Widespread SARS-CoV-2 exposure in West Africa: findings from a 20,748-participant multi-country seroepidemiology study

Udoakang, Aniefiok John and Oduro-Mensah, Daniel and Amegatcher, Gloria and Folarin, Onikepe and Aliyu, Isah Abubakar and Owusu, Irene Amoakoh and Dzabeng, Francis and Ouedraogo, Alphonse and Ayivor-Djanie, Reuben and Gyamfi, Jones and Sanou, Moumouni Armel and Tapela, Kesego and Binyet, Manfreddy and Boateng, Kyerewaa Akuamoah and Amole, Taiwo Gboluwaga and Okolie, Johnson and Musa, Baba Maiyaki and Bala, Jamilu Abubakar and Akano, Kazeem and Olayemi, Ajibade Olufunke and Achonduh-Atijegbe, Olivia and Nnennaya, Ajayi and Ihere, Okoro Sylvanus and Benedict, Azuogu and Ukpabi, Okechukwu and Kingsley, Ojide Chiedozie and Abu, Augustine and Osoba, Moyosoore and Oyejide, Nicholas and Owusu, Evans Agyapong and Adade, Bismark and Sampah, James Ekow and Ishaq, Samed and Agyei, George and Benjamin, Boateng and Oduro-Obeng, William and Ogoe-Anderson, Janet and Amekpordi, Nicholas Aloba and Alhassan, Safiatu and Afrifa, David and Opoku, Bismark Akwasi and Ayodeji, Oladele Oluwafemi and Abejegah, Chukwuyem and Adedosu, Akinola Nelson and Ahmed, Liasu Adeagbo and Serme, Samuel S. and Ouattara, Maurice and Hien, Denise and Issa, Nebié and Boateng, Rachael O. and Opurum, Precious C. and Oyawoye, Fatima O. and Ayeke, Dzidzor Yawa and Ofori, Michael and Achille, Nikiema Sindimbasba and Sow, Bazoumana and Pare-Toe, Lea and Guissou, Charles and Minna, Bismark and Amponsah, Gifty and Dassah, Sylvester Donne and Abdullahi, Sharif Alhassan and Garba, Nura and Bala, Khadija Muhammad and Zubair, Rufai Umar and Haddad, Mahfuz Muhammad and Amenga-Etego, Lucas and Amuzu, Dominic S. Y. and Morang’a, Collins M. and Sarpong, Kwabena A. N. and Narkwa, Patrick Williams and Ampofo, William K and Asiedu-Bekoe, Franklin and Kuma-Aboagye, Patrick and Duedu, Kwabena and Abugri, James and Mutocheluh, Mohamed and Helegbe, Gideon Kofi and Aryee, Paul Armah and Duah, James and Yeboah, Peter and Bediako, Yaw and Diabate, Abdulai and Galadanci, Hadiza Shehu and Sirima, Sodiomon B. and Happi, Christian and Awandare, Gordon A. and Quashie, Peter Kojo (2026) Widespread SARS-CoV-2 exposure in West Africa: findings from a 20,748-participant multi-country seroepidemiology study. Frontiers in Public Health, 14. ISSN 2296-2565

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Abstract

Background

Africa seemed to have had low SARS-CoV-2 infection and COVID-19 morbidity and mortality. While several studies reported high SARS-CoV-2 seropositivity among healthy Africans, others hypothesized that this could have resulted from pre-existing cross-reactive antibodies. Our study tracks trends in seropositivity across three West African countries during the Delta- and Omicron-dominant pandemic periods using validated SARS-CoV-2 IgG/IgM rapid diagnostic tests (Prestige Diagnostics in Ghana and Burkina Faso; SD Biosensor in Nigeria).

Methods

Cross-sectional studies were conducted in three West African countries (Burkina Faso, Ghana, and Nigeria), with study sites conveniently selected within each country. Using validated immunoassay kits with published validation procedures, SARS-CoV-2 antibodies were detected in peripheral blood during the Delta- and Omicron-dominant periods. Because we did not perform widespread viral sequencing on participant samples, we could not attribute seropositivity to a specific variant; instead, we classified sampling periods by the variant reported as dominant nationally/globally at the time of sample collection. Participants’ demographic and clinical data were obtained using a semi-structured questionnaire, and the primary outcome was the proportion of each population with SARS-CoV-2 antibodies.

Results

Across the 3 countries, 20,748 participants were recruited, and SARS-CoV-2 IgG seropositivity ranged from 24.1 to 76.4%, with higher rates during the Omicron-dominant period. All sites showed low self-reported vaccination rates, suggesting that seropositivity may be primarily driven by natural infection rather than vaccination. While there was a significant positive association between seropositivity and age across all sites, the association with other demographic factors was country-dependent, and most participants expressed positive opinions of vaccination.

Conclusion

This is one of the largest multi-country community-based SARS-CoV-2 seroepidemiology studies in Africa, showing widespread exposure to SARS-CoV-2 infection among our study population across three West African countries. These findings are consistent with a marked disconnect between high population exposure and low reported clinical burden, underscoring the need for strengthened community surveillance.

Item Type:	Article
Identification Number:	10.3389/fpubh.2026.1945355
Dates:	Date Event 29 September 2026 Accepted 26 October 2026 Published Online
Uncontrolled Keywords:	Burkina Faso, COVID-19, Ghana, Nigeria, SARS-CoV-2, seroepidemiology, seroprevalence, West Africa
Subjects:	CAH03 - biological and sport sciences > CAH03-01 - biosciences > CAH03-01-01 - biosciences (non-specific)
Divisions:	Life and Health Sciences > Life and Sports Sciences
Depositing User:	Gemma Tonks
Date Deposited:	03 Nov 2026 14:57
Last Modified:	03 Nov 2026 14:57
URI:	https://www.open-access.bcu.ac.uk/id/eprint/17290

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