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BackgroundThe impact of COVID-19 in Africa remains poorly defined. We sought to describe trends in hospitalisation due to all medical causes, pneumonia-specific admissions, and inpatient mortality in Kenya before and during the first five waves of the COVID-19 pandemic in Kenya. MethodsWe conducted a hospital-based, multi-site, longitudinal observational study of patients admitted to 13 public referral facilities in Kenya from January 2018 to December 2021. The pre-COVID population included patients admitted before 1 March 2020. We fitted time series models to compare observed and predicted trends for each outcome. To estimate the impact of the COVID-19 pandemic, we calculated incidence rate ratios (IRR) and corresponding 95% confidence intervals (CI) from negative binomial mixed-effects models. ResultsOut of 302,703 patients hospitalised across the 13 surveillance sites (range 11547 to 57011), 117642 (39%) were admitted to adult wards. Compared with the pre-COVID period, hospitalisations declined markedly among adult (IRR 0.68, 95% CI 0.63 to 0.73) and paediatric (IRR 0.67, 95% CI 0.62 to 0.73) patients. Adjusted in-hospital mortality also declined among both adult (IRR 0.83, 95% CI 0.77 to 0.89) and paediatric (IRR 0.85, 95% CI 0.77 to 0.94) admissions. Pneumonia-specific admissions among adults increased during the pandemic (IRR 1.75, 95% CI 1.18 to 2.59). Paediatric pneumonia cases were lower than pre-pandemic levels in the first year of the pandemic and elevated in late 2021 (IRR 0.78, 95% CI 0.51 to 1.20). ConclusionsContrary to initial predictions, the COVID-19 pandemic was associated with lower hospitalisation rates and in-hospital mortality, despite increased pneumonia admissions among adults. These trends were sustained after the withdrawal of containment measures that disrupted essential health services, suggesting a role for additional factors that warrant further investigation.
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BackgroundThere is uncertainty about the mortality impact of the COVID-19 pandemic in Africa because of poor ascertainment of cases and limited national civil vital registration. We analysed excess mortality from 1st January 2020-5th May 2022 in a Health and Demographic Surveillance Study in Coastal Kenya where the SARS-CoV-2 seroprevalence reached 75% among adults in March 2022 despite vaccine uptake of only 17%. MethodsWe modelled expected mortality in 2020-2022 among a population of 306,000 from baseline surveillance data between 2010-2019. We calculated excess mortality as the ratio of observed/expected deaths in 5 age strata for each month and for each national wave of the pandemic. We estimated cumulative mortality risks as the total number of excess deaths in the pandemic per 100,000 population. We investigated observed deaths using verbal autopsy. FindingWe observed 16,236 deaths among 3,410,800 person years between 1st January 2010 and 5th May 2022. Across 5 waves of COVID-19 cases during 1st April 2020-16th April 2022, population excess mortality was 4.1% (95% PI -0.2%, 7.9%). Mortality was elevated among those aged [≥]65 years at 14.3% (95% PI 7.4%, 21.6%); excess deaths coincided with wave 2 (wild-type), wave 4 (Delta) and wave 5 (Omicron BA1). Among children aged 1-14 years there was negative excess mortality of -20.3% (95% PI -29.8%, -8.1%). Verbal autopsy data showed a transient reduction in deaths from acute respiratory infections in 2020 at all ages. For comparison with other studies, cumulative excess mortality risk for January 2020-December 2021, age-standardized to the Kenyan population, was 47.5/100,000. InterpretationNet excess mortality during the pandemic was substantially lower in Coastal Kenya than in many high income countries. However, adults, aged [≥]65 years, experienced substantial excess mortality suggesting that targeted COVID-19 vaccination of older persons may limit further COVID-19 deaths by protecting the residual pool of naive individuals. FundingWellcome Trust
