# Geographical coverage of SARS-CoV-2 screening and care centers in Haiti: what do national surveillance data tell us?

## TL;DR

The study finds that Haiti's poorest areas had fewer COVID-19 testing and care centers, leading to likely underestimation of the true impact of the pandemic.

## Contribution

The study provides new insights into how geographic and socioeconomic disparities in healthcare access may have led to underreported COVID-19 cases and deaths in Haiti.

## Key findings

- Only 40.7% of communes had a screening center, and incidence was six times higher in these areas.
- Mortality was five times higher in communes with care centers, and wealthier communes had more resources.
- Male gender, older age, and Haitian nationality were individual factors associated with infection.

## Abstract

In Haiti, reported incidence and mortality rates for COVID-19 were lower than expected. We aimed to analyze factors at communal and individual level that might lead to an underestimation of the true burden of the COVID-19 epidemic in Haiti during its first two years.

We analyzed national COVID-19 surveillance data from March 2020 to December 2021, to describe the epidemic using cluster detection, time series, and cartographic approach. We performed multivariate Quasi-Poisson regression models to determine socioeconomic factors associated with incidence and mortality. We performed a mixed-effect logistic regression model to determine individual factors associated with the infection.

Among the 140 communes of Haiti, 57 (40.7%) had a COVID-19 screening center, and the incidence was six times higher in these than in those without. Only 22 (15.7%) communes had a COVID-19 care center, and the mortality was five times higher in these than in those without. All the richest communes had a COVID-19 screening center while only 30.8% of the poorest had one. And 75% of the richest communes had a COVID-19 care center while only 15.4% of the poorest had one. Having more than three healthcare workers per 1000 population in the commune was positively associated with the incidence (SIR: 3.31; IC95%: 2.50, 3.93) and the mortality (SMR: 2.73; IC95%: 2.03, 3.66). At the individual level, male gender (adjusted OR: 1.11; IC95%: 1.01, 1.22), age with a progressive increase of the risk compared to youngers, and having Haitian nationality only (adjusted OR:2.07; IC95%: 1.53, 2.82) were associated with the infection.

This study highlights the weakness of SARS-CoV-2 screening and care system in Haiti, particularly in the poorest communes, suggesting that the number of COVID-19 cases and deaths were probably greatly underestimated.

The online version contains supplementary material available at 10.1186/s12889-024-19262-7.