High Asymptomatic Presentation of Covid-19 in Ghana: Factors to Consider for Enhanced Pandemic Control

Abstract

Keziah L. Malm, Franklin Asiedu Bekoe, George Asumah Adu, Charles N. Lwanga, Badu Sarkodie, Patrick Aboagye and Ernest Kenu

Background: Ghana recorded its first two COVID-19 cases on March 12, 2020; and as of May 05, 2020, a total of 2719 confirmed cases and 18 deaths were recorded in ten (10) regions of Ghana with Greater Accra Region been the epicenter of the outbreak. Analysis of patient data by the Ghana Health Service (GHS) revealed an asymptomatic carrier rate of 93%. This was higher compared with the 25-50% rates for China, Singapore and other parts of the world. Consequently, this study sought to determine factors associated with the asymptomatic presentation of Ghana’s COVID-19 cases to inform design and targeting of control interventions.

Methods: A cross-sectional survey was conducted from 20th July to 14th August 2020 in all 10 regions that had confirmed up to 20 cases as of May 14, 2020. Study participants were randomly selected and asked questions on socio-demographics, lifestyle, medical history among others. Data was described using frequencies, proportions, means and standard deviation. Association between patient asymptomatic status and the predictive variables were determined by logistic regression.

Results: In all, 672 patients participated in this study, mean age been 31.0 years (standard deviation, SD) ±5.3), and majority been male 388 (57.7%). Eighty-five percent (571) of participants showed no symptom of the disease. Factors associated with asymptomatic presentation included: patient having three (3) meals in a day [cOR=0.56 (0.33-0.97)], adding green leafy vegetables to meal [cOR=0.41 (0.19-0.88)], drinking hibiscus flower tea (“Sobolo”) [cOR=0.56 (0.31-0.98)], performing extra physical activity [cOR=0.7 (0.17-2.88)], patient attaining some level of formal education [Primary cOR=0.16 (0.03- 0.93); Junior High School (JHS) cOR=0.24 (0.08-0.75); and Senior High School (SHS) cOR=0.14 (0.05-0.41)]. Hypertension increased the odds [cOR=1.71 (1.21-2.99)] of symptom(s) presentation among its victims.

Conclusion: This study found an asymptomatic proportion of 85%, slightly lower than the 93% reported by GHS. Factors associated with asymptomatic COVID-19 status were patients having three (3) meals per day, adding green leafy vegetables to meal, drinking hibiscus flower (“Sobolo”) tea, indulging in extra physical activity, and attaining Primary, JHS and SHS education. On the other hand, patients with hypertension were more prone to show symptom(s) of the disease than non- hypertensives. Efforts at controlling the disease should include education on adding green leafy vegetables to meals and hypertension prevention and management. Designated state institutions and the research fraternity should carry out further studies to give guidance on use of hibiscus flower.

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