Prevalence of anxiety, depression, stress and insomnia among healthcare professionals during COVID-19 in Africa: umbrella review of existing meta-analyses

Introduction

The coronavirus was initially reported in Wuhan City, China, in December 2019, which has spread worldwide (World Health Organization, 2020). In terms of COVID-19 protection and management, healthcare professionals are at the forefront. The stressors related to COVID-19 pandemic, coupled with the fear of infection and the emotional toll of witnessing suffering and loss among patients, contribute to detrimental effects on mental health. Due to their duty they are vulnerable to COVID-19, and the high contact rate with COVID-19 patients result in stress and depression during the pandemic (Asnakew, Amha & Kassew, 2021; Shaukat, Mansoor Ali & Razzak, 2020).

The COVID-19 pandemic has had a profound impact on healthcare professionals worldwide, including those in Africa. The healthcare workforce in Africa has long been under-resourced and overburdened, with high levels of burnout and mental health issues already prevalent before the pandemic. The added stress and pressure of the COVID-19 pandemic have likely exacerbated these issues, leading to higher rates of depression, anxiety, stress, and insomnia among healthcare professionals. The ongoing COVID-19 pandemic has affected healthcare systems everywhere, particularly in Africa, with challenges that have never been seen before. The continent has a fragile healthcare infrastructure and limited resources to combat the pandemic’s effects, leading healthcare professionals to face significant physical, emotional, and psychological strains. COVID-19 pandemic and related restrictions can impact mental health (Dragioti et al., 2022). The fear, worry, and uncertainty surrounding such an unknown threat and containment strategies can put a burden on mental health (Chen et al., 2021). A significant number of HCWs manifest various psychological problems in Africa. According to Olashore et al. (2021) reported the psychological impact of COVID-19 on health care workers in African countries and the most common psychological problems were anxiety disorder (with rates ranging from 9.5% to 73.3%) and depression (with rates ranging from 12.5% to 71.9%). The pandemic impacts African healthcare workers through insomnia, depression, and fear of safety in their families (Nchasi et al., 2022).

In Africa until March 2024, about 12,381,551 COVID-19 confirmed cases and 259,261 death were reported by Africa CDC (2024). Africa, as a continent, presents a diverse range of challenges for healthcare professionals. Many countries in Africa struggle with limited resources, inadequate infrastructure, high patient-to-staff ratios, and a lack of mental health support systems. These challenges often place a significant burden on healthcare professionals, leading to increased stress levels, burnout, and ultimately, the development of mental health problems. Likewise, the tension of the pandemic on healthcare professionals cannot be understated. With an unprecedented number of patients, a shortage of necessary medical supplies, and major protocol changes, healthcare workers are being pushed to the brink of their limits. Many are forced to work long hours and take on significantly more patients than they would normally be expected to handle. Moreover, the fact that the threat of COVID-19 lingers has illuminated the higher risk that many healthcare professionals face. To address the mental health crisis amongst healthcare professionals, it is important for employers and healthcare organizations to offer their staff more support. This support can come in the form of offering additional time off, providing counseling services and emotional support, or opening up channels for communication to ensure that healthcare professionals feel heard (Hasen, Seid & Mohammed, 2023c).

During the pandemic, healthcare workers are affected by mental disorders (Hill et al., 2022). The higher prevalence rates of depression in the African population compared to elsewhere (Chen et al., 2021). South Africa’s healthcare professionals working in a tertiary hospital were with high levels of mental health problems during the early COVID-19, and the prevalence of mental distress was 57.4% (Lee et al., 2022). During COVID-19, the prevalence of mental distress was 92.7% among Ugandan health workers (Kirabira et al., 2022). Also in Egypt, HCWs had a high prevalence of anxiety, at 49.38%, insomnia at 56.17%, and poor sleep quality at 67.9% (Al-Otaibi et al., 2022). During the pandemic studies in Ethiopia presented that the prevalence of stress on healthcare professionals was 78.3% (Yitayih et al., 2021), 61.8% (Teshome et al., 2020), 63.7% (Asnakew, Amha & Kassew, 2021), 40.2% (Hajure et al., 2021), 42% (Tsehay, Belete & Necho, 2020), 51.6% (Chekole et al., 2020), 31.4% (GebreEyesus et al., 2021), study in Egypt 66.6% (El-qushayri et al., 2021). and 55.1% (Asnakew, Amha & Kassew, 2021).

