RESUMO
ContextIn low-income settings where access to biological diagnosis is limited, data on the spread of the COVID-19 epidemic are scarce. In September 2020, after the first COVID-19 wave, Mali reported 3,086 confirmed cases and 130 deaths. Most reports originated form Bamako, the capital city, with 1,532 reported cases and 81 deaths for an estimated 2.42 million population. This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We also assessed demographic, social and living conditions, health behaviors and knowledge associated with SARS-CoV-2 seropositivity. Material and methodsWe conducted a cross-sectional multistage cluster household survey in commune VI, which reported, September 2020, 30% (n=466) of the total cases reported at Bamako. We measured serological status by detection of SARS-CoV-2 spike protein Antibodies in venous blood sampled after informed consent. We documented housing conditions and individual health behaviors through KABP questionnaires among participants aged 12 years and older. We estimated the number of SARS-CoV-2 infections and deaths in the total population of Bamako using the age and sex distributions of SARS-CoV-2 seroprevalence. A logistic generalized additive multilevel model was performed to estimate household conditions and demographic factors associated with seropositivity. ResultsWe recruited 1,526 inhabitants in the 3 investigated areas (commune VI, Bamako) belonging to the 306 sampled households. We obtained 1,327 serological results, 220 household questionnaires and collected KABP answers for 962 participants. The prevalence of SARS-CoV-2 seropositivity was 16.4% after adjusting on the population structure. This suggested that [~]400,000 cases and [~] 2,000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. KABP analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown or curfew), and limited mask wearing. ConclusionIn spite of limited numbers of reported cases, the first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. This highlight the difficulty of developing epidemic control strategies when screening test are not available or not used, even more when the transmission modalities are not well known by the population. Targeted policies based on health education prevention have to be implemented to improve the COVID-19 risk perception among the local population and fight to false knowledge and beliefs.
RESUMO
Like in many countries and regions, spread of the COVID 19 pandemic has exhibited important spatial heterogeneity across France, one of the most affected countries so far. To better understand factors associated with incidence, mortality and lethality heterogeneity across the 96 administrative departments of metropolitan France, we thus conducted a geoepidemiological analysis based on publicly available data, using hierarchical ascendant classification (HAC) on principal component analysis (PCA) of multidimensional variables, and multivariate analyses with generalized additive models (GAM). Our results confirm a marked spatial heterogeneity of in-hospital COVID 19 incidence and mortality, following the North East / South West diffusion of the epidemic. The delay elapsed between the first COVID-19 associated death and the onset of the national lockdown on March 17th, 2020, appeared positively associated with in-hospital incidence, mortality and lethality. Mortality was also strongly associated with incidence. Mortality and lethality rates were significantly higher in departments with older population, but they were not significantly associated with the number of intensive-care beds available in 2018. We did not find any significant association between incidence, mortality or lethality rates and incidence of new chloroquine and hydroxychloroquine dispensations in pharmacies either, nor between COVID 19 incidence and climate, nor between economic indicators and in-hospital COVID 19 incidence or mortality. This ecological study highlights the impact of population age structure, epidemic spread and transmission mitigation policies in COVID-19 morbidity or mortality heterogeneity.