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BackgroundUp-to-date SARS-CoV-2 antibody seroprevalence estimates are important for informing public health planning, including priorities for Coronavirus disease 2019 (COVID-19) vaccination programs. We sought to estimate infection- and vaccination-induced SARS-CoV-2 antibody seroprevalence within representative samples of the Kenyan population approximately two years into the COVID-19 pandemic and approximately one year after rollout of the national COVID-19 vaccination program. MethodsWe conducted cross-sectional serosurveys within random, age-stratified samples of Kilifi Health and Demographic Surveillance System (HDSS) and Nairobi Urban HDSS residents. Anti-spike (anti-S) immunoglobulin G (IgG) and anti-nucleoprotein (anti-N) IgG were measured using validated in-house ELISAs. Target-specific Bayesian population-weighted seroprevalence was calculated overall, by sex and by age, with adjustment for test performance as appropriate. Anti-S IgG concentrations were estimated with reference to the WHO International Standard (IS) for anti-SARS-CoV-2 immunoglobulin and their reverse cumulative distributions plotted. ResultsBetween February and June 2022, 852 and 851 individuals within the Kilifi HDSS and the Nairobi Urban HDSS, respectively, were sampled. Only 11.0% (95% confidence interval [CI] 9.0-13.3) of all Kilifi HDSS participants and 33.4% (95%CI 30.2-36.6) of all Nairobi Urban HDSS participants had received any doses of COVID-19 vaccine. Population-weighted anti-S IgG seroprevalence was 69.1% (95% credible interval [CrI] 65.8-72.3) within the Kilifi HDSS and 88.5% (95%CrI 86.1-90.6) within the Nairobi Urban HDSS. Among COVID-unvaccinated residents of the Kilifi HDSS and Nairobi Urban HDSS, it was 66.7% (95%CrI 63.3-70.0) and 85.3% (95%CrI 82.1-88.2), respectively. Population-weighted, test-adjusted anti-N IgG seroprevalence within the Kilifi HDSS was 53.5% (95%CrI 46.5-61.1) and 65.5% (95%CrI 56.0-75.6) within the Nairobi Urban HDSS. The prevalence of anti-N antibodies was similar in vaccinated and unvaccinated subgroups in both HDSS populations. Anti-S IgG concentrations were significantly lower among Kilifi HDSS residents than among Nairobi Urban HDSS residents (p< 0.001). ConclusionsApproximately, 7 in 10 Kilifi residents and 9 in 10 Nairobi residents were seropositive for anti-S IgG by May 2022 and June 2022, respectively. Given COVID-19 vaccination coverage, anti-S IgG seropositivity among COVID-unvaccinated individuals, and anti-N IgG seroprevalence, population-level anti-S IgG seroprevalence was predominantly derived from infection. Interventions to improve COVID-19 vaccination uptake should be targeted to individuals in rural Kenya who are at high risk of severe COVID-19.
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BackgroundFew studies have assessed the benefits of COVID-19 vaccines in settings where most of the population had been exposed to SARS-CoV-2 infection. MethodsWe conducted a cost-effectiveness analysis of COVID-19 vaccine in Kenya from a societal perspective over a 1.5-year time frame. An age-structured transmission model assumed at least 80% of the population to have prior natural immunity when an immune escape variant was introduced. We examine the effect of slow (18 months) or rapid (6 months) vaccine roll-out with vaccine coverage of 30%, 50% or 70% of the adult (> 18 years) population prioritizing roll-out in over 50-year olds (80% uptake in all scenarios). Cost data were obtained from primary analyses. We assumed vaccine procurement at $7 per dose and vaccine delivery costs of $3.90-$6.11 per dose. The cost-effectiveness threshold was USD 919. FindingsSlow roll-out at 30% coverage largely targets over 50-year-olds and resulted in 54% fewer deaths (8,132(7,914 to 8,373)) than no vaccination and was cost-saving (ICER=US$-1,343 (-1,345 to - 1,341) per DALY averted). Increasing coverage to 50% and 70%, further reduced deaths by 12% (810 (757 to 872) and 5% (282 (251 to 317) but was not cost-effective, using Kenyas cost-effectiveness threshold ($ 919.11). Rapid roll-out with 30% coverage averted 63% more deaths and was more cost-saving (ICER=$-1,607 (-1,609 to -1,604) per DALY averted) compared to slow roll-out at the same coverage level, but 50% and 70% coverage scenarios were not cost-effective. InterpretationWith prior exposure partially protecting much of the Kenyan population, vaccination of young adults may no longer be cost-effective. KEY QUESTIONSO_ST_ABSWhat is already known?C_ST_ABSO_LIThe COVID-19 pandemic has led to a substantial number of cases and deaths in low-and middle-income countries. C_LIO_LICOVID-19 vaccines are considered the main strategy of curtailing the pandemic. However, many African nations are still at the early phase of vaccination. C_LIO_LIEvidence on the cost-effectiveness of COVID-19 vaccines are useful in estimating value for money and illustrate opportunity costs. However, there is a need to balance these economic outcomes against the potential impact of vaccination. C_LI What are the new findings?O_LIIn Kenya, a targeted vaccination strategy that prioritizes those of an older age and is deployed at a rapid rollout speed achieves greater marginal health impacts and is better value for money. C_LIO_LIGiven the existing high-level population protection to COVID-19 due to prior exposure, vaccination of younger adults is less cost-effective in Kenya. C_LI What do the new findings imply?O_LIRapid deployment of vaccines during a pandemic averts more cases, hospitalisations, and deaths and is more cost-effective. C_LIO_LIAgainst a context of constrained fiscal space for health, it is likely more prudent for Kenya to target those at severe risk of disease and possibly other vulnerable populations rather than to the whole population. C_LI
