Retrospective mortality and prevalence of SARS-CoV-2 antibodies in greater Omdurman, Sudan: a population–based cross–sectional survey

  1. Wendelin Moser
  2. Mohammed Ahmed Hassan Fahal
  3. Elamin Abualas
  4. Shahinaz Bedri
  5. Mahgoub Taj Elsir
  6. Mona Fateh El Rahman Omer Mohamed
  7. Abdelhalim Babiker Mahmoud
  8. Amna Ismail Ibrahim Ahmad
  9. Mohammed A. Adam
  10. Sami Altalib
  11. Ola Adil DafaAllah
  12. Salahaldin Abdallah Hmed
  13. Andrew S. Azman
  14. Iza Ciglenecki
  15. Etienne Gignoux
  16. Alan González
  17. Christine Mwongera
  18. Manuel Albela
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Abstract

Background

Even after adjusting for the expected lower severity due to the younger age of the population, relatively low SARS-CoV-2 incidence and mortality rates have been reported throughout Africa. For investigating whether this is truly the case, we conducted a survey to estimate the COVID-19 related mortality and cumulative incidence of SARS-CoV-2 infections in Omdurman the most populated city of the tripartite metropolis Khartoum in Sudan.

Methods

A retrospective, cross–sectional, mortality and seroprevalence survey was conducted in Omdurman, Sudan, from March 1, until April 10 2021. A two–stage cluster sampling method was used to investigate the death rate for the pre–pandemic (January 1, 2019–February 29, 2020) and pandemic (March 1, 2020 – day of the survey) period using questionnaires. The seroprevalence survey was performed in a subset of households and all consenting members were tested with a rapid serological test (SD–Biosensor) and a subgroup additionally with ELISA (EUROIMMUN). Fisher’s exact test was used to assess differences between the pre–and pandemic periods and a random effect and Bayesian latent class model to adjust for test performance.

Findings

Data from 27315 people (3716 households) for the entire recall period showed a 67% (95% CI 32–110) increase in death rate between the pre–pandemic (0.12 deaths/10000 people/day [95% CI 0.10–0.14]) and pandemic (0.20 [0.16–0.23]) periods. Notably, a 74% (30–133) increase in death was observed among people aged ≥50 years. The adjusted seroprevalence of SARS-CoV-2 was 54.6% (95% CI 51.4–57.8). The seroprevalence was significantly associated with age, increasing up to 80.7% (71.7–89.7) for the oldest age group (≥50 years).

Interpretation

Our results showed a significant elevated mortality for the pandemic period with a considerable excess mortality in Omdurman, Sudan. The overall high seroprevalence indicated a different age pattern compared to other countries, with a significant increase by age.

Funding

Medécins Sans Frontières

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