Direct and Indirect Effects of Environmental and Socio-Economic Factors on COVID-19 in Africa Using Structural Equation Modeling

Understanding direct and indirect relationships of environmental, socio-economic and climate variables and the dynamics of epidemics is key to guiding targeted public health policy and interventions. This study investigates the direct and indirect effects of environmental and socio-economic factors on the COVID-19 dynamics in Africa (54 African countries from 2019 to 2021) using SEM approach. Specifically, the study aimed to: (i) assess the performance of two SEM estimation methods (Lisrel and PLS-SEM) in relationship to sample size (100, 200, 500, and 1000) and level of model complexity (No, two, and four indirect effects) and (ii) use the most performing SEM estimation method to examine direct and indirect effects of factors influencing the number of cases and deaths of COVID-19 in Africa. The results highlight a positive spatial correlation between factors such as temperature, humidity, age, the proportion of people aged over 65, and the COVID-19 incidence. Under the control of confounding factors, Lisrel turns out to be the most performing method, identifying climate, demographic and economic factors as the main determinants of COVID-19 dynamics. These factors have a direct and significant impact on the incidence of COVID-19. An indirect relationship was also observed between economic factors and the incidence of COVID-19 through air pollutants. The results highlight the importance of considering these factors in understanding the spread of the virus to avoid further disasters.