Prevalence and socioeconomic determinants of post-acute sequelae of SARS-CoV-2 among individuals from a peri-urban township and an informal settlement in Johannesburg, South Africa
DOI:
https://doi.org/10.7196/Keywords:
South Africa, Soweto, peri-urban, HDSS, long-COVIDAbstract
Background. Individuals infected with SARS-CoV-2 who develop COVID-19 are susceptible to persistent symptoms and sequelae, referred to as post-acute sequelae of SARS-CoV-2 (PASC). The prevalence of PASC is estimated to range between 10% and 30%. However, there is a paucity of data from African countries.
Objectives. To investigate the prevalence and sociodemographic determinants of PASC in a peri-urban township and an informal settlement in South Africa (SA) during the COVID-19 pandemic.
Methods. A prospective cohort study was conducted among individuals residing in sampled households within the Soweto and Thembelihle Health and Demographic Surveillance System in Gauteng Province, SA. Between August 2021 and January 2022, all individuals from 214 sampled households were tested for SARS-CoV-2 and followed up for 6 months for symptoms. The prevalence of PASC, defined as persistence of symptoms through to at least 30 (PASC-30) and 90 (PASC-90) days, was evaluated, and determinants of PASC were identified using logistic regression models.
Results. There were 268 individuals with documented COVID-19 illness identified, of whom 65.3% (n=175) were female. The median age was 24 years. The overall prevalence of PASC-30 was 23.9% (95% confidence interval (CI) 19.2 - 29.3), including 24.6% (95% CI 19.7 - 30.3) and 12.5% (95% CI 3.5 - 36.0) in individuals who were unvaccinated or had received a COVID-19 vaccine, respectively (p=0.283). The overall prevalence of PASC-90 was 2.2% (95% CI 1.0 - 4.8). Factors associated with PASC-30 included living in an informal (39.2%, 105/268) v. formal settlement (60.6%, 163/268) (adjusted odds ratio (aOR) 4.1, 95% CI 2.1 - 8.3), although participants living in larger households (aOR 0.8, 95% CI 0.7 - 0.9, p=0.011) were less likely to report PASC-30 than those from smaller households. Age, gender, marital status, level of education, employment status, vaccination status and the presence of comorbidities were not significantly associated with PASC.
Conclusion. PASC-30 (23.9%) was prevalent at the population level in individuals with documented COVID-19, particularly among residents of informal settlements, while PASC-90 (2.2%) was low. Further exploration into PASC within informal settlements is imperative to comprehensively understand these findings.
References
1. Thaweethai T, Jolley SE, Karlson EW, et al. Development of a definition of postacute sequelae of SARS- CoV-2 infection. JAMA 2023;329(22):1934. https://doi.org/10.1001/jama.2023.8823
2. Centers for Disease Control and Prevention. Long COVID basics. Atlanta: CDC, 2025. https://www. cdc.gov/covid/long-term-effects/ (accessed 18 September 2025).
3. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus. Geneva: WHO, 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_ COVID-19_condition-Clinical_case_definition-2021.1 (accessed 24 April 2026).
4. National Institute for Health and Care Excellence, UK. COVID-19 rapid guideline: Managing the long-term effects of COVID-19. Manchester: NICE, 2024. https://www.nice.org.uk/guidance/ng188 (accessed 22 June 2023).
5. Parums DV. Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC) and the urgent need to identify diagnostic biomarkers and risk factors. Med Sci Monit 2024;30:e946512. https://doi. org/10.12659/MSM.946512
6. Zimmermann RL, Shi X, Fritsche LG, Mukherjee B. Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: A meta-analysis and systematic review. J Infect Dis 2022;226(9):1593-1607. https://doi.org/10.1093/infdis/jiac136
7. O’Mahoney LL, Routen A, Gillies C, et al. The prevalence and long-term health effects of long COVID among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. eClinicalMedicine 2023;55:101762. https://doi.org/10.1016/j.eclinm.2022.101762
8. Frallonardo L, Segala FV, Chhaganlal KD, et al. Incidence and burden of long COVID in Africa: A systematic review and meta-analysis. Sci Rep 2023;13(1):21482. https://doi.org/10.1038/s41598- 023-48258-3
9. Mendelsohn AS, Nath N, de Sá A, von Pressentin KB. Two months follow-up of patients with non- critical COVID-19 in Cape Town, South Africa. S Afr Fam Pract 2022;64(1):a5429. https://doi. org/10.4102/safp.v64i1.5429
10. Dryden M, Mudara C, Vika C, et al. Post-COVID-19 condition 3 months after hospitalisation with SARS-CoV-2 in South Africa: A prospective cohort study. Lancet Glob Health 2022;10(9):e1247-e1256. https://doi.org/10.1016/S2214-109X(22)00286-8.