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Investment in Africa over the past year with regards to SARS-CoV-2 genotyping has led to a massive increase in the number of sequences, exceeding 100,000 genomes generated to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence within their own borders, coupled with a decrease in sequencing turnaround time. Findings from this genomic surveillance underscores the heterogeneous nature of the pandemic but we observe repeated dissemination of SARS-CoV-2 variants within the continent. Sustained investment for genomic surveillance in Africa is needed as the virus continues to evolve, particularly in the low vaccination landscape. These investments are very crucial for preparedness and response for future pathogen outbreaks. One-Sentence SummaryExpanding Africa SARS-CoV-2 sequencing capacity in a fast evolving pandemic.
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BackgroundThe impact of COVID-19 on all-cause mortality in sub-Saharan Africa remains unknown. MethodsWe monitored mortality among 306,000 residents of Kilifi Health and Demographic Surveillance System, Kenya, through four COVID-19 waves from April 2020-September 2021. We calculated expected deaths using negative binomial regression fitted to baseline mortality data (2010-2019) and calculated excess mortality as observed-minus-expected deaths. We excluded deaths in infancy because of under-ascertainment of births during lockdown. In February 2021, after two waves of wild-type COVID-19, adult seroprevalence of anti-SARS-CoV-2 was 25.1%. We predicted COVID-19-attributable deaths as the product of age-specific seroprevalence, population size and global infection fatality ratios (IFR). We examined changes in cause of death by Verbal Autopsy (VA). ResultsBetween April 2020 and February 2021, we observed 1,000 deaths against 1,012 expected deaths (excess mortality -1.2%, 95% PI -6.6%, 5.8%). Based on SARS-CoV-2 seroprevalence, we predicted 306 COVID-19-attributable deaths (a predicted excess mortality of 30.6%) within this period. Monthly mortality analyses showed a significant excess among adults aged [≥]45 years in only two months, July-August 2021, coinciding with the fourth (Delta) wave of COVID-19. By September 2021, overall excess mortality was 3.2% (95% PI -0.6%, 8.1%) and cumulative excess mortality risk was 18.7/100,000. By VA, there was a transient reduction in deaths attributable to acute respiratory infections in 2020. ConclusionsNormal mortality rates during extensive transmission of wild-type SARS-CoV-2 through February 2021 suggests that the IFR for this variant is lower in Kenya than elsewhere. We found excess mortality associated with the Delta variant but the cumulative excess mortality risk remains low in coastal Kenya compared to global estimates.
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BackgroundMost of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. MethodsWe selected random age-stratified population-based samples at HDSSs in Kisumu, Nairobi and Kilifi, in Kenya. Blood samples were collected from participants between 01 Dec 2020 and 27 May 2021. No participant had received a COVID-19 vaccine. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Locally-validated assay sensitivity and specificity were 93% (95% CI 88-96%) and 99% (95% CI 98-99.5%), respectively. We adjusted prevalence estimates using classical methods and Bayesian modelling to account for the sampling scheme and assay performance. ResultsWe recruited 2,559 individuals from the three HDSS sites, median age (IQR) 27 (10-78) years and 52% were female. Seroprevalence at all three sites rose steadily during the study period. In Kisumu, Nairobi and Kilifi, seroprevalences (95% CI) at the beginning of the study were 36.0% (28.2-44.4%), 32.4% (23.1-42.4%), and 14.5% (9.1-21%), and respectively; at the end they were 42.0% (34.7-50.0%), 50.2% (39.7-61.1%), and 24.7% (17.5-32.6%), respectively. Seroprevalence was substantially lower among children (<16 years) than among adults at all three sites (p[≤]0.001). ConclusionBy May 2021 in three broadly representative populations of unvaccinated individuals in Kenya, seroprevalence of anti-SARS-CoV-2 IgG was 25-50%. There was wide variation in cumulative incidence by location and age.
