The novel coronavirus disease (currently known as COVID-19) is a lethal and extremely contagious respiratory illness caused by the novel coronavirus, now named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [
In Ethiopia, the first case of COVID-19 was reported on 13th March 2020 [
A community-based cross-sectional study was conducted from 01 July to 31 August 2020 in northeastern Ethiopia. The study area included three zones: South Wollo Zone, Afar Regional State (nearest to the northeast region), and Oromia Special Zone in northeastern Ethiopia. There are two COVID-19 testing centers in this region of the country: Wollo University COVID-19 Laboratory Testing Center and Amhara Public Health Institute (APHI), Dessie branch. Moreover, each woreda and city has COVID-19 screening, sample collection, quarantine, and isolation centers. The catchment population for the geographical locations involved in this study is estimated to be more than 10 million people.
The source population comprises of all communities in the northeastern Ethiopia region. The study participants were selected using a simple random sampling technique from those who were suspected of having COVID-19, had contact with known COVID-19 cases, had symptoms of acute respiratory illnesses, and who were apparently healthy individuals involved as part of community surveillance in the northeastern Ethiopia region during the study period.
WHO standardized check list was used to obtain information of the study participants related to sociodemographic characteristics, clinical, and risk factor data [
The collected specimens were then placed in the tube rack and stored in a cold box which maintains 2–8°C maintaining the triple packaging procedure. The properly packaged oropharyngeal specimens were then transported to Wollo University COVID-19 Laboratory from the collection sites. When there is likely to be an unavoidable delay in specimens being tested in the laboratory, the specimens were kept refrigerated at 2–8°C until being processed.
About 200
The real-time fluorescent polymerase chain reaction (RT-PCR) kit was used for detecting the novel coronavirus (COVID-19). It is based on a qualitative in vitro nucleic acid amplification assay intended to detect ORF1ab gene of COVID-19 using reverse transcription PCR combining fluorescent probing. Primers and sequence-specific fluorescence probes were designed tailored to the high conservative region in COVID-19 genome. The probes were oligonucleotide attached fluorophores at the 5′ end with FAM as reporter and 3′ end with quencher. In the meantime, specific primers and probes were developed as internal reference with the fluorophore VIC attached at the 5′ end as reporter. Immediately after being out from the −20°C storage, the kit contents were thawed thoroughly at ambient temperature except the enzyme mix. About 20
To generate quality and reliable data, all quality control checks were performed in the whole data collection process. Specimen collection, transportation protocols, and special safety precautions were provided with the necessary job aids for the facilities under study to monitor their process quality. Moreover, all laboratory assays were performed by maintaining quality control procedures. Standard operating procedures (SOPs) were strictly followed through all aspects of data collection including specimen collection, handling, testing, and infection control strategies. No template control (NTC), which was composed of nuclease-free water, was included in each run to monitor reagent and system contamination during the RNA extraction process.
A negative control and positive control were used for every run to verify that sample processing, amplification, and detection steps were performed correctly. Viral RNA genome extraction was performed in a level 2 biosafety cabinet (BSL-2). To remove contamination, the sample preparation (BSC II, type A2) and amplification instruments were cleaned regularly based on the decontamination and cleaning protocol found within the operator manual. The data from the standardized check list were checked for its completeness and accuracy. And data cleaning and double data entry were applied to assure quality of the data.
Data were entered to Microsoft Excel and exported to SPSS version 22 software (IBM, USA) and analyzed. Descriptive statistics were summarized in tables and graphs. The chi-square test for the association between dependent and independent variables was used. Binary logistic regression was employed to show the association of each variable with the dependent variable. Moreover, a multivariate analysis was computed to identify factors that independently influence the occurrence of the dependent variable. The level of significance was set to 0.05 (
Ethical clearance was obtained from the Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University. Moreover, informed consent was obtained from each study participant or from parents/guardians for participants who could not give consent by themselves. The objectives of the study were explained to the participants by the data collectors. The study was conducted according to the principles expressed in the Declaration of Helsinki. Study participants were aware regarding the threats posed by the pandemic and the significance of being tested. Participants were also informed that positive results were communicated with the zonal and regional health offices, so that further contact tracing of positive individuals as well as proper management of positive individuals including quarantine, isolation, or critical patient care has been performed.
