Prevalence of SARS-CoV-2 in six districts in Zambia in July, 2020: a cross-sectional cluster sample survey
Open accessAbstract
BACKGROUND: Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infected people have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey. METHODS: Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections. FINDINGS: Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7-31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3-13·9). The rtPCR-positive prevalence was 7·6% (4·7-10·6) and ELISA-positive prevalence was 2·1% (1·1-3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705-596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute. INTERPRETATION: The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission. FUNDING: US Centers for Disease Control and Prevention.
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A serosurvey in six districts of Zambia showed that the case ascertainment rate was only one reported case per 92 actual infections, or 1.1%.
“A serosurvey in six districts of Zambia showed that the case ascertainment rate was only one reported case per 92 actual infections, or 1·1%.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [183]
Several serosurveys suggest that Africa experienced large waves of infection but that most cases went unreported, in part because they did not lead to severe disease.
“Several serosurveys suggest that Africa experienced large waves of infection but that most cases went unreported, in part because they did not lead to severe disease.”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [183]
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The Impact of COVID-19 on Tourism in Zambia
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- Authors
- Mulenga, L. B., Hines, J. Z., Fwoloshi, S., Chirwa, L., Siwingwa, M., Yingst, S., Wolkon, A., Barradas, D. T., Favaloro, J., Zulu, J. E., Banda, D., Nikoi, K. I., Kampamba, D., Banda, N., Chilopa, B., Hanunka, B., Stevens, T. L., Shibemba, A., Mwale, C., Sivile, S., Zyambo, K. D., Makupe, A., Kapina, M., Mweemba, A., Sinyange, N., Kapata, N., Zulu, P. M., Chanda, D., Mupeta, F., Chilufya, C., Mukonka, V., Agolory, S., & Malama, K.
- Affiliations
- Ministry of Health (ZM)
- Centers for Disease Control and Prevention (US)
- University Teaching Hospital (ZM)
- Zambia National Public Health Institute (ZM)
- Central Statistical Office (ZM)
- Corresponding author
- Hines, Jonas Z
- ORCID
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 9
- Issue
- 6
- Pages
- e773-e781
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC8382844
- OpenAlex
- W3133726144
- Cited by
- 149
- References
- 34
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 18 · 2023: 22 · 2022: 48 · 2021: 37
- FWCI
- 12.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- U.S. President’s Emergency Plan for AIDS Relief
- Centers for Disease Control and Prevention
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
- Keywords
- SARS-CoV-2, COVID-19 pandemic, prevalence, underreporting, asymptomatic infection, seroprevalence, RT-PCR, ELISA, household surveys, Zambia, testing capacity, surveillance systems, district-level estimates, real-time PCR, SARS-CoV-2 antibodies
- MeSH terms
- COVID-19, Adolescent, Adult, Child, Child, Preschool, Cross-Sectional Studies, Female, Health Surveys, Humans, Infant, Infant, Newborn, Male, Middle Aged, Zambia, Prevalence, Cluster Analysis, Young Adult
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