Likewise studies in Ethiopia reported that the prevalence of insomnia was 15.9% (Jemal et al., 2021), 50.20% (Yitayih et al., 2021) and 40.8% (Habtamu et al., 2021; Zhang et al., 2021) and global study prevalence was 34.4% (Batra et al., 2020), in Egypt 71.8% (El-qushayri et al., 2021) 73.3% (Sagaon-Teyssier et al. 2020), in Kenya 36% (Kwobah et al., 2021). A global meta-analysis result on the prevalence of anxiety among HCWs found that it was 23.2%, depression 22.8%, and insomnia 38.9% (Rezaei-Hachesu et al., 2022). Besides, a review of studies found that the worldwide prevalence of mental disorders among healthcare workers was between 29.9% and 32.7% had anxiety, 28.4% to 31.3% had depression, and about 40% had sleeping problems (Dragioti et al., 2020). The study findings in the prevalence of mental disorders among healthcare workers with wide disparity evident during this pandemic in Africa (Fernandez et al., 2021). Yet, little reviews were done in Africa regarding the prevalence of mental health problems among healthcare professionals during COVID-19.

Hence, a pooled summary of the results of the meta-analyses on the prevalence of mental health problems among African healthcare professionals during COVID-19 is crucial. This research intends to provide thorough data on the impact of the COVID-19 pandemic on the mental health of healthcare professionals in Africa. Studying an umbrella review on these mental health problems among healthcare professionals in Africa during COVID-19 can provide valuable insights into the magnitude of the problem, the risk factors involved, and potential interventions that can help support the mental well-being of healthcare workers in the region. This research can inform policies and practices aimed at mitigating the impact of the pandemic on the mental health of healthcare professionals and ultimately improving their overall well-being and ability to provide quality care to patients.

Materials and Methods

Protocol registration

We performed an umbrella review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020) guidelines for reporting of systematic reviews and meta-analyses presented in Fig. 1. The protocol was registered in the International Prospective Register of Systematic Reviews with PROSPERO registration number: CRD42022383939.

Results

This umbrella review summarized the meta-analysis study findings in Africa on the prevalence of mental health problems among healthcare professionals during the COVID-19 pandemic. Figure 1 shows a PRISMA diagram of the steps in the database search and refinement process for the study of healthcare professionals’ mental health issues during the COVID-19 pandemic. Initial results from our database search included 18 studies. Six studies were removed after 15 studies’ titles and abstracts were examined and three duplicates were removed. There were nine full-text studies examined, and four were excluded for reasons that did not meet the inclusion criteria i.e. single-level studies and studies not in Africa. At long last, we perceived five studies proper to this umbrella review.

The pooled prevalence of depression, anxiety, stress, and insomnia

As shown in the forest plot (Fig. 2), the prevalence of common mental health problems (depression, anxiety, stress and insomnia) among healthcare professionals during COVID-19 in Africa was found to be high. Accordingly, a total of five studies reported the prevalence of depression, and the pooled prevalence of depression was found to be 53.75% (95% CI [40.80–66.70], I² = 63.6%, p = 0.027), and I² = 63.6%, indicating that there exists significant heterogeneity among study findings on the prevalence of depression among health care professionals through the pandemic in Africa. Similarly, four studies reported the prevalence of anxiety, and the pooled prevalence of anxiety was found to be 49.97% (95% CI [34.71–65.23], I² = 71.26%, p = 0.014). There exists significant heterogeneity among study findings on the prevalence of anxiety among healthcare professionals in Africa through the pandemic I² = 71.26%. This study also reported the pooled prevalence of stress, and from a total of 2 studies, the pooled prevalence of stress was 57.27% (95% CI [42.28–72.25], I² = 58.9%, p = 0.119). No statistically significant heterogeneity of study results has been observed; this might be due to the limited studies included in the meta-analysis. Likewise, from a total of four studies, the pooled prevalence of insomnia was 45.16% (95% CI [32.94–57.39], I² = 50.8%, p = 0.107), and no statistically significant heterogeneity of study results has been observed.

