@article{fdi:010090272,
  title = {{M}orbidity and mortality burden of {COVID}-19 in rural {M}adagascar : results from a longitudinal cohort and nested seroprevalence study},
  author = {{G}architorena, {A}ndres and {R}asoloharimanana, {L}. {T}. and {R}akotonanahary, {R}. {J}. and {E}vans, {M}. and {M}iller, {A}. {C}. and {F}innegan, {K}. {E}. and {C}ordier, {L}. {F}. and {C}owley, {G}. and {R}azafinjato, {B}. and {R}andriamanambintsoa, {M}. and {A}ndrianambinina, {S}. and {P}opper, {S}. {J}. and {H}otahiene, {R}. and {B}onds, {M}. {H}. and {S}choenhals, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {T}hree years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of {COVID}-19 in the {W}orld {H}ealth {O}rganization {A}frica region. {H}igh quality, population-representative studies in {A}frica are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of {COVID}-19 in rural, low-resource settings. {H}ere, we estimated the spatio-temporal morbidity and mortality burden associated with {COVID}-19 in a rural health district of {M}adagascar until the first half of 2021.{M}ethods {W}e integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in {I}fanadiana {D}istrict, {M}adagascar. {S}ocio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect {I}g{G} and {I}g{M} antibodies against four specific proteins of {SARS}-{C}o{V}-2 in a bead-based multiplex immunoassay. {W}e evaluated spatio-temporal patterns in {COVID}-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions.{R}esults {E}ighteen percent of people had been infected by {A}pril-{J}une 2021, with seroprevalence increasing with individuals' age. {COVID}-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. {W}ealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. {A}dult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. {L}ess than 10% of mortality in this period would be directly attributed to {COVID}-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district. {C}onclusion {O}ur study provides a very granular understanding on {COVID}-19 transmission and mortality in a rural population of sub-{S}aharan {A}frica and suggests that the disease burden in these areas may have been substantially underestimated.},
  keywords = {{SARS}-{C}o{V}-2 seroprevalence ; {COVID}-19 risk factors ; {COVID}-19 mortality ; sub-{S}aharan {A}frica ; {MADAGASCAR} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{I}nternational {J}ournal of {E}pidemiology},
  volume = {[{E}arly access]},
  numero = {},
  pages = {[11 p.]},
  ISSN = {0300-5771},
  year = {2023},
  DOI = {10.1093/ije/dyad135},
  URL = {https://www.documentation.ird.fr/hor/fdi:010090272},
}