Objectives

In 2020, COVID-19 modeling studies predicted rapid epidemic growth and quickly overwhelmed health systems in humanitarian and fragile settings due to preexisting vulnerabilities and limited resources. Despite the growing evidence from Bangladesh, no study has examined the epidemiology of COVID-19 in out-of-camp settings in Cox’s Bazar during the first year of the pandemic (March 2020-March 2021). This paper aims to fill this gap.

Methods

Secondary data analyses were conducted on case and testing data from the World Health Organization and the national health information system via the District Health Information Software 2.

Results

COVID-19 in Cox’s Bazar was characterized by a large peak in June 2020, followed by a smaller wave in August/September and a new wave from March 2021. Males were more likely to be tested than females (68% vs. 32%, P < 0.001) and had higher incidence rates (305.29/100 000 males vs. 114.90/100 000 female, P < 0.001). Mortality was significantly associated with age (OR: 87.3; 95% CI: 21.03-350.16, P < 0.001) but not sex. Disparities existed in testing and incidence rates among upazilas.