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IntroductionVaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. MethodsWe used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews (n=12) were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with 2-doses, and the vaccine delivery costs per person vaccinated with 2-doses were estimated and reported in 2021USD. ResultsThe financial costs of vaccine procurement per person vaccinated with 2-doses ranged from $2.89-$13.09 in the 30% and 100% coverage levels respectively, however, the economic cost was $17.34 across all strategies. Financial vaccine delivery costs per person vaccinated with 2-doses, ranged from $4.28-$3.29 in the 30% and 100% coverage strategies: While the economic delivery costs were two to three times higher than the financial costs. The total procurement and delivery costs per person vaccinated with 2-doses ranged from $7.34-$16.47 for the financial costs and $29.7-$24.68 for the economic costs for the 30% and 100% coverage respectively. With the exception of procurement costs, the main cost driver of financial and economic delivery costs was supply chain costs (47-59%) and advocacy, communication and social mobilization (29-35%) respectively. ConclusionThis analysis presents cost estimates that can be used to inform local policy and may further inform parameters used in cost-effectiveness models. The results could potentially be adapted and adjusted to country-specific assumptions to enhance applicability in similar low-and middle-income settings.
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BackgroundPrivate retail pharmacies in developing countries present a unique channel for COVID-19 prevention. We assessed the response to the COVID-19 pandemic by pharmacies in Kenya, aiming to identify strategies for maximising their contribution to the national response. MethodsWe conducted a prospective mixed-methods study, consisting of a questionnaire survey (n=195), a simulated client survey (n=103), and in-depth interviews (n=18). Data collection started approximately seven months after the pandemic reached Kenya. Quantitative data were summarized using measures of central tendency and multivariable modelling done using logistic regression. Qualitative analysis followed a thematic approach. ResultsThe initial weeks of the pandemic were characterized by fear and panic among service providers and a surge in client flow. Subsequently, 61% of pharmacies experienced a dip in demand to below pre-pandemic levels and 31% reported challenges with unavailability, high price, and poor-quality of products. Almost all pharmacies were actively providing preventive materials and therapies; educating clients on prevention measures; counselling anxious clients; and handling and referring suspect cases. Fifty-nine pharmacies (55% [95% CI 45-65%]) reported ever receiving a client asking for COVID-19 testing and a similar proportion supported pharmacy-based testing. For treatment, most pharmacies (71%) recommended alternative therapies and nutritional supplements such as vitamin C; only 27% recommended conventional therapies such as antibiotics. While 48% had at least one staff member trained on COVID-19, a general feeling of disconnection from the national program prevailed. ConclusionsPrivate pharmacies in Kenya were actively contributing to the COVID-19 response, but more deliberate engagement, support and linkages are required. Notably, there is an urgent need to develop guidelines for pharmacy-based COVID-19 testing, a service that is clearly needed and which could greatly increase test coverage. Roll-out of this and other pharmacy-based COVID-19 programs should be accompanied with implementation research in order to inform current and future pandemic responses.
