1. Assessing the capacity of symptom scores to predict COVID-19 positivity in Nigeria: a national derivation and validation cohort study
- Author
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Chioma Dan-Nwafor, Chikwe Ihekweazu, Michael C. Asuzu, Abubakar Jafiya, Arisekola Jinadu, Puja R. Myles, Shaibu Oricha Bello, Olanrewaju Falodun, Babatunde Saka, Khadeejah L Hamza, Abimbola Bowale, Oluwatosin Wuraola Akande, Carina King, Habib Garba Zaiyad, Blessing Ebhodaghe, Chinedu Chukwujekwu Arinze, Emmanuel Joseph, C C Ibeh, John Tunde Aremu, William Nwachukwu, Tochi J. Okwor, Chinwe Lucia Ochu, Bamidele Mutiu, Anastacia Ojimba, Jack E. Gibson, Adebola Olayinka, Cornelius Ohonsi, Kelly Osezele Elimian, Giulia Gaudenzi, Chidiebere Ezeokafor, John Oladejo, Elsie Ilori, Olaolu Aderinola, Ehimario U. Igumbor, Tobias Alfvén, Ismail Abdus-Salam, and Nwando
- Subjects
Adult ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,Nigeria ,Logistic regression ,Cohort Studies ,COVID-19 Testing ,medicine ,Humans ,Derivation ,Child ,Aged ,Receiver operating characteristic ,SARS-CoV-2 ,business.industry ,public health ,COVID-19 ,General Medicine ,Cohort ,Medicine ,business ,Predictive modelling ,Cohort study ,Demography - Abstract
ObjectivesThis study aimed to develop and validate a symptom prediction tool for COVID-19 test positivity in Nigeria.DesignPredictive modelling study.SettingAll Nigeria States and the Federal Capital Territory.ParticipantsA cohort of 43 221 individuals within the national COVID-19 surveillance dataset from 27 February to 27 August 2020. Complete dataset was randomly split into two equal halves: derivation and validation datasets. Using the derivation dataset (n=21 477), backward multivariable logistic regression approach was used to identify symptoms positively associated with COVID-19 positivity (by real-time PCR) in children (≤17 years), adults (18–64 years) and elderly (≥65 years) patients separately.Outcome measuresWeighted statistical and clinical scores based on beta regression coefficients and clinicians’ judgements, respectively. Using the validation dataset (n=21 744), area under the receiver operating characteristic curve (AUROC) values were used to assess the predictive capacity of individual symptoms, unweighted score and the two weighted scores.ResultsOverall, 27.6% of children (4415/15 988), 34.6% of adults (9154/26 441) and 40.0% of elderly (317/792) that had been tested were positive for COVID-19. Best individual symptom predictor of COVID-19 positivity was loss of smell in children (AUROC 0.56, 95% CI 0.55 to 0.56), either fever or cough in adults (AUROC 0.57, 95% CI 0.56 to 0.58) and difficulty in breathing in the elderly (AUROC 0.53, 95% CI 0.48 to 0.58) patients. In children, adults and the elderly patients, all scoring approaches showed similar predictive performance.ConclusionsThe predictive capacity of various symptom scores for COVID-19 positivity was poor overall. However, the findings could serve as an advocacy tool for more investments in resources for capacity strengthening of molecular testing for COVID-19 in Nigeria.
- Published
- 2021