Contributors: Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC); Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD Occitanie )-Université de Montpellier (UM); Institut Pasteur de Madagascar; Pasteur Network (Réseau International des Instituts Pasteur); Harvard Medical School Boston (HMS); Department of Infectious Diseases Athens, GA, USA (Odum School of Ecology); University of Georgia USA -College of Veterinary Medicine Athens, GA, USA; PIVOT Ifanadiana, Madagascar; Department of Global Health and Social Medicine Boston, MA,USA; University of California Berkeley (UC Berkeley); University of California (UC); ANR-19-CE36-0001,SMALLER,Surveillance et contrôle du paludisme a des échelles locales grâce a des plateformes e-health(2019)
Abstract: International audience ; Introduction: Three years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of COVID-19 in the World Health Organization Africa region. High quality, population-representative studies in Africa are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of COVID-19 in rural, low-resource settings. Here, we estimated the spatio-temporal morbidity and mortality burden associated with COVID-19 in a rural health district of Madagascar until the first half of 2021.Methods We integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in Ifanadiana District, Madagascar. Socio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect IgG and IgM antibodies against four specific proteins of SARS-CoV-2 in a bead-based multiplex immunoassay. We evaluated spatio-temporal patterns in COVID-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions.Results Eighteen percent of people had been infected by April-June 2021, with seroprevalence increasing with individuals’ age. COVID-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. Wealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. Adult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. Less than 10% of mortality in this period would be directly attributed to COVID-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district.Conclusion Our study provides a ...
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