tests. Efforts to promote vaccination through education and access should be enhanced, particularly for those with underlying chronic conditions.
Contribution: The findings can inform strategies on prioritisation for disease vaccination and improving patient outcomes.
期刊介绍：
The Journal of Public Health in Africa (JPHiA) is a peer-reviewed, academic journal that focuses on health issues in the African continent. The journal editors seek high quality original articles on public health related issues, reviews, comments and more. The aim of the journal is to move public health discourse from the background to the forefront. The success of Africa’s struggle against disease depends on public health approaches.
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