The challenges of COVID-19 testing in Africa: the Ethiopian experience

Mulu, Andargachew; Bekele, Amsalu; Abdissa, Alemseged; Balcha, Taye Tolera; Habtamu, Meseret; Mihret, Adane; Alemayehu, Dawit Hailu; Beyene, Getachew Tesfaye; Bayih, Abebe Genetu

doi:10.11604/pamj.2021.38.6.26902

Cited by 40 publications

(45 citation statements)

References 2 publications

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“…Data on testing rates are scarce or not updated regularly in some countries in Africa and other regions. This may explain why the number of cases reported in some African countries remains low at this time and clearly influences what is known about the true incidence of COVID-19 in Africa [ 27 , 28 ]. To have a true picture of the disease incidence in Africa, increased testing rates across the continent is of paramount importance.…”

Section: Discussionmentioning

confidence: 99%

Current State of COVID-19 Pandemic in Africa: Lessons for Today and the Future

Obande

Bagudo

Mohamad

et al. 2021

IJERPH

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This study is a cross-sectional, observational analysis of the COVID-19 pandemic in Africa, to understand the progression of the disease across the continent. Published data on COVID-19 from 20 January 2020 to 21 June 2021 were obtained and analyzed. Case fatality ratios, as well as case growth rates and other indices were computed. On 21 June 2021, a total of 178,210,532 confirmed cases and 3,865,978 deaths had been recorded worldwide. While the Americas recorded the highest number of cases, Southern Africa recorded the majority of African cases. Fatality rate since from 20 February 2020 to 21 June 2021 was highest in the Americas (2.63%) and low in the South Eastern Asia region (1.39%), globally increasing from 2.17% at the end of January to 6.36% in May 2020 and decreasing to a range between 2.14% to 2.30% since January 2021. In Africa, the infection rate per 100,000 persons was up to 3090.18, while deaths per 100,000 and case fatality ratio were as high as 119.64 and 5.72%, respectively, among the 20 most-affected countries. The testing rate per million population was highest in Botswana (512,547.08). Fatality appears to be increasing in some regions of Africa. The rate of infection and fatality in Africa could still likely take an upward turn. Strict control measures are required, considering the continent’s weak healthcare systems.

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Section: Discussionmentioning

confidence: 99%

Current State of COVID-19 Pandemic in Africa: Lessons for Today and the Future

Obande

Bagudo

Mohamad

et al. 2021

IJERPH

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“…Similarly, the envisioned "real-time" monitoring based on randomized laboratory tests is still far from being possible and could still lead to incorrect political decisions heavily influencing the future of a country. One year on, in fact, although this risk has lowered, globally, it still is critical for some LMICs, where several challenges hinder COVID-19 testing [58].…”

Section: Discussionmentioning

confidence: 99%

The role of ethics in science: a systematic literature review from the first wave of COVID-19

et al. 2021

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This paper proposes a systematic literature review on ethics and CoviD-19, aiming to understand the impact and the perception of the pandemic during the first wave (January-June 2020) and the consequences one year later. PubMed was systematically searched up May 2020 to identify studies that took into consideration various ethical issues that have been arising from the Covid-19 outbreak. The eligibility of the papers was determined by two authors, who screened the results mediated by a third author. In order to facilitate the screening, the titles were divided into five sub-thematic macro-areas, namely allocation, policy, specialist, clinical trials, and technology and, when possible, per geographical area. Specifically, a posteriori, we decided to focus on the papers referring to policies and technology, as they highlighted ethical issues that are not overused and worthy of particular attention. Thus, 38 studies out of 233 met our inclusion criteria and were fully analysed. Accordingly, this review touches on themes such as fairness, equity, transparency of information, the duty of care, racial disparities, the marginalisation of the poor, and privacy and ethical concerns. Overall, it was found that despite the increased awareness of interdisciplinarity and the essential reference to ethics, many scientific articles use it with little competence, considering it only a "humanitarian" enrichment. In fact, as we understand, reflecting a year after the outbreak of the pandemic, although Covid-19 is leading scientists to increasingly recognise the importance of ethical issues, there is still a lot of confusion that could be helped by establishing international guidelines to act as a moral compass in times of crisis.