About 8752 laboratory-tested individuals were included in this study between 01 July 2020 and 31 August 2020. The mean (±SD) age of the study participants was 31.6 (±13.6). Sixty percent (60%) of the study participants were between the age group of 36 and 52 years. The sex ratio was skewed towards males. More than fifty percent (52.2%) of the individuals were permanently living in South Wollo Zone, and almost all study participants were from different parts of Amhara regional state (Table
Sociodemographic characteristics of the study participants in the northeastern region of Ethiopia, 2020.
Category | Individuals (8752) |
---|---|
Age, years | |
Mean (SD) | 31.6 (13.6) |
Range | 1–104 |
Age groups, | |
1–18 | 30 (0.4) |
19–35 | 862 (9.8) |
36–52 | 5236 (59.8) |
53–69 | 1880 (21.5) |
70–86 | 585 (6.7) |
87–104 | 159 (1.9) |
Sex, | |
Male | 5568 (63.6) |
Female | 3184 (36.4) |
Ethnic origin | |
Ethiopia | 8747 (99.9) |
Others (China, Oman, and Taiwan) | 5 (0.1) |
Permanent residence (region) | |
Amhara | 8728 (99.7) |
Afar | 19 (0.2) |
Others (Addis Ababa, Benishangul-Gumuz) | 5 (0.1) |
Permanent residence (zone) | |
South Wollo | 4572 (52.2) |
Dessie town | 1175 (13.4) |
Oromia Special Zone | 1893 (21.6) |
Wag Hemra | 980 (11.2) |
Others (North Wollo, Showa, Gojam, Gondar, and Afar) | 132 (1.5) |
The number of laboratory-confirmed COVID-19 infections was higher in males and in the age group of 36–52 years, but the infection was more prevalent among individuals who were in the age category of 87–104 years (5%). Thirty-three of the study participants had a travel history to the neighboring country, Djibouti, but all of them were negative for COVID-19 infection. Out of the total COVID-19 screened participants, the majority of positive cases were from the community surveillance which accounts 2.2%. About 233/291 COVID-19 infections were detected in the final quarter of the study period, accounting for the majority (2.7%) of the total 3.3% infection rate (Table
Prevalence of COVID-19 infection among study participants in the northeastern region of Ethiopia, 2020.
Positive | Negative | |||
---|---|---|---|---|
Sex | ||||
Female | 97 (1.1) | 97(3.0) | 3087 (97.0) | 0.272 |
Male | 194 (2.2) | 194 (3.5) | 5374 (96.5) | |
Age, years | ||||
1–35 | 27 (0.31) | 27 (2.7) | 965 (97.3) | 0.053 |
36–52 | 174 (2.0) | 174 (3.3) | 5062 (96.7) | |
53–69 | 60 (0.7) | 60 (3.2) | 1820 (96.8) | |
70–86 | 22 (0.3) | 22 (3.8) | 563 (96.2) | |
87–104 | 8 (0.1) | 8 (5.0) | 151 (95) | |
Time period of screening | ||||
July 1–July 15, 2020 | 0 (0) | 0 (0) | 179 (100) | <0.005 |
July 16–July 31, 2020 | 8 (0.1) | 8(1.1) | 717 (98.9) | |
August 1–August 15, 2020 | 50 (0.6) | 50 (2.1) | 2352(97.9) | |
August 16–August 31, 2020 | 233 (2.7) | 233(4.3) | 5213(95.7) | |
