Post-pandemic SARS-CoV-2 Antigen Detection and Clinical Patterns among Patients in a Tertiary Hospital in North Central Nigeria
Abstract:
Background: The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has posed a major public health challenge globally. Early diagnosis of infectious diseases such as COVID-19 is essential in limiting the spread and associated complications. Also, understanding the local disease dynamics, including its risk factors and clinical patterns, is critical for guiding preventive and control measures.
Objective: This study aimed to detect SARS-CoV-2 antigen in nasopharyngeal swabs from patients and to determine the associated risk factors and clinical patterns of infection among patients attending the Federal Medical Centre (FMC), Keffi, Nasarawa State, Nigeria.
Methods: A cross-sectional study was conducted between March and July 2023, recruiting 400 patients who presented with symptoms suggestive of COVID-19. Nasopharyngeal swab samples were collected and analyzed for SARS-CoV-2 antigen using the STANDARD Q COVID-19 Ag Test (SD BIOSENSOR, Inc, Korea) rapid test kit following the manufacturer’s instructions. Socio-demographic and clinical data, including age, sex, and symptoms, were collected using a questionnaire after consent was obtained. Results were analyzed using SPSS Version 25.0 (IBM Corp., USA). Descriptive statistics, Chi-square test and Fisher’s exact test were used to summarise and determine the association between categorical variables with a significance level of P < 0.05.
Results: Out of the 400 patients tested, 4 (1.0%) (95% CL: 0.3% - 1.97%) were positive. There was no statistically significant difference with gender (P > 0.05). However, a borderline significant association with infection status (P = 0.05) was observed for age, with higher prevalence in older age groups, suggesting vulnerability. Cough (P < 0.05), loss of smell (P < 0.05), and nasal congestion (P < 0.05) were significant. No significant association was observed for fever, loss of taste, or shortness of breath, occupation and hand hygiene (P > 0.05). Additionally, SARS-CoV-2 antigen positivity was significantly associated with lack of vaccination and the use of a facemask (P < 0.05).
Conclusion: The outcome of this study suggests a reduction in the number of COVID-19 infection cases among patients in the study area. Age was identified as a significant risk factor. Though the RDT method used and sample size may limit categorical conclusions, the RDT facilitates rapid detection, which is cost-effective and timely. It serves as an alternative for mass testing and public health surveillance.
KeyWords:
COVID-19, SARS-CoV-2 rapid test antigen detection, risk factors, post-pandemic, North Central
References:
- Africa CDC. (2024). Continental COVID-19 Update – 2024 Report. https://africacdc.org
- Akwa, V. L., Binbol, N. L., Samaila, K. L., & Marcus, N. D. (2007). Geographical perspective of Nassarawa State (p. 3). Onaiv Printing Publishing Company, Keffi.
- Aloui-Zarrouk, Z., Youssfi, L. E., Badu, K., Fagbamigbe, A. F., Matoke-Muhia, D., Ngugi, C., Dukhi, N., & Mwaura, G. (2020). The wearing of face masks in African countries under the COVID-19 crisis: luxury or necessity? AAS Open Research, 3, 36. https://doi.org/10.12688/aasopenres.13079.1
- Arikpo, D. I., Onyema, O. A., Oku, A. O., Meremikwu, C., Hamilton-Hurwitz, H., Toledo, J. P., Dunn, K., Baller, A., Smith, H. J., & Meremikwu, M. M. (2025). Factors influencing mask use and physical distancing for COVID-19: A qualitative evidence synthesis. Journal of public health in Africa, 16(2), 614. https://doi.org/10.4102/jphia.v16i2.614
- Augustine, O. (n.d.) Base map of Keffi town. https://www.slideshare.net/slideshow/base-map-of-keffi-town/165158049).
- Awopolagha, J. K., Awanye, A. M., Frank-Peterside, N., Cookey, T. I., Ibezim, C. N. E., Innocent-Adiele, H. C., Adim, C. C., Okerentugba, P. O., Onu, E. N., Okonko, B. J., & Okonko, I. O. (2024). Evaluation and validation of four rapid diagnostic test (RDTs) kits available for SARS-CoV-2 detection in Rivers State, Nigeria (Version 1). HAL Open Science. https://hal.science/hal-04575288v1
- Beale, S., Hoskins, S., Byrne, T., Fong, W. L. E., Fragaszy, E., Geismar, C., Kovar, J., Navaratnam, A. M. D., Nguyen, V., Patel, P., Yavlinsky, A., Johnson, A. M., Van Tongeren, M., Aldridge, R. W., Hayward, A., & Virus Watch Collaborative (2023). Differential Risk of SARS-CoV-2 Infection by Occupation: Evidence from the Virus Watch prospective cohort study in England and Wales. Journal of occupational medicine and toxicology (London, England), 18(1), 5. https://doi.org/10.1186/s12995-023-00371-9
- Bostanghadiri, N., Ziaeefar, P., Mofrad, M. G., Yousefzadeh, P., Hashemi, A., & Darban-Sarokhalil, D. (2023). COVID-19: An Overview of SARS-CoV-2 Variants-The Current Vaccines and Drug Development. BioMed research international, 2023, 1879554. https://doi.org/10.1155/2023/1879554
- Centers for Disease Control. (2021). Scientific Brief: SARS-CoV-2 Transmission. Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html
- Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine, 35(2), 121–126. https://doi.org/10.4103/0253-7176.116232.
