Beyond long COVID: post-acute infection syndromes across Africa, a systematic review

Abstract

Post-acute infection syndromes (PAIS) have gained global attention through Long COVID, yet many pathogens most closely linked to PAIS are endemic to Africa, where evidence remains scarce; a gap with implications for health equity and global health security. We aimed to systematically review the prevalence, clinical presentation, and associated factors of PAIS following non-COVID infections in Africa, and to identify priorities for future research. We conducted a systematic review, searching Medline, Embase, and grey literature until 7 November 2025 for studies in Africa reporting symptoms four or more weeks after acute infection. Case reports, case series, conference abstracts, secondary research, comments, and correspondence were excluded. Two reviewers independently screened records and extracted data on study characteristics, symptom prevalence, clinical presentation, and associated factors. As substantial heterogeneity was observed across studies, results were summarised descriptively. The study was registered on the Open Science Framework. Of 1,368 records, 65 studies were included, 42 on Ebola virus disease and 19 on chikungunya, with moderate to low risk of bias. Prevalence of PAIS ranged from 17.5% to 98.6% after Ebola and 12.1% to 78.6% after chikungunya. Musculoskeletal pain, ocular complications, headache, and fatigue predominated after Ebola; arthralgia was the hallmark of post-chikungunya disease. Substantial symptom burden persisted years after acute infection. Female sex, older age, and greater acute disease severity were the factors most frequently reported to be associated with persistent sequelae. An exploratory, non-systematic supplementary search additionally identified sex-specific consequences among female survivors including menstrual irregularities and adverse pregnancy outcomes. Despite scarce, heterogeneous, and geographically concentrated evidence, the reported prevalence of persistent symptoms among survivors is high, although the absence of comparison groups in most studies complicates attribution to the infection itself. Health systems in Africa must adapt to provide long-term survivor care, embedding follow-up into existing chronic care platforms. As pathogens endemic to Africa carry pandemic potential and expand geographically, understanding their chronic consequences is both a matter of health equity and an urgent global health security priority. Not applicable.