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BackgroundAlthough seroprevalence studies have demonstrated the wide circulation of SARS-COV-2 in African countries, the impact on population health in these settings is still poorly understood. Using representative samples of the general population, we evaluated retrospective mortality and seroprevalence of anti-SARS-CoV-2 antibodies in Lubumbashi and Abidjan. MethodsThe studies included retrospective mortality surveys and nested anti-SARS-CoV-2 antibody prevalence surveys. In Lubumbashi the study took place during April-May 2021 and in Abidjan the survey was implemented in two phases: July-August 2021 and October-November 2021. Crude mortality rates were stratified between pre-pandemic and pandemic periods and further investigated by age group and COVID waves. Anti-SARS-CoV-2 seroprevalence was quantified by rapid diagnostic testing (RDT) and laboratory-based testing (ELISA in Lubumbashi and ECLIA in Abidjan). ResultsIn Lubumbashi, the crude mortality rate (CMR) increased from 0.08 deaths per 10 000 persons per day (pre-pandemic) to 0.20 deaths per 10 000 persons per day (pandemic period). Increases were particularly pronounced among <5 years old. In Abidjan, no overall increase was observed during the pandemic period (pre-pandemic: 0.05 deaths per 10 000 persons per day; pandemic: 0.07 deaths per 10 000 persons per day). However, an increase was observed during the third wave (0.11 deaths per 10 000 persons per day). The estimated seroprevalence in Lubumbashi was 15.7% (RDT) and 43.2% (laboratory-based). In Abidjan, the estimated seroprevalence was 17.4% (RDT) and 72.9% (laboratory-based) during the first phase of the survey and 38.8% (RDT) and 82.2% (laboratory-based) during the second phase of the survey. ConclusionAlthough circulation of SARS-CoV-2 seems to have been extensive in both settings, the public health impact varied. The increases, particularly among the youngest age group, suggest indirect impacts of COVID and the pandemic on population health. The seroprevalence results confirmed substantial underdetection of cases through the national surveillance systems.
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BackgroundEven after adjusting for the expected lower severity due to the younger age of the population, relatively low SARS-CoV-2 incidence and mortality rates have been reported throughout Africa. For investigating whether this is truly the case, we conducted a survey to estimate the COVID-19 related mortality and cumulative incidence of SARS-CoV-2 infections in Omdurman the most populated city of the tripartite metropolis Khartoum in Sudan. MethodsA retrospective, cross-sectional, mortality and seroprevalence survey was conducted in Omdurman, Sudan, from March 1, until April 10 2021. A two-stage cluster sampling method was used to investigate the death rate for the pre-pandemic (January 1, 2019-February 29, 2020) and pandemic (March 1, 2020 - day of the survey) period using questionnaires. The seroprevalence survey was performed in a subset of households and all consenting members were tested with a rapid serological test (SD-Biosensor) and a subgroup additionally with ELISA (EUROIMMUN). Fishers exact test was used to assess differences between the pre-and pandemic periods and a random effect and Bayesian latent class model to adjust for test performance. FindingsData from 27315 people (3716 households) for the entire recall period showed a 67% (95% CI 32-110) increase in death rate between the pre-pandemic (0.12 deaths/10000 people/day [95% CI 0.10-0.14]) and pandemic (0.20 [0.16-0.23]) periods. Notably, a 74% (30-133) increase in death was observed among people aged [≥]50 years. The adjusted seroprevalence of SARS-CoV-2 was 54.6% (95% CI 51.4-57.8). The seroprevalence was significantly associated with age, increasing up to 80.7% (71.7-89.7) for the oldest age group ([≥]50 years). InterpretationOur results showed a significant elevated mortality for the pandemic period with a considerable excess mortality in Omdurman, Sudan. The overall high seroprevalence indicated a different age pattern compared to other countries, with a significant increase by age. FundingMedecins Sans Frontieres
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BackgroundCamps of forcibly displaced populations are considered to be at risk of large COVID-19 outbreaks. Low screening rates and limited surveillance led us to conduct a study in Dagahaley camp, located in the Dadaab refugee complex in Kenya to estimate SARS-COV-2 seroprevalence and, mortality and to identify changes in access to care during the pandemic. MethodsTo estimate seroprevalence, we conducted a cross-sectional survey among a sample of individuals (n=587) seeking care at the two main health centres and among all household members (n=619) of community health workers and traditional birth attendants working in the camp. We used a rapid immunologic assay (BIOSYNEX(R) COVID-19 BSS [IgG/IgM]) and adjusted for test performance and mismatch between the sampled population and that of the general camp population. To estimate mortality, we exhaustively interviewed all households (n=12860) in the camp about deaths occurring from January 2019 through March 2021. ResultsWe included 1206 participants in the seroprevalence study. In total, 8% (95% CI: 6.6%-9.7%) had a positive serologic test. After adjusting for test performance and standardizing on age, we estimated a seroprevalence of 5.8% (95% CI: 1.6%-8.4%). The mortality rate for 10,000 persons per day was 0.05 (95% CI 0.05-0.06) prior to the pandemic and 0.07 (95% CI 0.06-0.08) during the pandemic, representing a significant 42% increase (p<0.001). MSF health centre consultations and hospital admissions decreased by 38% and 37% respectively. ConclusionWe estimated that the number of infected people was 67 times higher than the number of reported cases. Participants aged 50 years or more where among the most affected. The mortality survey shows an increase in the mortality rate during the pandemic compared to before the pandemic. A decline in attendance at health facilities was observed and sustained despite the easing of restrictions. Summary BoxO_ST_ABSWhat is already known?C_ST_ABSO_LIAt the early stage of the COVID-19 pandemic, models predicted the risk of a large-scale COVID-19 outbreaks in camps of forcibly displaced populations that would have created excess mortality caused directly by the disease and indirectly by reduced access to care and/or congestion in health facilities. C_LIO_LITo date, this prediction has not materialized in most camps, the lower than expected number of cases and deaths could be attributed to a population characteristics and early implementation of confinement; alternatively, it could be an underestimate caused by limited screening and testing capacity and lack of morbidity and mortality surveillance. C_LIO_LIThe actual impact of COVID-19 on these populations therefore remains an open question. C_LI What are the new findings?O_LIIn Dagahaley camps in Kenya, we estimated that the number of infected people was 67 times higher than the number of reported cases. C_LIO_LIParticipants aged 50 years and over, who are most at risk of severe illness, were among the most affected. C_LIO_LIWe observed an increase in mortality rates during the pandemic, and a decrease in the use of health facilities, which continued despite the easing of restrictions, but access for severe cases was less impacted. C_LI What do the new findings imply?O_LITo our knowledge, this is the first combined survey of COVID-19 seroprevalence and retrospective mortality in a forcibly displaced population living in a camp. C_LIO_LIDespite mitigation measures, the virus has circulated, which should prompt rapid vaccination as most of the population remains susceptible; the collateral effects of the pandemic on access to care must be addressed and public confidence restored in order to limit the risk of excess mortality. C_LIO_LIThe varying situations of forcibly displaced populations living in camps around the world support the need for further research at other sites. C_LI