- Chauhan S. (2020). Comprehensive review of coronavirus disease 2019 (COVID-19). Biomedical Journal, 43(4), 334–340. https://doi.org/10.1016/j.bj.2020.05.023
- Chen, T. P., Yao, M., Midya, V., Kolod, B., Khan, R. F., Oduwole, A., Camins, B., Leitman, I. M., Nabeel, I., Oliver, K., & Valvi, D. (2023). Symptoms predicting SARS-COV-2 test results in resident physicians and fellows in New York City. COVID, 3(5), 671–681. https://doi.org/10.3390/covid3050049
- Chukwuocha, U. M., Ogboeze, J. C., Bosede, A. O., Dozie, U. W., Ekeleme, U. G., Akam, V. N., & Chukwu, R. O. (2022). Use of facemask during the COVID-19 pandemic in Southeastern Nigeria: an observational study. Journal of Public Health and Development, 20(2). https://doi.org/10.55131/jphd/2022/200209
- Demboux Lyelet, J. E., Mayengue, P. I., Koukouikila-Koussounda, F., Doniama Essialaba, A. J., Vembe Mahounga, C. M. S., Mandiangou, A. F., Fila-Fila, G. P. U., Lenguiya, L. H., Bobouaka Bonguili, N. C., Elguero, E., Leroy, E. M., Becquart, P., & Niama, F. R. (2025). Prevalence of post-pandemic SARS-CoV-2 in patients with respiratory syndrome in Brazzaville, Republic of the Congo. BMC infectious diseases, 25(1), 217. https://doi.org/10.1186/s12879-025-10541-1
- Diamreyan, O. O., Justice, K. A., Seleipiri, H., Jemina, & Oluwatoyin, O. F. (2024). Regional disparities in COVID-19 case fatality rates: A comparative analysis of Nigerian Geopolitical Regions in 2020 and 2023. GSC Advanced Research and Reviews, 18(3), 281–290. https://doi.org/10.30574/gscarr.2024.18.3.0495
- Dinnes J. (2021). COVID-19 rapid antigen testing strategies require careful evaluation. EBioMedicine, 70, 103491.https://doi.org/10.1016/j.ebiom.2021.103491
- Elimian, K. O., Aderinola, O., Gibson, J., Myles, P., Ochu, C. L., King, C., Okwor, T., Gaudenzi, G., Olayinka, A., Zaiyad, H. G., Ohonsi, C., Ebhodaghe, B., Dan-Nwafor, C., Nwachukwu, W., Abdus-Salam, I. A., Akande, O. W., Falodun, O., Arinze, C., Ezeokafor, C., . . . Ihekweazu, C. (2021). Assessing the capacity of symptom scores to predict COVID-19 positivity in Nigeria: a national derivation and validation cohort study. BMJ Open, 11(9), e049699. https://doi.org/10.1136/bmjopen-2021-049699
- Enabulele, O., & Mobolaji, A. (2022). COVID-19 pandemic: an assessment of risk perception and the implementation of precautionary measures in a group of primary care workers in Nigeria. Journal of preventive medicine and hygiene, 62(4), E822–E829. https://doi.org/10.15167/2421-4248/jpmh2021.62.4.2145
- Filgueiras, P. S., Corsini, C. A., Almeida, N. B., Assis, J. V., Pedrosa, M. L. C., De Miranda, D. A., Gomes, S. V., Silva, R. A., Medeiros, M. I. V., Lourenço, A. J., Bicalho, C. M., Vilela, R. V., Fernandes, G. R., & Grenfell, R. F. (2022). COVID-19 rapid antigen test at hospital admission associated to the knowledge of individual risk factors allow overcoming the difficulty of managing suspected patients in hospitals. Fortune Journal of Health Sciences, 05(02). https://doi.org/10.26502/fjhs.055
- Fisher, K. A., Barile, J. P., Guerin, R. J., Vanden Esschert, K. L., Jeffers, A., Tian, L. H., Garcia-Williams, A., Gurbaxani, B., Thompson, W. W., & Prue, C. E. (2020). Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020. MMWR. Morbidity and Mortality Weekly Report, 69(28), 933–937. https://doi.org/10.15585/mmwr.mm6928e3
- Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., ... & Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
- Karia, R., Gupta, I., Khandait, H., Yadav, A., & Yadav, A. (2020). COVID-19 and its Modes of Transmission. SN comprehensive clinical medicine, 2(10), 1798–1801. https://doi.org/10.1007/s42399-020-00498-4