Travel history | ||||
Yes (Djibouti) | 33 (0.4) | 0 | 33 (100) | 0.286 |
No | 291 (3.3) | 291 (3.3) | 8428 (96.7) | |
Individual classification for testing | ||||
New | 256 (2.9) | 256 (3.0) | 8310 (97.0) | <0.005 |
Follow-up | 35 (0.4) | 35 (18.8) | 151 (81.2) | |
Reason for testing (newly tested and follow-up) | ||||
Community surveillance | 189 (2.2) | 189 (2.7) | 6808 (97.3) | <0.005 |
Suspect | 37 (0.4) | 37 (3.9) | 919 (96.1) | |
Contact | 28 (0.3) | 28 (5.1) | 516 (94.9) | |
Facility-based survey | 2 (0.1) | 2 (2.9) | 67 (97.1) | |
Follow-up | 35 (0.4) | 35 (18.8) | 151 (81.2) |
COVID-19 infections had started increasing in prevalence in the fourth week of the study period, from July 24 to July 31, 2020, and peak prevalence was observed in the last two weeks. No positive cases were found during the first three weeks of the massive testing period of COVID-19 infection. From week 4 to week 6, however, the positivity rate of the infection was higher among males than female study participants. Female study participants, on the other hand, had a higher prevalence of COVID-19 infection in the last two weeks than males (Figure
Trends of COVID-19 infection in the northeastern region of Ethiopia from July 01 to August 31, 2020.
As given in Table
Trend of COVID-19 infection in the northeastern region of Ethiopia from July 01, 2020, to August 31, 2020, by different variables across each week (
Parameters | Week 1 | Week 2 | Week 3 | Week 4 | Week 5 | Week 6 | Week 7 | Week 8 | |
---|---|---|---|---|---|---|---|---|---|
Age, years | |||||||||
1–35 | Negative | 48 (0.8) | 54 (0.9) | 186 (3.1) | 386 (6.5) | 521 (8.8) | 1317 (22.2) | 2508 (42.3) | 907 (15.3) |
Positive | 0 (0) | 0 (0) | 0 (0) | 6 (3.0) | 17 (8.5) | 20 (10) | 104 (51.7) | 54 (26.9) | |
36–52 | Negative | 14 (0.7) | 14 (0.7) | 21 (1.1) | 124 (6.8) | 108 (5.9) | 330 (18.1) | 819 (45.0) | 390 (21.4) |
Positive | 0 (0) | 0 (0) | 0 (0) | 1 (1.7) | 3 (5.0) | 5 (8.3) | 29 (48.3) | 22 (36.7) | |
53–69 | Negative | 6 (1.0) | 9 (1.5) | 2 (0.3) | 25 (4.4) | 29 (5.0) | 79 (14.0) | 243 (43.2) | 170 (30.2) |
Positive | 0 (0) | 0 (0) | 0 (0) | 1 (4.5) | 0 (0) | 3 (13.6) | 9 (40.9) | 9 (40.9) | |
70–86 | Negative | 2 (1.3) | 4 (2.7) | 0 (0) | 1 (0.7) | 8 (5.4) | 28 (19.6) | 52 (36.4) | 48 (33.6) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (16.7) | 4 (66.7) | 1 (16.7) | |
87–104 | Negative | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (12.5) | 2 (25.0) | 5 (62.5) | 0 (0) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (50.0) | 0 (0) | 0 (0) | 1 (50.0) | |
Permanent residence by zone | |||||||||
Dessie town | Negative | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 28 (2.5) | 527 (46.9) | 668 (50.6) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 3 (5.8) | 9 (17.3) | 40 (76.9) | |
