Amuasi John H, Afum-Adjei Awuah Anthony, Obirikorang Christian, Adu Evans Asamoah, Boham Eric Ebenezer Amprofi, Boakye Alexander Owusu, Alani Hakim, Newton Sylvester, Almoustapha Nana Safi, Deke James, Dzadey Welbeck Odame, Adu-Amoah Louis, Kroduah Sally-Ann, Grant Mary Ama, Asare Gracelyn, Amoako-Adusei Amos, Loag Wibke, Kettenbeil Jenny, Adu Sarkodie Yaw, Oduro Ebenezer, Yawson Alfred E, Apanga Stephen, Odotei Adjei Rose, Adobasom Anane Austin Gideon, Lorenz Eva, Souares Aurelia, Maiga Ascofare Oumou, Jurgen May, Struck Nicole S
Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
BMJ Public Health. 2025 Jun 23;3(1):e001994. doi: 10.1136/bmjph-2024-001994. eCollection 2025.
Estimates of SARS-CoV-2-specific IgG antibodies using robust designs and serological assays have been a key component in assessing and reporting the overall occurrence of COVID-19 infection burden in the general population. The objective of this study was to estimate the seroprevalence and characteristics of COVID-19 infection transmission in Ghana.
We conducted a cross-sectional survey using a two-stage stratified random sampling of community household members from February 2021 to February 2022 in Ghana, to estimate SARS-CoV-2 seroprevalence. Bayesian models with poststratification weighting of the demographic structure of the sample population were used for seroprevalence estimates, accounting for the uncertainty of diagnostic assay in a hierarchical model. Exposure-wide analysis was performed to evaluate the characteristics of the widespread SARS-CoV-2 infection.
On average, two members per household were recruited from 299 households in Accra, 348 in Kumasi and 268 in Tamale. Test-performance adjusted seroprevalence estimate was 42.8% (95% CI 37.5% to 48.5%) in Kumasi, 52.6% (95% CI 46.5% to 59.4%) in Accra and 81.7% (95% CI 74.6% to 89.0%) in Tamale. The poststratification for age, sex and household structure raised the overall seroprevalence estimates marginally to 43.9% (95% CI 38.1% to 50.1%) in Kumasi, 53.3% (95% CI 46.9% to 60.1%) in Accra and 84.7% (95% CI 76.4% to 95.6%) in Tamale. These estimates indicate that COVID-19 surveillance and reporting largely underestimates the true extent of infections and herd immunity in Ghana, with an estimated infection-to-case ratio of 19:1 in Kumasi; 85:1 in Accra and 49:1 in Tamale, as of March 2021, October 2021, February 2022, respectively. The seroprevalence estimate was not affected by the sex and age of the study participants. In an exposure-wide analysis, after adjusting for temporal biases in sample collection, age and sex, the average number of contacts per day was the only significant exposure variable associated with increased SARS-CoV-2 seropositivity, with an OR between 1.5 and 1.8.
Our data highlight a sustained national transmission of COVID-19 disease through individual contacts and suggests a situation of asymptomatic endemic circulation of the SARS-CoV-2 virus and potential herd immunity.
使用稳健设计和血清学检测方法对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）特异性IgG抗体进行评估，一直是评估和报告普通人群中新型冠状病毒肺炎（COVID-19）感染负担总体发生率的关键组成部分。本研究的目的是估计加纳COVID-19感染传播的血清阳性率及特征。
我们于2021年2月至2022年2月在加纳对社区家庭成员进行了两阶段分层随机抽样的横断面调查，以估计SARS-CoV-2血清阳性率。采用对样本人口结构进行事后分层加权的贝叶斯模型进行血清阳性率估计，在分层模型中考虑了诊断检测的不确定性。进行广泛暴露分析以评估SARS-CoV-2广泛感染的特征。
平均每户有两名成员被招募，来自阿克拉的299户家庭、库马西的348户家庭和塔马利的268户家庭。经检测性能调整后的血清阳性率估计值在库马西为42.8%（95%可信区间37.5%至48.5%），在阿克拉为52.6%（95%可信区间46.5%至59.4%），在塔马利为81.7%（95%可信区间74.6%至89.0%）。按年龄、性别和家庭结构进行事后分层后，总体血清阳性率估计值在库马西略有提高至43.9%（95%可信区间38.1%至50.1%），在阿克拉为53.3%（95%可信区间46.9%至60.1%），在塔马利为84.7%（95%可信区间76.4%至95.6%）。这些估计表明，COVID-19监测和报告在很大程度上低估了加纳感染和群体免疫的真实程度，截至2021年3月、2021年10月、2022年2月，库马西的估计感染与病例比为19:1；阿克拉为85:1，塔马利为49:1。血清阳性率估计不受研究参与者的性别和年龄影响。在广泛暴露分析中，在调整样本采集、年龄和性别的时间偏差后，每天的平均接触次数是与SARS-CoV-2血清阳性率增加相关的唯一显著暴露变量，优势比在1.5至1.8之间。
我们的数据突出了COVID-19疾病通过人际接触在全国持续传播，并表明存在SARS-CoV-2病毒无症状地方性传播及潜在群体免疫的情况。