Discussion

The current comprehensive umbrella review aimed to determine the pooled prevalence of mental health problems during the COVID-19 pandemic among healthcare professionals in Africa. This review detected five systematic reviews and meta-analyses that evaluated the prevalence of mental health symptoms among healthcare professionals during the COVID-19 pandemic. From the included meta-analysis there is heterogeneity among studies. The variations might be: For example, study populations can greatly impact heterogeneity in research findings. Different demographics, socioeconomic backgrounds, cultural norms, and healthcare access among study participants can all influence how interventions are received and implemented, leading to varying outcomes. Methodologies are another critical factor that can contribute to heterogeneity in research. Variations in study design, data collection methods, sample sizes, and statistical analysis techniques can all affect the reliability and validity of study findings. For instance, using different measurement tools or data collection techniques can produce inconsistent results, making it difficult to compare or generalize findings across studies. However, it is important to consider the implications of heterogeneity on the validity of the study findings. High levels of heterogeneity may indicate that the results are not consistent across studies, which could affect the generalizability of the findings.

The most commonly studied symptoms across all meta-analyses were depression, anxiety, stress and insomnia. The pooled prevalence of depression, anxiety, stress and insomnia is discussed as follows. This umbrella review demonstrates the prevalence rates for depression among healthcare professionals during COVID-19 in Africa, and the pooled prevalence of depression was found to be 53.75% ranging from 40.80% to 66.70%. This is higher than the meta-analysis findings in China, where the pooled prevalence of depression was 39% (Xiong et al., 2022) and also worldwide depression pooled prevalence of 13.4% (Hill et al., 2022), 37% (Saragih et al., 2021), 22.8% (Rezaei-Hachesu et al., 2022). Also the result is higher than globally reported umbrella review prevalence of depression was 28.4% (Dragioti et al., 2020), 17.9% (Fernandez et al., 2021). Compared to a studies in Asia, with pooled prevalence of depression 37.5% (Ching et al., 2021), 34.61% (Norhayati, Che Yusof & Yacob Azman, 2021), the magnitude is high in africa. The cause for the high prevalence and differences of depression in Africa among healthcare professionals during COVID-19 might be due to there were growing concerns over the challenges on the African healthcare workers such as economic insecurity and stressful working conditions, limited access to personal protective equipment and other vital resources such as ventilators. Moreover, the pandemic influences African healthcare workers to social stigma, burnout, insomnia, depression, and fear of safety in their families (Nchasi et al., 2022).

Similarly, the pooled prevalence of anxiety was found 49.97% ranged from 34.71% to 65.23%. This is higher than meta-analysis findings in China pooled prevalence of anxiety was 37% (Xiong et al., 2022) and also worldwide anxiety pooled prevalence 16.1% (Hill et al., 2022), 40% (Saragih et al., 2021). The result is higher than global umbrella review results prevalence of anxiety 29.9% (Dragioti et al., 2020), 22.2% to 33.0% (Fernandez et al., 2021). It is higher than the study in Asia reported the pooled prevalence of anxiety 39.7(95%) (Ching et al., 2021), 34.81% (Norhayati, Che Yusof & Yacob Azman, 2021).

The pooled prevalence of stress was 57.27% ranged from 42.28% to 72.25%. This is much higher than meta-analysis findings in worldwide pooled prevalence of stress was 37% (Saragih et al., 2021), Asia 36.4% (Ching et al., 2021), 31.72% (Norhayati, Che Yusof & Yacob Azman, 2021).

