Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey.
<h4>Background</h4>The structural environment of urban slums, including physical, demographic, and socioeconomic attributes, renders inhabitants more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Yet, little is known about the specific determinants...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-09-01
|
| Series: | PLoS Medicine |
| Online Access: | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004093&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849468870432129024 |
|---|---|
| author | Mariam O Fofana Nivison Nery Juan P Aguilar Ticona Emilia M M de Andrade Belitardo Renato Victoriano Rôsangela O Anjos Moyra M Portilho Mayara C de Santana Laiara L Dos Santos Daiana de Oliveira Jaqueline S Cruz M Catherine Muenker Ricardo Khouri Elsio A Wunder Matt D T Hitchings Olatunji Johnson Mitermayer G Reis Guilherme S Ribeiro Derek A T Cummings Federico Costa Albert I Ko |
| author_facet | Mariam O Fofana Nivison Nery Juan P Aguilar Ticona Emilia M M de Andrade Belitardo Renato Victoriano Rôsangela O Anjos Moyra M Portilho Mayara C de Santana Laiara L Dos Santos Daiana de Oliveira Jaqueline S Cruz M Catherine Muenker Ricardo Khouri Elsio A Wunder Matt D T Hitchings Olatunji Johnson Mitermayer G Reis Guilherme S Ribeiro Derek A T Cummings Federico Costa Albert I Ko |
| author_sort | Mariam O Fofana |
| collection | DOAJ |
| description | <h4>Background</h4>The structural environment of urban slums, including physical, demographic, and socioeconomic attributes, renders inhabitants more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Yet, little is known about the specific determinants that contribute to high transmission within these communities. We therefore aimed to investigate SARS-CoV-2 seroprevalence in an urban slum in Brazil.<h4>Methods and findings</h4>We performed a cross-sectional serosurvey of an established cohort of 2,041 urban slum residents from the city of Salvador, Brazil between November 2020 and February 2021, following the first Coronavirus Disease 2019 (COVID-19) pandemic wave in the country and during the onset of the second wave. The median age in this population was 29 years (interquartile range [IQR] 16 to 44); most participants reported their ethnicity as Black (51.5%) or Brown (41.7%), and 58.5% were female. The median size of participating households was 3 (IQR 2 to 4), with a median daily per capita income of 2.32 (IQR 0.33-5.15) US Dollars. The main outcome measure was presence of IgG against the SARS-CoV-2 spike protein. We implemented multilevel models with random intercepts for each household to estimate seroprevalence and associated risk factors, adjusting for the sensitivity and specificity of the assay, and the age and gender distribution of our study population. We identified high seroprevalence (47.9%, 95% confidence interval [CI] 44.2% to 52.1%), particularly among female residents (50.3% [95% CI 46.3% to 54.8%] versus 44.6% [95% CI 40.1% to 49.4%] among male residents, p < 0.01) and among children (54.4% [95% CI 49.6% to 59.3%] versus 45.4% [95% CI 41.5% to 49.7%] among adults, p < 0.01). Adults residing in households with children were more likely to be seropositive (48.6% [95% CI 44.8% to 52.3%] versus 40.7% [95% CI 37.2% to 44.3%], p < 0.01). Women who were unemployed and living below the poverty threshold (daily per capita household income <$1.25) were more likely to be seropositive compared to men with the same employment and income status (53.9% [95% CI 47.0% to 60.6%] versus 32.9% [95% CI 23.2% to 44.3%], p < 0.01). Participation in the study was voluntary, which may limit the generalizability of our findings.<h4>Conclusions</h4>Prior to the peak of the second wave of the COVID-19 pandemic, cumulative incidence as assessed by serology approached 50% in a Brazilian urban slum population. In contrast to observations from industrialized countries, SARS-CoV-2 incidence was highest among children, as well as women living in extreme poverty. These findings emphasize the need for targeted interventions that provide safe environments for children and mitigate the structural risks posed by crowding and poverty for the most vulnerable residents of urban slum communities. |
| format | Article |
| id | doaj-art-e578f2deaadd477e94f229f716b5408e |
| institution | Kabale University |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2022-09-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-e578f2deaadd477e94f229f716b5408e2025-08-20T03:25:42ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762022-09-01199e100409310.1371/journal.pmed.1004093Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey.Mariam O FofanaNivison NeryJuan P Aguilar TiconaEmilia M M de Andrade BelitardoRenato VictorianoRôsangela O AnjosMoyra M PortilhoMayara C de SantanaLaiara L Dos SantosDaiana de OliveiraJaqueline S CruzM Catherine MuenkerRicardo KhouriElsio A WunderMatt D T HitchingsOlatunji JohnsonMitermayer G ReisGuilherme S RibeiroDerek A T CummingsFederico CostaAlbert I Ko<h4>Background</h4>The structural environment of urban slums, including physical, demographic, and socioeconomic attributes, renders inhabitants more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Yet, little is known about the specific determinants that contribute to high transmission within these communities. We therefore aimed to investigate SARS-CoV-2 seroprevalence in an urban slum in Brazil.