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Saeedzai SA, Sahak MN, Arifi F, Abdelkreem Aly E, Gurp MV, White LJ, Chen S, Barakat A, Azim G, Rasoly B, Safi S, Flegg JA, Ahmed N, Ahadi MJ, Achakzai NM, AbouZeid A. COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study. BMJ Open 2022; 12:e060739. [PMID: 35896297 PMCID: PMC9334691 DOI: 10.1136/bmjopen-2021-060739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The primary objectives were to determine the magnitude of COVID-19 infections in the general population and age-specific cumulative incidence, as determined by seropositivity and clinical symptoms of COVID-19, and to determine the magnitude of asymptomatic or subclinical infections. DESIGN, SETTING AND PARTICIPANTS We describe a population-based, cross-sectional, age-stratified seroepidemiological study conducted throughout Afghanistan during June/July 2020. Participants were interviewed to complete a questionnaire, and rapid diagnostic tests were used to test for SARS-CoV-2 antibodies. This national study was conducted in eight regions of Afghanistan plus Kabul province, considered a separate region. The total sample size was 9514, and the number of participants required in each region was estimated proportionally to the population size of each region. For each region, 31-44 enumeration areas (EAs) were randomly selected, and a total of 360 clusters and 16 households per EA were selected using random sampling. To adjust the seroprevalence for test sensitivity and specificity, and seroreversion, Bernoulli's model methodology was used to infer the population exposure in Afghanistan. OUTCOME MEASURES The main outcome was to determine the prevalence of current or past COVID-19 infection. RESULTS The survey revealed that, to July 2020, around 10 million people in Afghanistan (31.5% of the population) had either current or previous COVID-19 infection. By age group, COVID-19 seroprevalence was reported to be 35.1% and 25.3% among participants aged ≥18 and 5-17 years, respectively. This implies that most of the population remained at risk of infection. However, a large proportion of the population had been infected in some localities, for example, Kabul province, where more than half of the population had been infected with COVID-19. CONCLUSION As most of the population remained at risk of infection at the time of the study, any lifting of public health and social measures needed to be considered gradually.
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Affiliation(s)
- Sayed Ataullah Saeedzai
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | | | - Fatima Arifi
- WHE, World Health Organization, Kabul, Afghanistan
| | - Eman Abdelkreem Aly
- Information Systems for Health Unit, WHO Eastern Mediterranean Regional Office, Cairo, Egypt
| | | | - Lisa J White
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Universiry of Oxford, Oxford, UK
| | - Siyu Chen
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Universiry of Oxford, Oxford, UK
| | - Amal Barakat
- Infectious Hazard Preparedness Unit, WHO Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Giti Azim
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Bahara Rasoly
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Soraya Safi
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Jennifer A Flegg
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Nasar Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Mohmmad Jamaluddin Ahadi
- Monitoring, Evaluation and Health Information System, Ministry of Public Health, Kabul, Afghanistan
| | - Niaz M Achakzai
- Department of Molecular Biology, Forensic Medicine Directorate, Ministry of Public Health, Kabul, Afghanistan
- Central Public Health Laboratory (CPHL), Ministry of Public Health, Kabul, Afghanistan
| | - Alaa AbouZeid
- Department of Public Health, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
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