Our study also reported the prevalence of insomnia among African healthcare professionals during the COVID-19 pandemic, and the pooled prevalence of insomnia was 45.16% ranged from 32.94% to 57.39%. Compared to the global findings, it is high in magnitude. For instance, a pooled prevalence of insomnia was estimated at 38 9% (Rezaei-Hachesu et al., 2022). The result is higher than the global umbrella review result prevalence of insomnia was 40% (Dragioti et al., 2020), Asia 37.89% (Norhayati, Che Yusof & Yacob Azman, 2021). The high heterogeneity in the pooled prevalence of mental health problems in Africa compared to others could be due to a variety of factors, including: Socioeconomic factors: Africa has a diverse range of socio-economic conditions and disparities, which could contribute to differences in the prevalence of anxiety disorders across different regions within the continent. Access to mental health services: Limited access to mental health services and treatment options in many African countries could result in underreporting of anxiety disorders and higher levels of untreated anxiety. Methodological differences: Variations in study design, methodology, and sampling techniques across different studies could also contribute to the heterogeneity in the pooled prevalence of anxiety in Africa compared to other.

This umbrella review helps primarily to assess the magnitude of mental health problems among healthcare professionals during COVID-19 in Africa. Literatures have indicated Africa as psychologically vulnerable during the pandemic, however such reports are often not summarized, and our umbrella review tried to indicate the mental health problems such as depression, anxiety, stress, and insomnia were highly prevalent in Africa. The study’s findings highlight the need for increased awareness and interventions to address mental health problems among healthcare professionals in Africa during the COVID-19 pandemic. This could include implementing mental health support programs, providing training on coping strategies, and developing policies to support mental health needs. The study’s findings have implications for policy development around mental health support for healthcare professionals in Africa. Policymakers may need to consider implementing guidelines and regulations to support mental health needs, as well as incorporating mental health support into healthcare policies and systems. Also this study involved on the importance of collaboration and partnerships in addressing mental health problems among healthcare professionals in Africa. This could involve collaboration between healthcare providers, government agencies, mental health organizations, and other stakeholders to develop and implement comprehensive mental health support programs. Also our umbrella review highlights the need to improve the quality of systematic reviews and meta analysis in this field of research. Additionally, summarizing existing meta-analyses can help identify gaps and inconsistencies in the existing literature, which can guide future research efforts. By synthesizing the findings of multiple meta-analyses, the researchers can identify common themes and trends in the existing evidence on mental health in Africa, as well as areas where further research is needed.

Whereas, this study has strengths and limitation. To our knowledge, this is the first umbrella review to examine the pooled prevalence of depression, anxiety, stress and insomnia among healthcare professionals during COVID-19 in Africa. One strength of this methodology is that it offers comprehensive evidence on the mental health challenges faced by healthcare professionals during the COVID-19 pandemic in Africa. The screening, data extraction and methodological quality assessment were done by two authors independently. The quality assessment was checked by the Joanna Briggs Institute (JBI) critical appraisal checklist for systematic reviews and research syntheses. Moreover, this study presents the predictive interval in which future studies finding might be in it. However, there are potential limitations to be aware of. Firstly in the absence of sufficient meta-analysis studies on the prevalence of mental health problems among healthcare professionals in Africa, subgroup analyses were not performed due to the limited studies included. Secondly, there is a risk of selection bias as non-English language meta-analyses were not included, potentially skewing the results. Thirdly, there is overlap in primary studies across meta-analyses of insomnia studies might leading to biased estimates. Fourthly, Hetrogeneity in methodologies among primary studies, including sampling methods and assessment tools, could impact the accuracy of prevalence estimates for stress, anxiety, depression, and insomnia. Lastly, it is important to recognize that these mental health problems may vary among different groups of healthcare professionals, highlighting the need for future research to explore prevalence estimates within specific circumstances.

Conclusions

In conclusion, healthcare professionals in Africa were at a high risk of experiencing a variety of mental health problems during the COVID-19 pandemic. The prevalence of anxiety, depression, stress and insomnia among healthcare professionals were significantly higher in Africa compared to other regions. This study’s findings highlight the need to develop appropriate public health interventions to address healthcare professionals’ mental health needs in Africa during COVID-19 and related public health crises.

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