South Wollo | Negative | 47 (1.0) | 42 (0.9) | 189 (4.2) | 352 (7.9) | 487 (10.9) | 1147 (25.7) | 1723 (38.6) | 473 (10.6) |
Positive | 0 (0) | 0 (0) | 0 (0) | 2 (1.8) | 15 (13.4) | 8 (7.1) | 73 (65.2) | 14 (12.5) | |
Oromia Zone | Negative | 5 (0.3) | 10 (0.6) | 20 (1.1) | 88 (4.9) | 119 (6.6) | 201 (10.5) | 947 (52.6) | 422 (23.4) |
Positive | 0 (0) | 0 (0) | 0 (0) | 3 (3.3) | 6 (6.5) | 11 (12.0) | 42 (45.7) | 30 (32.6) | |
Wag Hemra | Negative | 18 (1.8) | 29 (3.0) | 0 (0.0) | 83 (8.7) | 61 (6.2) | 388 (40.6) | 373 (39.0) | 4 (0.4) |
Positive | 0 (0) | 0 (0) | 0 (0) | 1 (4.2) | 0 (0) | 7 (29.2) | 16 (66.7) | 0 (0) | |
Others | Negative | 0 (0) | 0 (0) | 0 (0) | 13 (10.7) | 0 (0) | 3 (2.5) | 57 (47.1) | 48 (39.7) |
Positive | 0 (0) | 0 (0) | 0 (0) | 2 (18.2) | 0 (0) | 0 (0) | 6 (54.5) | 3 (27.3) | |
Classification of study subjects for COVID-19 screening | |||||||||
New | Negative | 70 (0.8) | 80 (1.0) | 209 (2.5) | 536 (6.5) | 667 (8.0) | 1708 (20.6) | 3564 (42.9) | 1476 (17.8) |
Positive | 0 (0) | 0 (0) | 0 (0) | 8 (3.1) | 21 (8.2) | 28 (10.9) | 132 (51.6) | 67 (26.2) | |
Follow-up | Negative | 0 (0) | 1 (0.7) | 0 (0) | 0 (0) | 0 (0) | 48 (31.8) | 63 (41.7) | 39 (25.8) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (2.9) | 14 (40.0) | 20 (57.1) | |
Reason for testing | |||||||||
Community surveillance | Negative | 10 (0.1) | 25 (0.4) | 63 (0.9) | 394 (5.8) | 546 (8.0) | 1618 (23.8) | 3182 (46.7) | 970 (14.2) |
Positive | 0 (0) | 0 (0) | 0 (0) | 6 (3.2) | 9 (4.8) | 19 (10.1) | 108 (57.1) | 47 (24.9) | |
Suspect | Negative | 24 (2.5) | 41 (4.3) | 146 (15.3) | 29 (3.0) | 61 (6.6) | 28 (3.0) | 275 (29.9) | 315 (34.3) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 6 (16.2) | 9 (24.3) | 14 (37.8) | 8 (21.6) | |
Contact | Negative | 36 (7.0) | 14 (2.7) | 0 (0) | 46 (8.9) | 60 (11.6) | 62 (12.0) | 107 (20.7) | 191 (37.0) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 6 (21.4) | 0 (0) | 10 (35.7) | 12 (42.9) | |
Facility-based survey | Negative | 0 (0) | 0 (0) | 0 (0) | 69 (100) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Positive | 0 (0) | 0 (0) | 0 (0) | 2 (100) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
Follow-up | Negative | 0 (0) | 1 (0.7) | 0 (0) | 0 (0) | 0 (0) | 49 (31.8) | 63 (41.7) | 39 (25.8) |
Positive | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (2.9) | 14 (40.0) | 20 (57.1) |
Except for the gender parameter, the rest of the variables in the current study were found to have a statistically significant association with the laboratory test result of COVID-19 screening. Participants aged 87–104 years were 6 times (AOR = 6.03, 95% CI = 1.19–30.4,
COVID-19 infections and associated factors among study participants in the northeastern region of Ethiopia, 2020.
