RESUMEN
Introduction: Pregnant women are considered a high-risk group for COVID-19, and a priority for vaccination. Routine antenatal (ANC) care provides an opportunity to track trends and factors associated with vaccine uptake. We sought to evaluate COVID-19 vaccine uptake among pregnant women attending ANC in Zambia. Methods We conducted a repeated cross-sectional study in 39 public health facilities in four districts in Zambia from September 2021 to September 2022. Pregnant women who were aged 15-49 years were enrolled during their first ANC visit. Every month, ~20 women per facility were interviewed during individual HIV testing and counseling. We estimated vaccine uptake as the proportion of eligible participants who self-reported having received the COVID-19 vaccine. Results A total of 9,203 pregnant women were screened, of which 9,111 (99%) were eligible and had vaccination status. Of the 9,111 included in the analysis, 1,818 (20%) had received the COVID-19 vaccine during the study period, with a trend of increasing coverage with time (0.5% in September 2020, 27% in September 2022). Conversely, 3,789 (42%) reported not being offered a COVID-19 vaccine. We found that older age, education, employment status, and prior COVID-19 infection were significantly associated with vaccine uptake. Conclusion COVID-19 vaccine uptake among pregnant women was lower than estimates from the general population (27% across the four districts in September 2022), pointing to missed opportunities to protect this high-risk group. ANC visits were a viable point for conducting COVID-19 surveillance. Incorporating the vaccine as part of the routine ANC package might increase coverage in this group.
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COVID-19RESUMEN
BackgroundSeveral seroprevalence studies in Africa documented the extent of spread of SARS-CoV-2, yet there is limited data on signs, symptoms and conditions that continue or develop after acute COVID-19 infection (long COVID). We sought to examine patient characteristics at post-acute COVID-19 (PAC-19) clinics in Zambia and assess factors associated with long COVID at first visit to a PAC-19 clinic and longitudinally among a cohort of patients. MethodsLong COVID was defined, initially in the Zambia PAC-19 clinical guidelines, as new, relapsing or persistent symptoms lasting >4 weeks after an initial SARS-CoV-2 infection. Severe illness was defined as COVID-19 episode that required supplemental oxygen therapy, intensive care unit stay or treatment with steroids/remdesivir. We fitted logistic regression models with cross-sectional and longitudinal data and considered statistical significance at p<0.05. ResultsIn total, 1,359 patients attended PAC-19 clinics and had data abstracted from Aug-2020 to Jan-2023; 548 (40.3%) patients with [≥]2 visits were included in the longitudinal analysis. Patients median age was 53 (interquartile range [IQR]: 41-63) years, 919 (67.6%) were hospitalized for acute COVID-19, and of whom 686 (74.6%) had severe illness. Patients with hospital length of stay [≥]15 days (adjusted odds ratio [aOR]: 5.50; 95% confidence interval [95% CI]: 3.06-10.3), severe illness (aOR: 3.23; 95% CI: 1.68-6.75), and comorbidities (aOR:1.51; 95% CI: 1.04-2.22) had significantly higher odds of long COVID. Longitudinally, long COVID prevalence significantly (p<0.001) declined from 75.4% at the first PAC-19 visit to 26.0% by the fifth visit. The median follow-up time was 7 (IQR: 4-12) weeks. ConclusionLong COVID symptoms were common among patient presenting for care in PAC-19 clinics in Zambia, but most recovered within [~]2 months. Despite potentially substantial morbidity due to long COVID, few patients overall with COVID-19 attended a PAC-19 clinic. Scaling up PAC-19 services and integrating into routine clinical care could improve access by patients.