Seroprevalence of SARS-CoV-2 Antibodies and Retrospective Mortality in a Refugee Camp, Dagahaley, Kenya

Abstract

Background: Camps of forcibly displaced populations are considered to be at risk of large COVID-19 outbreaks. Low screening rates and limited surveillance led us to conduct a study in Dagahaley camp, located in the Dadaab refugee complex in Kenya to estimate SARS-COV-2 seroprevalence and, mortality and to identify changes in access to care during the pandemic. Methods: To estimate seroprevalence, we conducted a cross-sectional survey among a sample of individuals (n=587) seeking care at the two main health centres and among all household members (n=619) of community health workers and traditional birth attendants working in the camp. We used a rapid immunologic assay (BIOSYNEX® COVID‐19 BSS [IgG/IgM]) and adjusted for test performance and mismatch between the sampled population and that of the general camp population. To estimate mortality, we exhaustively interviewed all households (n=12860) in the camp about deaths occurring from January 2019 through March 2021.Results: We included 1206 participants in the seroprevalence study. In total, 8% (95% CI: 6.6%-9.7%) had a positive serologic test. After adjusting for test performance and standardizing on age, we estimated a seroprevalence of 5.8% (95% CI: 1.6%-8.4%). The mortality rate for 10,000 persons per day was 0.05 (95% CI 0.05-0.06) prior to the pandemic and 0.07 (95% CI 0.06-0.08) during the pandemic, representing a significant 42% increase (pInterpretation: We estimated that the number of infected people was 67 times higher than the number of reported cases. Participants aged 50 years or more where among the most affected. The mortality survey shows an increase in the mortality rate during the pandemic compared to before the pandemic. A decline in attendance at health facilities was observed and sustained despite the easing of restrictions.Funding Information: The study was funded by the Operational Centre of Geneva of Médecins Sans Frontières.Declaration of Interests: The authors have declared that no competing interests exist.Ethics Approval Statement: This protocol was approved by the MSF Ethics Review Board ( V. 1.1, 24.12.2020, ID: 20105) and the KEMRI SERU Scientific and Ethic Review Board (KEMRI/SERU/CIPDR/045/4164). All study procedures involving subject’s participation were conducted in compliance with the principles enunciated in the Declaration of Helsinki.