Abstract
BACKGROUND AND AIM: Wastewater based epidemiology (WBE) is a promising tool to monitor the prevalence of COVID-19 disease at community level through detection of SARS-CoV-2 RNA in wastewater. Although WBE has been largely adopted in developed countries as complementary to clinical surveillance, the approach is still not widely applied in low-and-lower-middle-income countries (LMICs) owing to number of drawbacks. Despite these limitations, a small number of studies on wastewater based epidemiology for SARS-CoV-2 detection have been conducted in LMICs. The current systematic review provides an overview of the efficacy of WBE in LMICs. METHODS: We conducted keyword searches in PubMed, Web of Science, and Scopus for articles published between January 2020 to February 2022. A total of 2,057 relevant articles were identified, and 21 met our inclusion/exclusion criteria. RESULTS: The most common analytical steps used in included studies are sampling, storage, concentration, extraction, and detection. Studies utilized either composite/grab raw sludge or influents mostly from wastewater treatment plants, which covered a population of one to ten million. Among the studies, Among the studies, the most commonly used concentration technique was Poly Ethylene Glycol (PEG), and the most frequently targeted gene was the N gene. The overall sample positivity was found 81.18%, with viral loads of 40 to 45,000 copies/L. Most of the studies found positive correlation between SARS-CoV-2 viral loads in wastewater and the detected COVID-19 cases. Besides, few studies found higher signals in wastewater with a time lag of one to two weeks before clinical case detection. CONCLUSIONS: These findings of systematic review illustrate the analytical methods used in WBE research, as well as the future of WBE in LMICs, thereby allowing decision-makers to take strategic preventative actions to curb the spread of COVID-19 diseases in LMICs.
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