Social environment, inequality, and COVID 19 in Nicaragua: did we underreport COVID-19 impact on those most highly vulnerable socioeconomic population groups?

Abstract

Background and aims: In Nicaragua, COVID-19 official figures are very limited for vulnerable socio-economic population groups. Therefore, we conducted a multiapproach study to investigate the health impact of the pandemic in such groups and to estimate underreporting of COVID-19 cases. Method: We implemented both a web-based survey (n=8,200 respondents) and a face-to-face interview-based survey (n=321 respondents) to explore self-reports of suspected and confirmed cases of COVID-19. The health impact was assessed by calculating the COVID-19 years of life lost (YLLs) and the COVID-19 Disability-Adjusted Life Years. We also performed a national-level registry study of public official data, then by combining that information we created an underreporting index (UI) by region, age, and gender since official data are reported only according to those variables. We explored factors associated with underreporting and health impact through nonlinear multi regression analysis. Results: National level estimated percentage of underreporting varied between 60 to 90% of cases during the COVID-19 pandemic. The UI was higher among young females, people with disability, older adults living alone, older workers with no access to social security or limited ace to public health care, Afro-Caribbean ethnic groups, people living in rural areas, and belonging to low and very low socioeconomic strata. Also, the municipality with the highest national poverty index had the highest UI. Our data strongly suggest that the relative burdens of both the YLDs and DALYs were also higher among those groups with a higher UI. Conclusion: The COVID-19 greatly impacts highly vulnerable population groups, however, this situation is not being reflected in the official figures. To make visible the true impact of the pandemic and establish effective measures to assist the most vulnerable groups, we need to start by making the situation of such groups visible to society. Keywords: COVID 19, underreporting, vulnerable groups, Nicaragua.