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McCabe R, Whittaker C, Sheppard RJ, Abdelmagid N, Ahmed A, Alabdeen IZ, Brazeau NF, Ahmed Abd Elhameed AE, Bin-Ghouth AS, Hamlet A, AbuKoura R, Barnsley G, Hay JA, Alhaffar M, Koum Besson E, Saje SM, Sisay BG, Gebreyesus SH, Sikamo AP, Worku A, Ahmed YS, Mariam DH, Sisay MM, Checchi F, Dahab M, Endris BS, Ghani AC, Walker PG, Donnelly CA, Watson OJ. Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems. SCIENCE ADVANCES 2023; 9:eadg7676. [PMID: 37294754 PMCID: PMC10256151 DOI: 10.1126/sciadv.adg7676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/05/2023] [Indexed: 06/11/2023]
Abstract
Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide.
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Affiliation(s)
- Ruth McCabe
- Department of Statistics, University of Oxford, Oxford, UK
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, Liverpool, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Richard J. Sheppard
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Nada Abdelmagid
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Sudan COVID-19 Research Group, Khartoum, Sudan
| | - Aljaile Ahmed
- Sudan COVID-19 Research Group, Khartoum, Sudan
- Sudan Youth Peer Education Network, Khartoum, Sudan
| | | | - Nicholas F. Brazeau
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Rahaf AbuKoura
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Sudan COVID-19 Research Group, Khartoum, Sudan
| | - Gregory Barnsley
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - James A. Hay
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine, London, UK and Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Emilie Koum Besson
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Semira Mitiku Saje
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam Girma Sisay
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Seifu Hagos Gebreyesus
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adane Petros Sikamo
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aschalew Worku
- School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maysoon Dahab
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Sudan COVID-19 Research Group, Khartoum, Sudan
| | - Bilal Shikur Endris
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Azra C. Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Patrick G. T. Walker
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, UK
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, Liverpool, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Oliver J. Watson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Simons E, Nikolay B, Ouedraogo P, Pasquier E, Tiemeni C, Adjaho I, Badjo C, Chamman K, Diomandé M, Dosso M, Doumbia M, Izia YA, Kakompe H, Katsomya AM, Kij V, Akissi VK, Mambula C, Mbala-Kingebeni P, Muzinga J, Ngoy B, Penali L, Pini A, Porten K, Salou H, Sevede D, Luquero F, Gignoux E. Seroprevalence of SARS-CoV-2 antibodies and retrospective mortality in two African settings: Lubumbashi, Democratic Republic of the Congo and Abidjan, Côte d'Ivoire. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001457. [PMID: 37289736 DOI: 10.1371/journal.pgph.0001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
Although 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. The 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). In 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. Although 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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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Hugues Kakompe
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | - Vicky Kij
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Jacques Muzinga
- Laboratoire National de Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Basile Ngoy
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Lou Penali
- Institut Pasteur Cote d'Ivoire, Abidjan, Cote d'Ivoire
| | | | | | | | - Daouda Sevede
- Institut Pasteur Cote d'Ivoire, Abidjan, Cote d'Ivoire
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