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“…In many LMICs, there are significant gaps to support RT-PCR testing, resulting in limited access to testing. Although a typical RT-PCR assay takes an average of 4-6 hours, in most countries, the time to get results is much longer due to logistics, inefficient reporting systems and lack of digital data management 8,9 . Furthermore, access is much more limited in hard-to-reach communities, making controlling the pandemic a problematic task.…”

Section: Introductionmentioning

confidence: 99%

Field performance of NowCheck rapid antigen test for SARS-CoV-2 in Kisumu County, western Kenya

Onsongo

Otieno

Duijn

et al. 2021

Preprint

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Background Low- and middle-income countries (LMICs) are increasingly adopting low-cost Coronavirus disease 2019 (COVID-19) rapid antigen tests to meet the high demand for SARS-CoV-2 testing. Whilst testing using real-time polymerase chain reaction (RT-PCR) is the current gold standard, its widespread use in LMICs is limited by high costs, turnaround times and is not readily available in most places. COVID-19 antigen tests (Ag-RDT) provide a suitable alternative due to their low cost, rapid turnaround time and easy to set up and use. This study aimed to assess the field performance of the NowCheck COVID-19 antigen kit (Ag-RDT) as a point of care test (POCT) in select healthcare facilities in western Kenya. Methods We conducted a prospective multi-facility field evaluation study of the NowCheck COVID-19 rapid antigen test (Ag-RDT) compared to SARS-CoV-2 RT-PCR (RT-PCR). After obtaining informed consent, trained laboratory technicians collected two pairs of oropharyngeal and nasopharyngeal swabs, both antigen and RT-PCR testing, first for Ag-RDT and next for RT-PCR. We performed Ag-RDTs on-site and shared the results with both the study participants and their healthcare providers within 15-30 minutes. We carried out all RT-PCR tests in a central referral laboratory. The turnaround time for RT-PCR results was typically 24-48 hours. We captured the results of both methods using an electronic digital application. Findings Between December 2020 and March 2021, we enrolled 997 participants who met the Kenyan Ministry of Health COVID-19 case definition. The median age of study participants was 39 years (range one to 80 years), with 54% male. Ag-RDT had a sensitivity of 84.5% (76.0-90.8) and a specificity of 94.4% (95% CI: 92.7-95.8) with an accuracy of 94.2% (92.5- 95.6) when a cycle threshold value (Ct value) of ≤35 was used. The highest sensitivity of 87.7% (77.2-94.5) was observed in samples with Ct values ≤ 30 and the highest specificity of 97.5% (96.2-98.5) at Ct value of <40. Interpretation The NowCheck COVID-19 Ag-RDT showed good performance in field evaluation in multiple healthcare facilities in a developing country. The sensitivity of the kit exceeded the minimum recommended cut-off of 80% as recommended by WHO1. The high specificity of this kit at 94.4% at Ct values ≤33 and 97.5% at Ct values <40 matched that of real-time PCR, making it a good rule-out test for symptomatic patients with COVID-19- like symptoms. The faster turnaround time to results, lower cost, simple analytical steps requiring no equipment or infrastructure makes antigen testing an attractive field-screening method to meet the high demand for COVID-19 testing.

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The challenges of COVID-19 testing in Africa: the Ethiopian experience

Cited by 40 publications

References 2 publications

Current State of COVID-19 Pandemic in Africa: Lessons for Today and the Future

Current State of COVID-19 Pandemic in Africa: Lessons for Today and the Future

The role of ethics in science: a systematic literature review from the first wave of COVID-19

Field performance of NowCheck rapid antigen test for SARS-CoV-2 in Kisumu County, western Kenya

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