<h4>Methods and findings</h4>We performed a cross-sectional serosurvey of an established cohort of 2,041 urban slum residents from the city of Salvador, Brazil between November 2020 and February 2021, following the first Coronavirus Disease 2019 (COVID-19) pandemic wave in the country and during the onset of the second wave. The median age in this population was 29 years (interquartile range [IQR] 16 to 44); most participants reported their ethnicity as Black (51.5%) or Brown (41.7%), and 58.5% were female. The median size of participating households was 3 (IQR 2 to 4), with a median daily per capita income of 2.32 (IQR 0.33-5.15) US Dollars. The main outcome measure was presence of IgG against the SARS-CoV-2 spike protein. We implemented multilevel models with random intercepts for each household to estimate seroprevalence and associated risk factors, adjusting for the sensitivity and specificity of the assay, and the age and gender distribution of our study population. We identified high seroprevalence (47.9%, 95% confidence interval [CI] 44.2% to 52.1%), particularly among female residents (50.3% [95% CI 46.3% to 54.8%] versus 44.6% [95% CI 40.1% to 49.4%] among male residents, p < 0.01) and among children (54.4% [95% CI 49.6% to 59.3%] versus 45.4% [95% CI 41.5% to 49.7%] among adults, p < 0.01). Adults residing in households with children were more likely to be seropositive (48.6% [95% CI 44.8% to 52.3%] versus 40.7% [95% CI 37.2% to 44.3%], p < 0.01). Women who were unemployed and living below the poverty threshold (daily per capita household income <$1.25) were more likely to be seropositive compared to men with the same employment and income status (53.9% [95% CI 47.0% to 60.6%] versus 32.9% [95% CI 23.2% to 44.3%], p < 0.01). Participation in the study was voluntary, which may limit the generalizability of our findings.<h4>Conclusions</h4>Prior to the peak of the second wave of the COVID-19 pandemic, cumulative incidence as assessed by serology approached 50% in a Brazilian urban slum population. In contrast to observations from industrialized countries, SARS-CoV-2 incidence was highest among children, as well as women living in extreme poverty. These findings emphasize the need for targeted interventions that provide safe environments for children and mitigate the structural risks posed by crowding and poverty for the most vulnerable residents of urban slum communities.https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004093&type=printable |
| spellingShingle | Mariam O Fofana Nivison Nery Juan P Aguilar Ticona Emilia M M de Andrade Belitardo Renato Victoriano Rôsangela O Anjos Moyra M Portilho Mayara C de Santana Laiara L Dos Santos Daiana de Oliveira Jaqueline S Cruz M Catherine Muenker Ricardo Khouri Elsio A Wunder Matt D T Hitchings Olatunji Johnson Mitermayer G Reis Guilherme S Ribeiro Derek A T Cummings Federico Costa Albert I Ko Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. PLoS Medicine |
| title | Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. |
| title_full | Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. |
| title_fullStr | Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. |
| title_full_unstemmed | Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. |
| title_short | Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey. |
| title_sort | structural factors associated with sars cov 2 infection risk in an urban slum setting in salvador brazil a cross sectional survey |
| url | https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1004093&type=printable |
| work_keys_str_mv | AT mariamofofana structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT nivisonnery structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT juanpaguilarticona structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT emiliammdeandradebelitardo structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT renatovictoriano structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT rosangelaoanjos structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT moyramportilho structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT mayaracdesantana structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT laiaraldossantos structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT daianadeoliveira structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT jaquelinescruz structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT mcatherinemuenker structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT ricardokhouri structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT elsioawunder structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT mattdthitchings structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT olatunjijohnson structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT mitermayergreis structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT guilhermesribeiro structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT derekatcummings structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT federicocosta structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey AT albertiko structuralfactorsassociatedwithsarscov2infectionriskinanurbanslumsettinginsalvadorbrazilacrosssectionalsurvey |