INTRODUCTION : The 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.
METHODOLOGY : This 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
RESULTS : The 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.
CONCLUSION : Mass 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.