11. Mubiwa B, Annegarn H. Historical spatial change in the Gauteng city-region. Occasional paper 4. Johannesburg: Gauteng City-Region Observatory, 2013.
12. Wang HC. Consolidating informal settlements through upgrading? The temporary implications of in- situ electrification from Thembelihle in Johannesburg, South Africa. J Asian Afr Stud 2024;59(2):425- 442. https://doi.org/10.1177/00219096221113586.
13. Statistics South Africa. South African Census Community Profiles 2011. Pretoria: Stats SA, 2014.
https://doi.org/10.25828/6N0M-7M52
14. Jassat W, Mudara C, Vika C, et al. A cohort study of post-COVID-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalised and nonhospitalised participants. Int J Infect Dis 2023;128:102-111. https://doi.org/10.1016/j.ijid.2022.12.036
15. Nyasulu PS, Tamuzi JL, Erasmus RT. Burden, causation, and particularities of long COVID in African populations: A rapid systematic review. Int J Infect Dis 2023;8:137-144. https://doi.org/10.1016/j. ijregi.2023.08.004
16. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988;93(3):580-586.
https://doi.org/10.1378/chest.93.3.580
17. Demers RY, Fischetti LR, Neale AV. Incongruence between self-reported symptoms and objective evidence of respiratory disease among construction workers. Soc Sci Med 1990;30(7):805-810. https:// doi.org/10.1016/0277-9536(90)90204-6
18. Sylvester SV, Rusu R, Chan B, Bellows M, O’Keefe C, Nicholson S. Sex differences in sequelae from COVID-19 infection and in long COVID syndrome: A review. Curr Med Res Opin 2022;38(8):1391- 1399. https://doi.org/10.1080/03007995.2022.2081454
19. Corburn J, Vlahov D, Mberu B, et al. Slum health: Arresting COVID-19 and improving well-being in urban informal settlements. J Urban Health 2020;97(3):348-357. https://doi.org/10.1007/s11524- 020-00438-6
20. Joy M, Hobbs FR, Bernal JL, et al. Excess mortality in the first COVID pandemic peak: Cross- sectional analyses of the impact of age, sex, ethnicity, household size, and long-term conditions in people of known SARS-CoV-2 status in England. Br J Gen Pract 2020;70(701):e890-e898. https://doi. org/10.3399/bjgp20X713393
21. Kim D. Who gets long COVID and suffers its mental health and socioeconomic consequences in the United States? Preliminary findings from a large nationwide study. medRxiv 2023. https://doi.org/10.11 01/2023.01.06.23284199
22. Coste J, Delpierre C, Richard JB, et al. Prevalence of long COVID in the general adult population according to different definitions and sociodemographic and infection characteristics. A nationwide random sampling survey in France in autumn 2022. Clin Microbiol Infect 2023;30(7):924-929. https:// doi.org/10.2139/ssrn.4612725
23. Silverberg JI, Zyskind I, Naiditch H, et al. Predictors of chronic COVID-19 symptoms in a community- based cohort of adults. PLoS ONE 2022;17(8):e0271310. https://doi.org/10.1371/journal.pone.0271310
Downloads
Published
License
Copyright (c) 2026 T Machemedze, P Mutevedzi, A Izu, N Myburgh, C Verwey, S Mahtab, Z Dangor, S Madhi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
