SARS-CoV-2 infection in Africa: A systematic review and meta-analysis of standardised seroprevalence studies, from January 2020 to December 2021
Open accessPreprint — published as 10.1136/bmjgh-2022-008793
Abstract
INTRODUCTION: Estimating COVID-19 cumulative incidence in Africa remains problematic due to challenges in contact tracing, routine surveillance systems and laboratory testing capacities and strategies. We undertook a meta-analysis of population-based seroprevalence studies to estimate SARS-CoV-2 seroprevalence in Africa to inform evidence-based decision making on public health and social measures (PHSM) and vaccine strategy. METHODS: We searched for seroprevalence studies conducted in Africa published 1 January 2020-30 December 2021 in Medline, Embase, Web of Science and Europe PMC (preprints), grey literature, media releases and early results from WHO Unity studies. All studies were screened, extracted, assessed for risk of bias and evaluated for alignment with the WHO Unity seroprevalence protocol. We conducted descriptive analyses of seroprevalence and meta-analysed seroprevalence differences by demographic groups, place and time. We estimated the extent of undetected infections by comparing seroprevalence and cumulative incidence of confirmed cases reported to WHO. PROSPERO: CRD42020183634. RESULTS: We identified 56 full texts or early results, reporting 153 distinct seroprevalence studies in Africa. Of these, 97 (63%) were low/moderate risk of bias studies. SARS-CoV-2 seroprevalence rose from 3.0% (95% CI 1.0% to 9.2%) in April-June 2020 to 65.1% (95% CI 56.3% to 73.0%) in July-September 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 100:1, ranging from 18:1 to 954:1) and steady over time. Seroprevalence was highly heterogeneous both within countries-urban versus rural (lower seroprevalence for rural geographic areas), children versus adults (children aged 0-9 years had the lowest seroprevalence)-and between countries and African subregions. CONCLUSION: We report high seroprevalence in Africa suggesting greater population exposure to SARS-CoV-2 and potential protection against COVID-19 severe disease than indicated by surveillance data. As seroprevalence was heterogeneous, targeted PHSM and vaccination strategies need to be tailored to local epidemiological situations.
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Other studies have done multinational systematic reviews and meta-analyses of seroprevalence surveys.
“other studies have done multinational systematic reviews and meta-analyses of seroprevalence surveys.14, 15”
From Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis (2022) · cites this paper as [14]
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Anti SARS-CoV-2 seroprevalence in Zanzibar in 2021 before the Omicron wave
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Self-citationSARS-CoV-2 Seropositivity and HIV Viral Load Among Mozambican Pregnant Women
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Seroprevalence of SARS-CoV-2 antibodies in Republic of Congo, February 2022
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Factors affecting social integration after road traffic orthopaedic injuries in Rwanda
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The Drivers of Low Vaccination Utilization in Niger
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Seroepidemiology of SARS-CoV-2 in a cohort of pregnant women and their infants in Uganda and Malawi
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Self-citationEvaluation of Covid-19 Ag-RDTs self-testing in Lesotho and ZambiaPreprint
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- Authors
- Lewis, H., Ware, H., Whelan, M., Subissi, L., Li, Z., Ma, X., Nardone, A., Valenciano, M., Cheng, B., Noel, K., Cao, C., Yanes-Lane, M., Herring, B., Talisuna, A., Nsenga, N., Balde, T., Clifton, D., Van Kerkhove, M., Buckeridge, D., Bobrovitz, N., Okeibunor, J., Arora, R., Bergeri, I., & the UNITY Studies Collaborator Group
- Affiliations
- University of Calgary (CA)
- World Health Organization (CH)
- University of Waterloo (CA)
- University of Toronto (CA)
- World Health Organization Regional Office for Africa (CG)
- ORCID
- Venue
- BMJ Global Health
- Publisher
- openRxiv
- Published
- 2022-02-15
- Volume
- 7
- Issue
- 8
- Pages
- e008793-e008793
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC9402450
- OpenAlex
- W4292774342
- Cited by
- 177
- References
- 46
- Citations by year
- 2026: 25 · 2025: 30 · 2024: 39 · 2023: 47 · 2022: 36
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Global Health (publishedVersion, cc-by-nc)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc-nd)
- HAL (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- World Health Organization
- Public Health Agency of Canada
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
- Public Health Agency
- Bundesministerium für Gesundheit
- Canadian Medical Association
- Robert Koch Institut
- Centers for Disease Control and Prevention
- Medical Research Council (MR/T008822/1)
- 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, seroprevalence, Africa, underreporting of infections, urban-rural differences, age differences in infection, subregional variation, public health and social measures, risk of bias assessment, SARS-CoV-2 reinfection
- MeSH terms
- COVID-19, SARS-CoV-2, Adult, Africa, Child, Europe, Humans, Seroepidemiologic Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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