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Meta-Analysis
. 2022 May;7(5):e008477.
doi: 10.1136/bmjgh-2022-008477.

Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications

Andrew T Levin  1   2 , Nana Owusu-Boaitey  3 , Sierra Pugh  4 , Bailey K Fosdick  5 , Anthony B Zwi  6 , Anup Malani  7 , Satej Soman  8 , Lonni Besançon  9 , Ilya Kashnitsky  10 , Sachin Ganesh  11 , Aloysius McLaughlin  11 , Gayeong Song  11 , Rine Uhm  11 , Daniel Herrera-Esposito  12 , Gustavo de Los Campos  13 , Ana Carolina Pecanha Peçanha Antonio  14 , Enyew Birru Tadese  15 , Gideon Meyerowitz-Katz  16   17
Affiliations
Meta-Analysis

Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications

Andrew T Levin et al. BMJ Glob Health. 2022 May.

Abstract

Introduction: The infection fatality rate (IFR) of COVID-19 has been carefully measured and analysed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries.

Methods: We systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using representative samples collected by February 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analysed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible.

Results: In most locations in developing countries, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups.Age-specific IFRs were roughly 2 times higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure.

Conclusion: The burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to ensure medical equity to populations in developing countries through provision of vaccine doses and effective medications.

Keywords: COVID-19; Epidemiology; Public Health; Serology; Systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Map of study locations. IFR, infection fatality rate.
Figure 2
Figure 2
Estimates of seroprevalence.
Figure 3
Figure 3
Age‐specific seroprevalence by location.
Figure 4
Figure 4
Ratio of seroprevalence for older adults (60+ years) compared with adults (40–59 years).
Figure 5
Figure 5
metaregression results. IFR, infection fatality rate.
Figure 6
Figure 6
IFR in developing countries compared to high‐income countries. IFR, infection fatality rate.
Figure 7
Figure 7
Population IFR for ages 18–65 years. IFR, infection fatality rate.
Figure 8
Figure 8
Population IFR and well‐certified death registrations. IFR, infection fatality rate.
Figure 9
Figure 9
Excess mortality adjusted population IFRs. IFR, infection fatality rate.
See this image and copyright information in PMC

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