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].