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IntroductionTo support the government response to the coronavirus disease 2019 (COVID-19) pandemic, accessible and sustainable testing approaches are needed. Private retail pharmacies are a key channel through which communities can access COVID-19 testing. We examined the level and determinants of the willingness to pay (WTP) for rapid COVID-19 testing delivered through private retail pharmacies in Kenya. MethodsData was collected following a cross-sectional double-bounded dichotomous choice contingent valuation survey across 341 clients visiting five private retail pharmacies in Nairobi, Kisumu and Siaya counties. ResultsOur findings indicate mean and median WTP levels of KES 611 (US$ 5.59) and KES 506 (US$ 4.63), respectively. Estimated WTP varied across counties and increased with household income and self-reported interest in pharmacy-based COVID-19 rapid testing. ConclusionThese findings can inform price setting, price differentiation, price subsidization and other program design features geared towards enhancing affordability, equity, and uptake. Key QuestionsO_ST_ABSWhat is already known?C_ST_ABSO_LIThe Coronavirus disease 2019 (COVID-19) global pandemic continues to cause great morbidity, mortality, social and economic burden. C_LIO_LIPharmacies in Kenya have been involved in the delivery of several health interventions, such as malaria rapid testing, HIV self-testing, and other disease screening services. C_LIO_LIWhile COVID-19 testing remains an important response strategy to the ongoing COVID-19 pandemic, it is not clear how much pharmacy clients in Kenya and similar settings would be willing to pay (WTP) to obtain rapid COVID-19 testing at pharmacies C_LI What are the new findings?O_LIThe mean and median willingness to pay (WTP) for a rapid test delivered at a private retail pharmacy was KES 611 (US$ 5.59) and KES 506 (US$ 4.63), respectively. C_LIO_LIWTP varied by county, hence, the need for county-specific price-setting for pharmacy-based COVID-19 testing. C_LIO_LIWTP increased with household income and interest in getting the COVID-19 test at a private retail pharmacy. C_LI What do the new findings imply?O_LIA better understanding of the users willingness to pay price that can guide price setting, price differentiation, price subsidization and other program design features geared towards enhancing affordability, equity, and uptake. C_LI
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BackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and advanced critical care persist. This study assessed the cost-effectiveness of investments in essential and advanced critical care to inform the prioritization of investment decisions. MethodsWe employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and advanced critical care (EC+ACC) compared to current health care provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data was obtained from primary empirical analysis while outcomes data was obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of the results. ResultsThe status quo option is more costly and less effective compared to investment in essential care and is thus dominated by the later. The incremental cost effectiveness ratio (ICER) of Investment in essential and advanced critical care (EC+ACC) was US $1,378.21 per DALY averted and hence not a cost-effective strategy when compared to Kenyas cost-effectiveness threshold (USD 908). ConclusionWhen the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritizes investments in essential care before investments in advanced critical care. This information on cost-effectiveness will however need to be considered as part of a multi-criteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society. Key questionsO_ST_ABSWhat is already known?C_ST_ABSO_LIThe COVID-19 pandemic is responsible for substantial health effects in low- and middle-income countries C_LIO_LIThe case management of COVID-19 is one of the key control interventions deployed by country health systems. C_LIO_LISimilar to other low- and middle-income countries, Kenya had substantial gaps in both essential and advanced critical care at the beginning of the pandemic. C_LI What are the new findings?O_LIProvision of essential care and advanced critical care for COVID-19 at the current health system capacity (status quo) was costly and the least effective strategy. C_LIO_LIInvestment in both essential care and advanced critical care for COVID-19 is not cost-effective in Kenya when compared to investment in essential care. C_LI What do the new findings imply?O_LIPrioritizing investments in filling capacity gaps in essential care before investing in filling capacity gaps in advanced critical care for COVID-19 is more cost-effective in Kenya C_LIO_LIThese findings are intended to inform the sequencing of investments in case management rather than the selection of either strategy, within a context of substantial resource constraint, and capacity gaps in both essential and advanced critical care or COVID-19 C_LIO_LIKenya will need to consider these findings on cost-effectiveness within a multi-criteria decision-making framework that use a range of criteria that reflect societal values. C_LI
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BackgroundThe transmission networks of SARS-CoV-2 in sub-Saharan Africa remain poorly understood. MethodsWe undertook phylogenetic analysis of 747 SARS-CoV-2 positive samples collected across six counties in coastal Kenya during the first two waves (March 2020 - February 2021). Viral imports and exports from the region were inferred using ancestral state reconstruction (ASR) approach. ResultsThe genomes were classified into 35 Pango lineages, six of which accounted for 79% of the sequenced infections: B.1 (49%), B.1.535 (11%), B.1.530 (6%), B.1.549 (4%), B.1.333 (4%) and B.1.1 (4%). Four identified lineages were Kenya specific. In a contemporaneous global subsample, 990 lineages were documented, 261 for Africa and 97 for Eastern Africa. ASR analysis identified >300 virus location transition events during the period, these comprising: 69 viral imports into Coastal Kenya; 93 viral exports from coastal Kenya; and 191 inter-county import/export events. Most international viral imports (58%) and exports (92%) occurred through Mombasa City, a key touristic and commercial Coastal Kenya center; and many occurred prior to June 2020, when stringent local COVID-19 restriction measures were enforced. After this period, local virus transmission dominated, and distinct local phylogenies were seen. ConclusionsOur analysis supports moving control strategies from a focus on international travel to local transmission. FundingThis work was funded by Wellcome (grant#: 220985) and the National Institute for Health Research (NIHR), project references: 17/63/and 16/136/33 using UK aid from the UK Government to support global health research, The UK Foreign, Commonwealth and Development Office.