- Kiani, P., Hendriksen, P. A., Kim, A. J., Garssen, J., & Verster, J. C. (2024). Comparative Analysis of the Clinical Presentation of Individuals Who Test Positive or Negative for SARS-CoV-2: Results from a Test Street Study. Viruses, 16(7), 1031. https://doi.org/10.3390/v16071031
- Kolude, O., Emmanuel, E. E., Aibinuomo, A. O., Ipinnimo, T. M., Ilesanmi, M. O., & Adu, J. A. (2022). Assessment of the quality of COVID-19 antigen rapid diagnostic testing in the testing sites of Ekiti State, Nigeria: A quality improvement cross-sectional study. Cureus, 14(4), e24173. https://doi.org/10.7759/cureus.24173
- Laguna-Goya, R., Utrero-Rico, A., Talayero, P., Lasa-Lazaro, M., Ramirez-Fernandez, A., Naranjo, L., Segura-Tudela, A., Cabrera-Marante, O., Rodriguez de Frias, E., Garcia-Garcia, R., Fernández-Ruiz, M., Aguado, J. M., Martinez-Lopez, J., Lopez, E. A., Catalan, M., Serrano, A., & Paz-Artal, E. (2020). IL-6-based mortality risk model for hospitalized patients with COVID-19. The Journal of allergy and clinical immunology, 146(4), 799–807.e9. https://doi.org/10.1016/j.jaci.2020.07.009
- Meltzer, L., Amit, S., Gilboa, M., Tal, I., Mechnik, B., Irony, A., Engelrad, H., Epstein, A., Frenkel-Nir, Y., Levy, Y., Kreiss, Y., & Regev-Yochay, G. (2023). The use of rapid COVID-19 antigen test in the emergency Department as a Decision-Support tool. Microorganisms, 11(2), 284. https://doi.org/10.3390/microorganisms11020284
- Morawska, L., Tang, J. W., Bahnfleth, W., Bluyssen, P. M., Boerstra, A., Buonanno, G., Cao, J., Dancer, S., Floto, A., Franchimon, F., Haworth, C., Hogeling, J., Isaxon, C., Jimenez, J. L., Kurnitski, J., Li, Y., Loomans, M., Marks, G., Marr, L. C., . . . Yao, M. (2020). How can airborne transmission of COVID-19 indoors be minimised? Environment International, 142, 105832. https://doi.org/10.1016/j.envint.2020.105832
- Nigeria Centre for Disease Control (NCDC). (2022). COVID-19 Nigeria Situation Reports. https://ncdc.gov.ng
- Obi, I. R., Obi, K. M., Seer-Uke, E. N., Onuorah, S. I., & Okafor, N. P. (2021). Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria. The Pan African medical journal, 39, 83. https://doi.org/10.11604/pamj.2021.39.83.26997
- Ogunsola, F. T., Ejekam, C. S., Balogun, M., Ugonna, I., Odukoya, O., Oduyebo, O., Adeyemo, W. L., Oladele, R. O., & Akanmu, S. A. (2023). Universal use of face mask for the prevention of the spread of COVID-19 in community settings in a South-western State of Nigeria: willingness and barriers. Antimicrobial Resistance and Infection Control, 12(1), 64. https://doi.org/10.1186/s13756-023-01267-3
- Oluwale, Y. (2025). Commissioning the Multi-Specialty Complex at the Federal Medical Centre Keffi, Nasarawa State. Federal Ministry of Health and Social Welfare. https://health.gov.ng/commissioning-the-multi-specialty-complex-at-the-federal-medical-centre-keffi-nasarawa-state/
- Omonkhua, A. A., Faneye, A., Akinwande, K. S., Evaezi, O., Shehu, N. Y., Onayade, A., Ochu, C. L., Popoola, M., Emmanuel, N., Ojo, T., Ohonsi, C., Abubakar, A., Odeh, E., Akinduti, P., Folarin, O., Bimba, J. S., Igumbor, E., Elimian, K., Edem, V. F., . . . Group, C. R. V. I. N. S. (2024). Performance evaluation of SARS-CoV-2 rapid diagnostic tests in Nigeria: A cross-sectional study. PLOS Global Public Health, 4(7), e0003371. https://doi.org/10.1371/journal.pgph.0003371
