General interpretation of the results in the context of other evidence
This systematic review aimed to evaluate the mental health issues related to the current pandemic among African universities’ students. Overall, we summarized data pertaining to 12 studies and involving 7,293 students living in seven different countries. Six studies concerned sub-Saharan Africa, with four in Ethiopia. We found that approximately 2-8/10 and 1-3/10 students had respectively depression and severe depression, that nearly 3-6/10 and 1-3/10 suffered from anxiety and severe anxiety, and that around 2-5/10 and 1-2/10 students were stressed and severely stressed.
Compared to data on African universities students’ mental health before the pandemic, we found relatively higher rates of mental health issues. For example, a review assessing the prevalence of depression among universities students in low and middle income countries (LMICs) and that included three studies in Africa, found a depression prevalence of 34.2% for African students [36]. On another side, while focusing on the COVID-19 pandemic mental health impact amid the general population in Africa during this pandemic, there is a scarcity of review articles [37]. Nevertheless, a systematic review of the prevalence of anxiety among the general population during the COVID-19 pandemic found that the prevalence in Africa was 61.8% (95% CI, 57%-66.4%) [38], which is higher than the one we found. This difference might be due to the role played by populations type such as health care workers (especially doctors and nurses) in the increase of these frequencies [39,40].
We generally found equal or higher frequencies of psychological concerns than studies reporting the same outcomes in others parts of the word. For instance, Li et al. in a meta-analysis of 706,415 college students showed that the prevalence of depression was 39% (95% CI: 27-51%) and that of anxiety was 36% (95% CI: 26-46%) [41]. In the same way, Deng and colleagues while summarizing data of eighty-nine studies and 1,441,828 higher education students during the COVID-19 pandemic, found that the pooled prevalence of depressive symptoms and anxiety symptoms was 34% and 32% respectively [42]. More specifically, they reported depression and anxiety pooled prevalence of 55% and 74% for the United States of America, and 24% and 23% for China [42]. Regarding China, a systematic review involving 1,292,811 universities students displayed pooled depressive symptoms prevalence of 26% [16]. Explanatory factors of the dissimilarities between our findings and the one reported in previous published review might be the difference regarding sample size, but also the disparity pertaining to the tools used as well as related cut-off scores. Looking for instance at this last reason, Deng et al. in their review reported that most of studies used the PHQ-9 for depression and the GAD-7 for anxiety [42], while in our review most of studies used the DASS-21 for both. Otherwise, the higher prevalence reported by previous papers for some world regions such as America[42], might be linked to a greater COVID-19 morbidity and mortality when compared to Africa [43]. Concerning factors associated with negative mental health consequences among universities’ students, other reports in literature highlighted that the pandemic had a more pronounced effect on female students [44,45]. This is also the case for low socio-economic status [45].