Positive | Negative | COR (95% CI) | AOR (95% CI) | |||
---|---|---|---|---|---|---|
Sex | ||||||
Female | 97 (3.0) | 3087 (97.0) | 1.00 | 1.00 | ||
Male | 194 (3.5) | 5374 (96.5) | 1.15 (0.9–1.47) | 0.272 | 1.17 (0.91–1.50) | 0.230 |
Age, years | ||||||
1–35 | 27 (2.7) | 965 (97.3) | 1.00 | 1.00 | ||
36–52 | 174 (3.3) | 5062 (96.7) | 0.14 (0.03–0.64) | 0.012 | 1.02 (0.76–1.38) | 0.871 |
53–69 | 60 (3.2) | 1820 (96.8) | 0.13 (0.03–0.63) | 0.011 | 1.19 (0.75–1.87) | 0.466 |
70–86 | 22 (3.8) | 563 (96.2) | 0.16 (0.03–0.78) | 0.024 | 1.15 (0.49–2.67) | 0.749 |
87–104 | 8 (5.0) | 151 (95) | 0.17 (0.03–0.97) | 0.046 | 6.03 (1.19–30.4) | 0.030 |
Permanent residence by zone | ||||||
Dessie town | 52 (4.4) | 1123 (95.6) | 1.00 | 1.00 | ||
South Wollo | 112 (2.4) | 4460 (97.6) | 0.54 (0.39–0.76) | <0.005 | 0.56 (0.39–0.79) | 0.001 |
Special zone of Oromia | 92 (4.9) | 1801 (95.1) | 1.10 (0.779–1.56) | 0.580 | 0.98 (0.68–1.41) | 0.92 |
Wag Hemra | 24 (2.4) | 956 (97.6) | 0.54 (0.33–0.87) | 0.015 | 0.59 (0.36–0.99) | 0.044 |
Others | 11 (8.3) | 121 (91.7) | 1.96 (0.998–3.86) | 0.051 | 2.03 (1.03–3.99) | 0.041 |
Classification of study subjects for COVID-19 screening | ||||||
New | 256 (3.0) | 8310 (97.0) | 7.52 (5.1–11.1) | <0.005 | 7.63 (5.07–11.5) | <0.005 |
Follow-up | 35 (18.8) | 151 (81.2) | 1.00 | 1.00 | ||
Reason for testing | ||||||
Community surveillance | 189 (2.7) | 6808 (97.3) | 1.00 | 1.00 | ||
Suspect | 17 (3.9) | 919 (96.1) | 1.45 (1.01–2.08) | 0.042 | 1.38 (0.33–5.7) | 0.657 |
Contact | 28 (5.1) | 516 (94.9) | 1.96 (1.3–2.94) | 0.001 | 1.65 (1.09–2.51) | 0.018 |
Facility-based survey | 2 (2.9) | 67 (97.1) | 1.07 (0.26–4.42) | 0.920 | ||
Follow-up | 35 (18.8) | 151 (81.2) | 8.35 (5.62–12.4) | <0.005 | 1.32 (0.91–1.90) | 0.145 |
In the present community-based cross-sectional study conducted from 01 July to 31 August 2020, a total of 8752 study participants were involved. Out of the total study participants, 291 (3.3%) were found to be infected with the virus with an overall prevalence of 3.3%, which is in line with a facility-based study conducted in Ataye, Northeast Ethiopia (3.3%) [
In the current study, the rate of infection showed increment in the course of time. There were no any laboratory-confirmed positive cases during the first 15 days of the study period (July 1–15, 2020), and then, it reached 1.1%, 2.1%, and 4.3% in the second, third, and fourth 15 days, respectively. This finding is not in agreement with a population screening report in Iceland where the percentage of infected participants remained steady during the screening period in the country [
A study performed in Pakistan reported that male study participants, 85 (70.25%), were more affected by the pandemic than female counterparts and 36 (29.8%) with an observed significant difference (
The prevalence of COVID-19 was increasing across age categories in the present study. Its prevalence among study participants in the age category of 1–35 years, 36–52 years, 53–69 years, 70–86 years, and 87–104 years was 27 (2.7%), 174 (3.3%), 60 (3.2%), 22 (3.8%), and 8 (5.0%), respectively. Similarly, elderly study participants were found to be more affected by COVID-19, and the positivity rate was found to be higher [
Of the total study participants, 33 (0.38%) had a history of travel from Djibouti, but none of them were found to be confirmed (positive) cases of COVID-19. The first confirmed case in Djibouti was reported on 18 March 2020; the total number of confirmed cases in the country as of 18 April 2020 was 732, while it was only 96 in Ethiopia [
The number of COVID-19 confirmed cases among newly diagnosed individuals, 256 (2.9%), was higher than those study participants who were under follow-up, 35 (0.4%). This might indicate a bad impression that the virus is already disseminated in the community of our testing area and might also indicate a good recovery rate of the known positive cases. A similar scenario took place in a study conducted in Djibouti where very few numbers of primary cases were able to disseminate the virus to large number of the community members [
