Recovery and long-term health outcomes of SARS-CoV-2 infection in a prospective cohort in an urban setting, Kenya

Introduction: Evidence on Long COVID remains limited in sub-Saharan countries. This study aimed to explore the occurrence of COVID-19-related symptoms and factors affecting recovery and Long COVID severity in Nairobi, Kenya. Methods: A prospective cohort of individuals testing positive for SARS-CoV-2 between February 2022 and February 2023 were followed until June 2023. COVID-19-related symptoms were assessed every three months. Time to recovery was analyzed using survival analysis, while factors affecting recovery and Long COVID severity using Cox proportional hazard and Poisson regression, respectively. Results: 42/291 (14%) participants had severe/critical infection, 59.1% were female and median age was 34. At 6 and 12 months post-positive PCR, 53.1% and 33.5% had [≥]1 COVID-19-related symptoms, respectively. Fatigue (40.2%), pain (36.8%), sore throat (36.8%), headaches (36.4%), and loss of strength (31.6%) were the most frequently reported symptoms. Median time to recovery was longer in participants with severe/critical infection than those with mild/moderate (234 vs 206 days, p=0.016). Participants aged 40-64 years experienced slower recovery than those aged <40 years (aHR=0.635 [95%CI, 0.429;0.941]). Participants with tertiary education recovered faster than those with primary education (aHR=1.869 [95%CI, 1.050;3.327]). Long COVID severity was associated with female sex (aIRR=1.413 [95%CI; 1.089;1.833]), tertiary education (aIRR, 0.525 [95%CI, 0.350;0.786]), and [≥]1 comorbidity (aIRR=2.540 [95%CI, 1.377;4.687]). Conclusions: Six months post-infection, half of participants had lingering symptoms, with a third still affected after a year. Recovery was faster in younger, more educated individuals, while severe Long COVID was more common in women and those with low education and pre-existing conditions. Findings highlight the burden of Long COVID in Kenya and the need for support for vulnerable groups.