- Orji, B., Oliveras, E., Odio, B., Anoke, C., Onuoha, H., Ugwa, E., Howard, M., Idris, I., Akpan, E., Okoh, F., Nwani, C., Adetiloye, O., Lawrence, N., Oduenyi, C., Ogharu, E., Enne, J., Abolaji, F. W., Adegbulu, R. S., & Bryce, E. (2023). Knowledge, attitudes and practices of infection prevention and control among healthcare workers during the COVID 19 pandemic: a descriptive cross-sectional study in three Nigerian states. BMC health services research, 23(1), 253. https://doi.org/10.1186/s12913-023-09218-9
- Perra N. (2021). Non-pharmaceutical interventions during the COVID-19 pandemic: A review. Physics reports, 913, 1–52. https://doi.org/10.1016/j.physrep.2021.02.001
- Rahman, H. S., Aziz, M. S., Hussein, R. H., Othman, H. H., Omer, S. H. S., Khalid, E. S., Abdulrahman, N. A., Amin, K., & Abdullah, R. (2020). The transmission modes and sources of COVID-19: A systematic review. International Journal of Surgery Open, 26, 125–136. https://doi.org/10.1016/j.ijso.2020.08.017
- Sarkar, M., & Madabhavi, I. (2024). COVID-19 mutations: An overview. World journal of methodology, 14(3), 89761. https://doi.org/10.5662/wjm.v14.i3.89761
- Sarker, R., Roknuzzaman, A. S. M., Nazmunnahar, Shahriar, M., Hossain, M. J., & Islam, M. R. (2023). The WHO has declared the end of pandemic phase of COVID‐19: Way to come back in the normal life. Health Science Reports, 6(9), e1544. https://doi.org/10.1002/hsr2.1544
- Turcato, G., Zaboli, A., Pfeifer, N., Sibilio, S., Tezza, G., Bonora, A., Ciccariello, L., & Ausserhofer, D. (2021). Rapid antigen test to identify COVID-19 infected patients with and without symptoms admitted to the Emergency Department. The American Journal of Emergency Medicine, 51, 92–97. https://doi.org/10.1016/j.ajem.2021.10.022
- Uchenna, T., Ismaila, I., Emmanuel, A., Emmanuel, O., Emmanuel, O., Mercy, O., & Usman, M. (2024). COVID-19 in suspected cases at Federal Medical Centre Keffi. International Journal of Research and Scientific Innovation, XI(VII), 1–9. https://doi.org/10.51244/ijrsi.2024.1107001
- Utulu, R., Ajayi, I. O., Bello, S., Balogun, M. S., Madubueze, U. C., Adeyemi, I. T., Omoju, O. T., Adeke, A. S., Adenekan, A. O., & Iyare, O. (2022). Risk factors for COVID-19 infection and disease severity in Nigeria: a case-control study. The Pan African medical journal, 41, 317. https://doi.org/10.11604/pamj.2022.41.317.34307
- World Health Organisation. (2021). Tracking SARS-CoV-2 Variants. World Health Organization. Retrieved from: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants
- World Health Organization. (2025). Coronavirus disease (COVID-19). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19)
- World Health Organization: WHO. (2020). Coronavirus. https://www.who.int/health-topics/coronavirus
- World Health Orginisation. (2025). COVID-19 Dashboard. https://covid19.who.int
- Yazdi-Feyzabadi, V., Sabermahani, M., Borhaninejad, V., & Iranmanesh, M. (2025). Breaking barriers: challenges faced by the older adults in accessing primary healthcare in a developing country. BMC geriatrics, 25(1), 946. https://doi.org/10.1186/s12877-025-06712-z
- Zabidi, N. Z., Liew, H. L., Farouk, I. A., Puniyamurti, A., Yip, A. J. W., Wijesinghe, V. N., Low, Z. Y., Tang, J. W., Chow, V. T. K., & Lal, S. K. (2023). Evolution of SARS-CoV-2 Variants: Implications on Immune Escape, Vaccination, Therapeutic and Diagnostic Strategies. Viruses, 15(4), 944. https://doi.org/10.3390/v15040944
- Zhang, J., Wang, X., Jia, X., Li, J., Hu, K., Chen, G., Wei, J., Gong, Z., Zhou, C., Yu, H., Yu, M., Lei, H., Cheng, F., Zhang, B., Xu, Y., Wang, G., & Dong, W. (2020). Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clinical Microbiology and Infection, 26(6), 767–772. https://doi.org/10.1016/j.cmi.2020.04.012