What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study
Objectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy, inner-city morgue in Lusaka.Participants We sampled a random subset of all decedents who transited the University Teaching Hospital morgue. We samp...
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e066763.full |
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| author | Lawrence Mwananyanda William B MacLeod Donald M Thea Rachel C Pieciak Christopher J Gill Geoffrey Kwenda Zachariah Mupila Rotem Lapidot Leah Forman Lauren Etter Ruth Nakazwe Daniel Bridges Chilufya Chikoti Sarah Chirwa Charles Chimoga Ben Katowa James Lungu Japhet Matoba Gift Mwinga Benjamin Mubemba Walter Muleya Mulenga Mwenda Benard Ngoma Diana Nzara Natalie Pawlak Lillian Pemba Ngonda Saasa Edgar Simulundu Baron Yankonde |
| author_facet | Lawrence Mwananyanda William B MacLeod Donald M Thea Rachel C Pieciak Christopher J Gill Geoffrey Kwenda Zachariah Mupila Rotem Lapidot Leah Forman Lauren Etter Ruth Nakazwe Daniel Bridges Chilufya Chikoti Sarah Chirwa Charles Chimoga Ben Katowa James Lungu Japhet Matoba Gift Mwinga Benjamin Mubemba Walter Muleya Mulenga Mwenda Benard Ngoma Diana Nzara Natalie Pawlak Lillian Pemba Ngonda Saasa Edgar Simulundu Baron Yankonde |
| author_sort | Lawrence Mwananyanda |
| collection | DOAJ |
| description | Objectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy, inner-city morgue in Lusaka.Participants We sampled a random subset of all decedents who transited the University Teaching Hospital morgue. We sampled the posterior nasopharynx of decedents using quantitative PCR. Prevalence was weighted to account for age-specific enrolment strategies.Interventions Not applicable—this was an observational study.Primary outcomes Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.Secondary outcomes Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.Results From 1118 decedents enrolled between January and June 2021, COVID-19 was detected among 32.0% (358/1116). Roughly four COVID-19+ community deaths occurred for every facility death. Antemortem testing occurred for 52.6% (302/574) of facility deaths but only 1.8% (10/544) of community deaths and overall, only ~10% of COVID-19+ deaths were identified in life. During peak transmission periods, COVID-19 was detected in ~90% of all deaths. We observed three waves of transmission that peaked in July 2020, January 2021 and ~June 2021: the AE.1 lineage and the Beta and Delta variants, respectively. PCR signals were strongest among those whose deaths were deemed ‘probably due to COVID-19’, and weakest among children, with an age-dependent increase in PCR signal intensity.Conclusions COVID-19 was common among deceased individuals in Lusaka. Antemortem testing was rarely done, and almost never for community deaths. Suspicion that COVID-19 was the cause of deaths was highest for those with a respiratory syndrome and lowest for individuals <19 years. |
| format | Article |
| id | doaj-art-7ef49b34ff0f4b2d8060279cfc60fbb2 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
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| spelling | doaj-art-7ef49b34ff0f4b2d8060279cfc60fbb22025-08-20T02:14:23ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-066763What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance studyLawrence Mwananyanda0William B MacLeod1Donald M Thea2Rachel C Pieciak3Christopher J Gill4Geoffrey Kwenda5Zachariah Mupila6Rotem Lapidot7Leah Forman8Lauren Etter9Ruth Nakazwe10Daniel Bridges11Chilufya Chikoti12Sarah Chirwa13Charles Chimoga14Ben Katowa15James Lungu16Japhet Matoba17Gift Mwinga18Benjamin Mubemba19Walter Muleya20Mulenga Mwenda21Benard Ngoma22Diana Nzara23Natalie Pawlak24Lillian Pemba25Ngonda Saasa26Edgar Simulundu27Baron Yankonde28Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USABiomedical Sciences, University of Zambia, Ridgeway Campus, Lusaka, Lusaka, ZambiaAvencion, Lusaka, ZambiaPediatric Infectious Diseases, Boston Medical Center, Brookline, Massachusetts, USABiostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USADepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USABiomedical Sciences, University of Zambia University Teaching Hospital, Lusaka, Lusaka, ZambiaProgram for Applied Technology in Health (PATH), Lusaka, ZambiaAvencion Limited, Lusaka, ZambiaAvencion Limited, Lusaka, ZambiaAvencion Limited, Lusaka, ZambiaMacha Research Trust, Choma, Southern Province, ZambiaAvencion Limited, Lusaka, ZambiaMacha Research Trust, Choma, Southern Province, ZambiaAvencion Limited, Lusaka, ZambiaWildlife Sciences, The Copperbelt University, Kitwe, Copperbelt, ZambiaBiomedical Sciences, University of Zambia School of Veterinary Medicine, Lusaka, Lusaka, ZambiaProgram for Applied Technology in Health, Lusaka, ZambiaAvencion Limited, Lusaka, ZambiaAvencion Limited, Lusaka, ZambiaTufts University School of Medicine, Boston, Massachusetts, USAAvencion Limited, Lusaka, ZambiaUniversity of Zambia School of Veterinary Medicine, Lusaka, ZambiaMacha Research Trust, Choma, Southern Province, ZambiaAvencion Limited, Lusaka, ZambiaObjectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy, inner-city morgue in Lusaka.Participants We sampled a random subset of all decedents who transited the University Teaching Hospital morgue. We sampled the posterior nasopharynx of decedents using quantitative PCR. Prevalence was weighted to account for age-specific enrolment strategies.Interventions Not applicable—this was an observational study.Primary outcomes Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.Secondary outcomes Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.Results From 1118 decedents enrolled between January and June 2021, COVID-19 was detected among 32.0% (358/1116). Roughly four COVID-19+ community deaths occurred for every facility death. Antemortem testing occurred for 52.6% (302/574) of facility deaths but only 1.8% (10/544) of community deaths and overall, only ~10% of COVID-19+ deaths were identified in life. During peak transmission periods, COVID-19 was detected in ~90% of all deaths. We observed three waves of transmission that peaked in July 2020, January 2021 and ~June 2021: the AE.1 lineage and the Beta and Delta variants, respectively. PCR signals were strongest among those whose deaths were deemed ‘probably due to COVID-19’, and weakest among children, with an age-dependent increase in PCR signal intensity.Conclusions COVID-19 was common among deceased individuals in Lusaka. Antemortem testing was rarely done, and almost never for community deaths. Suspicion that COVID-19 was the cause of deaths was highest for those with a respiratory syndrome and lowest for individuals <19 years.https://bmjopen.bmj.com/content/12/12/e066763.full |
| spellingShingle | Lawrence Mwananyanda William B MacLeod Donald M Thea Rachel C Pieciak Christopher J Gill Geoffrey Kwenda Zachariah Mupila Rotem Lapidot Leah Forman Lauren Etter Ruth Nakazwe Daniel Bridges Chilufya Chikoti Sarah Chirwa Charles Chimoga Ben Katowa James Lungu Japhet Matoba Gift Mwinga Benjamin Mubemba Walter Muleya Mulenga Mwenda Benard Ngoma Diana Nzara Natalie Pawlak Lillian Pemba Ngonda Saasa Edgar Simulundu Baron Yankonde What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study BMJ Open |
| title | What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study |
| title_full | What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study |
| title_fullStr | What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study |
| title_full_unstemmed | What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study |
| title_short | What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study |
| title_sort | what is the prevalence of covid 19 detection by pcr among deceased individuals in lusaka zambia a postmortem surveillance study |
| url | https://bmjopen.bmj.com/content/12/12/e066763.full |
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