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Introduction Residual COVID-19 sequelae create a public health concern as they add to the already heavy burden of non-communicable diseases. We set out to investigate the magnitude of residual cardiopulmonary manifestations postacute COVID-19 and their associated factors in Tanzania.Methods This was an ambispective study conducted between 26 March 2021 and 30 July 2021, among 712 hospitalised adults confirmed with SARS-CoV-2 in five tertiary-level hospitals in Tanzania. Retrospective data were analysed to determine baseline characteristics of the patients during acute COVID-19 admission. This was linked to prospective data that were collected 2 years postacute hospitalisation with COVID-19 to determine cardiopulmonary complications among these patients. Radiological pulmonary abnormalities were assessed by contrasted CT scan. Lung function tests were measured using a spirometer. Pulmonary hypertension and heart failure were confirmed by a transthoracic echocardiography. Generalised estimating equations were used to assess the associations between sociodemographic factors, clinical characteristics, treatment modalities and residual cardiopulmonary sequelae.Results About half 317/712 (44.5%) were diagnosed with residual cardiopulmonary complications. Approximately 54% of participants were male. Median age (IQR) was 60 (48–69) years. Cardiopulmonary sequelae were significantly associated with body mass index (BMI) ≥25.0 kg/m 2 compared with those with BMI <25.0 kg/m2 (adjusted OR (aOR) (95% CI)=3.4 (2.47 to 4.84), p<0.001), smokers compared with non-smokers (aOR (95% CI)=2.39 (1.09 to 5.23), p=0.030] and among participants who did not receive steroids during the acute COVID-19 (aOR (95% CI)= 1.62(1.16 to 1.92), p=0.042].Conclusion The independent predictors of residual cardiopulmonary manifestations due to COVID-19 were overweight, cigarette smoking, hypoxia and non-use of steroids during the acute phase of COVID-19 disease. Public health interventions addressing weight reduction and smoking cessation in conjunction with steroid use in acute COVID-19 may largely reduce the incidence of cardiopulmonary long COVID-19.