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In tropical Africa, SARS-CoV-2 epidemiology is poorly described because of lack of access to testing and weak surveillance systems. Since April 2020, we followed SARS-CoV-2 seroprevalence in plasma samples across the Kenya National Blood Transfusion Service. We developed an IgG ELISA against full length spike protein. Validated in locally-observed, PCR-positive COVID-19 cases and in pre-pandemic sera, sensitivity was 92.7% and specificity was 99.0%. Using sera from 9,922 donors, we estimated national seroprevalence of SARS-CoV-2 antibodies at 4.3% in April-June 2020 and 9.1% in August-September 2020. Kenyas second COVID-19 wave peaked in November 2020. Here we estimate national seroprevalence in early 2021. Between January 3 and March 15, 2021, we collected 3,062 samples from donors aged 16-64 years. Among 3,018 samples that met our study criteria, 1,333 were seropositive (crude seroprevalence 44.2%, 95% CI 42.4-46.0%). After Bayesian test-performance adjustment and population weighting to represent the national population distribution, the national estimate of seroprevalence was 48.5% (95% CI 45.2-52.1%). Seroprevalence varied little by age or sex but was higher in Nairobi (61.8%), the capital city, and lower in two rural regions. Almost half of Kenyas adult donors had evidence of past SARS-CoV-2 infection by March 2021. Although high, the estimate is corroborated by other population-specific estimates in country. Between March and June, 2% of the population were vaccinated against COVID-19 and the country experienced a third epidemic wave. Natural infection is outpacing vaccine delivery substantially in Africa, and this reality needs to be considered as objectives of the vaccine programme are set.
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Policy decisions on COVID-19 interventions should be informed by a local, regional and national understanding of SARS-CoV-2 transmission. Epidemic waves may result when restrictions are lifted or poorly adhered to, variants with new phenotypic properties successfully invade, or when infection spreads to susceptible sub-populations. Three COVID-19 epidemic waves have been observed in Kenya. Using a mechanistic mathematical model we explain the first two distinct waves by differences in contact rates in high and low social-economic groups, and the third wave by the introduction of a new higher-transmissibility variant. Reopening schools led to a minor increase in transmission between the second and third waves. Our predictions of current population exposure in Kenya ([~]75% June 1st) have implications for a fourth wave and future control strategies. One Sentence SummaryCOVID-19 spread in Kenya is explained by mixing heterogeneity and a variant less constrained by high population exposure
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The government of Kenya has launched a phased rollout of COVID-19 vaccination. A major barrier is vaccine hesitancy; the refusal or delay of accepting vaccination. This study evaluated the level and determinants of vaccine hesitancy in Kenya. We conducted a cross-sectional study administered through a phone-based survey in February 2021 in four counties of Kenya. Multivariate logistic regression was used to identify individual perceived risks and influences, context-specific factors, and vaccine-specific issues associated with COVID-19 vaccine hesitancy. COVID-19 vaccine hesitancy in Kenya was high: 60.1%. Factors associated with vaccine hesitancy included: older age, lower education level, perceived difficulty in adhering to government regulations on COVID-19 prevention, less adherence to wearing of face masks, not having ever been tested for COVID-19, no reported socio-economic loss as a result of COVID public-health restriction measures, and concerns regarding vaccine safety and effectiveness. There is a need for the prioritization of interventions to address vaccine hesitancy and improve vaccine confidence as part of the vaccine roll-out plan. These messaging and/or interventions should be holistic to include the value of other public health measures, be focused and targeted to specific groups, raise awareness on the risks of COVID-19 and effectively communicate the benefits and risks of vaccines.
