Epidemiology, clinical characteristics, and risk factors of SARS-CoV-2 in Côte d'Ivoire: a cross-sectional study

the COVID-19 pandemic has posed significant epidemiological challenges globally, with marked regional variations in transmission, severity, and outcomes. In Côte d'Ivoire, disparities in healthcare infrastructure, testing capacity, and demographics have influenced SARS-CoV-2 infection dynamics. This study aims to describe the epidemiological and clinical characteristics of SARS-CoV-2 infection, as well as to identify the risk factors associated with the severity of the infection.

a study was conducted using nasopharyngeal samples collected between January and December 2020, as part of Côte d'Ivoire's national COVID-19 response. The study included individuals from all socio-professional groups across urban and rural areas. Sampling was performed in various settings, including hospitals, testing centres, and community-based screenings. The testing was voluntary, systematic, and based on several factors, including both symptomatic and asymptomatic individuals, contacts of confirmed cases, suspected individuals, hospitalised patients, and participation in public health campaigns. All individuals who underwent testing were included without any specific selection process. The study population was generally representative of the national population, although a higher proportion of urban individuals were included due to limited testing in rural areas. SARS-CoV-2 was detected by real-time RT-PCR. Statistical analyses included chi-squared tests, logistic regression, and Multiple Correspondence Analysis (MCA) to identify factors associated with positivity, hospitalisation, and mortality.

the study included 240,599 individuals, with a mean age of 38 years (SD = 13.97). Of the total, 93,391 (39%) were women and 147,208 (61%) were men. The SARS-CoV-2 prevalence was 9.31% (95% CI: [0.89 - 0.97]), with higher prevalence in women (10.07%) compared to men (8.83%) (X² = 102.47, df = 1, P < .001). Positivity rate varied by age, ranging from 5.76% in children (0-5 years) to 11.13% in the elderly (60+ years) (X² = 233.41, df = 5, P < .001). In multivariable analysis of hospitalisation, each additional year of age increased the probability of hospitalisation by 2.3% (aOR = 1.023, 95% CI: [1.014 - 1.032], P < .001). Patients with cough were 4.15 times more likely to be hospitalised (aOR = 4.15, 95% CI: [3.18 - 5.39], P < .001). Gastrointestinal symptoms (diarrhoea or vomiting) increased the likelihood of hospitalisation by 367 times (aOR = 367, 95% CI: [68.01 - 1686.00], P < .001). For mortality, each additional year of age increased mortality risk by 16% (aOR = 1.16, 95% CI: [1.15 - 1.16], P < .001). Patients with cough had 64.67 times higher risk of death (aOR = 64.67, 95% CI: [62.92 - 66.47], P < .001).

this study identifies key factors influencing hospitalisation and mortality in SARS-CoV-2-positive patients. Age, cough, and gastrointestinal symptoms (diarrhoea or vomiting) were strongly associated with an increased likelihood of hospitalisation, while age and cough were significant predictors of mortality. These findings highlight the importance of early identification and monitoring of patients with these characteristics, particularly in settings with limited healthcare infrastructure.