The four catchment areas investigated in the current study were Dessie town, South Wollo Zone, Oromia Special Zone, and Wag Hemra Zone. Study participants whose permanent residence was outside these catchment areas and who provided specimen in any of the four areas were considered to have an intercity travel history. Accordingly, in relation to study participants who had permanent residency in Dessie town, the likelihood of acquiring COVID-19 infection was more than 2 times higher among study participants who had an intercity travel history (AOR = 2.03, 95% CI = 1.03–3.99,
This surveillance was conducted to check the dissemination pattern of the pandemic in the community among suspected cases, among those who had a contact history, among those working in different facilities, and among follow-up cases. In the current study, individuals who have been suspected by the physician of developing COVID-19 infection did not have a statistically significant association with the positivity rate. Due to the similarity of signs and symptoms of COVID-19 with pneumonia and other types of respiratory diseases, physicians (clinicians) could suspect individuals with other morbidities as COVID-19 infection and send their specimen for laboratory confirmation. In the present study, having a history of contact with confirmed cases of COVID-19 had 1.65 times higher odds of acquiring the infection. Quarantine of patients and close contact appear to have been associated with a reduction in COVID-19 transmission in China. On the contrary, if contact of the primary cases with noninfected individuals could not be controlled, the transmission of infection would be paramount. This fact can be supported by a study in Djibouti where the rate of primary cases was only 2%, whereas the rate of infection among study participants who had a history of contact was substantial [
The trend in the prevalence of COVID-19 infection in the northeastern region has shown a rise in tandem with the expansion of testing capacity. The prevalence of the virus was found to be significantly higher among old-aged individuals, intercity travelers, and those who had contact with confirmed/clinical suspects of COVID-19. Whereas, its prevalence is significantly low in relatively semiurban or less dense areas of the survey. Although Ethiopia has taken some steps to detect, manage, and control the transmission of COVID-19, more effort is needed to expand testing capacity and bring about behavioral changes in the community in order to halt spread of the pandemic. The country needs to put in place alternative options to mitigate interruptions of essential healthcare services and scientific research studies of significant impact.
This study employed a cross-sectional study design, which could not draw conclusions regarding causality and alternative explanations for the findings. Clinical and risk factor data were not included in the study. Moreover, the present study did not address the molecular level sequence of the viral nucleic acid from the confirmed cases nor did it include data on hematological and clinical chemistry parameters.
The data used to support the findings of this study are included within the article.
The authors declare that they have no conflicts of interest.
The authors would like to express their gratitude to the Ministry of Health, Ethiopian Public Health Institution (EPHI), and Wollo University for their financial, material, and equipment support for this research work. The authors have special thanks to Yonas Erkihun, Minilik Yitna, Zewdu Mulatie, Fetiya Ahmed, Temesgen Fiseha, Hussen Ebrahim, Demis Bekele, Aderaw Adamu, Yeabsira Asmare, Mihreteab Alebachew, Saleamlak Sebsibe, Mihret Tilahun, Habtiye Bisetegn, Habtu Debash, Osman Abdu, and Yeshimebet Kassa for their professional contribution in analyzing the oropharyngeal samples in the laboratory.