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BackgroundThe ongoing COVID-19 pandemic has led to an unprecedented global research effort to build a body of knowledge that can inform mitigation strategies. We carried out a bibliometric analysis to describe the COVID-19 research output in Africa. MethodsWe searched for articles published between 1st December 2019 and 3rd January 2021 from various databases including PubMed, African Journals Online, MedRxiv, BioRxiv, Collabovid, the World Health Organisation global research database and Google for grey literature. Editorial type publications and papers reporting original research done in Africa and were included. Data analysis was done using Microsoft Excel. ResultsA total of 1296 articles were retrieved. 46.6% were primary research articles, 48.6% were editorials type articles while 4.6% were secondary research articles. 20.3% articles used the entire continent of Africa as their study setting while South Africa (15.4%) was the most common country focused setting. 90.3% of the articles had at least one African researcher as author, 78.5% had an African researcher as first author, while 63.5% had an African researcher as last author. The University of Cape Town tops the list with the greatest number of first and last authors. Over 13% of the articles were published in MedRxiv and of the studies that declared funding, the Wellcome Trust was the top funding body. The most common research topics include "country preparedness and response" (24.9%) and "the direct and indirect health impacts of the pandemic" (21.6%). However, only 1.0% of articles focus on therapeutics and vaccines. ConclusionsThis study sheds light on the contribution of African researchers to COVID-19 research in Africa and highlights Africas existing capacity to carry out research that addresses local problems. However, the uneven distribution of research productivity amongst African countries emphasizes the need for increased investment where needed.
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BackgroundFew studies have assessed the seroprevalence of antibodies against SARS-CoV-2 among Health Care Workers (HCWs) in Africa. We report findings from a survey among HCWs in three counties in Kenya. MethodsWe recruited 684 HCWs from Kilifi (rural), Busia (rural) and Nairobi (urban) counties. The serosurvey was conducted between 30th July 2020 and 4th December 2020. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Assay sensitivity and specificity were 93% (95% CI 88-96%) and 99% (95% CI 98-99.5%), respectively. We adjusted prevalence estimates using Bayesian modeling to account for assay performance. ResultsCrude overall seroprevalence was 19.7% (135/684). After adjustment for assay performance seroprevalence was 20.8% (95% CI 17.5-24.4%). Seroprevalence varied significantly (p<0.001) by site: 43.8% (CI 35.8-52.2%) in Nairobi, 12.6% (CI 8.8-17.1%) in Busia and 11.5% (CI 7.2-17.6%) in Kilifi. In a multivariable model controlling for age, sex and site, professional cadre was not associated with differences in seroprevalence. ConclusionThese initial data demonstrate a high seroprevalence of antibodies to SARS-CoV-2 among HCWs in Kenya. There was significant variation in seroprevalence by region, but not by cadre.
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In October 2020, anti-SARS-CoV-2 IgG seroprevalence among truck drivers and their assistants (TDA) in Kenya was 42.3%, higher than among other key populations. TDA transport essential supplies during the COVID-19 pandemic, placing them at increased risk of being infected and of transmitting SARS-CoV-2 infection over a wide geographical area.
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IntroductionCase management for COVID-19 patients is one of key interventions in country responses to the pandemic. Countries need information on the costs of case management to inform resource mobilization, planning and budgeting, purchasing arrangements, and assessments of the cost-effectiveness of interventions. We estimated unit costs for COVID-19 case management for patients with asymptomatic, mild to moderate, severe, and critical COVID-19 disease in Kenya. MethodsWe estimated per patient per day unit costs of COVID-19 case management for patients that are asymptomatic and those that have mild to moderate, severe, and critical symptoms. For asymptomatic and mild to moderate patients, we estimated unit costs for home-based care and institutional (hospitals and isolation centers). We used an ingredients approach, adopted a health system perspective and patient episode of care as our time horizon. We obtained data on inputs and their quantities from COVID-19 case management guidelines, home based care guidelines, and human resource guidelines, and augmented this with data provided by three public covid-19 treatment hospitals in Kenya. We obtained input prices for services from a recent costing survey of 20 hospitals in Kenya and for pharmaceuticals, non-pharmaceuticals, devices and equipment from market price databases for Kenya. ResultsPer day per patient unit cost for asymptomatic patients and patients with mild to moderate COVID-19 disease under home based care are KES 1,993.01 (USD 18.89) and 1995.17 (USD 18.991) respectively. When these patients are managed in an isolation center of hospital, the same unit costs for asymptomatic patients and patients with mild to moderate disease are 7,415.28 (USD 70.29) and 7,417.44 (USD 70.31) respectively. Per day unit costs for patients with severe COVID-19 disease managed in general hospital wards and those with critical COVID-19 disease admitted in intensive care units are 12,570.75 (USD 119.16) and 59,369.42 (USD 562.79). ConclusionCOVID-19 case management costs are substantial. Unit costs for asymptomatic and mild to moderate COVID-19 patients in home-based care is 4-fold lower compared institutional care of the same patients. Kenya will not only need to mobilize substantial resources to finance COVID-19 case management but also explore additional service delivery adaptations that will reduce unit costs.
