Approaches, achievements, challenges, and lessons learned in setting up an urban-based Health and Demographic Surveillance System in South Africa

Sunday A Adedini; Dineo Thaele; Matshidiso Sello; Portia Mutevedzi; Cleopas Hywinya; Nonhlanhla Ngwenya; Nellie Myburgh; Shabir A Madhi

doi:10.1080/16549716.2021.1874138

Approaches, achievements, challenges, and lessons learned in setting up an urban-based Health and Demographic Surveillance System in South Africa

Glob Health Action. 2021 Jan 1;14(1):1874138. doi: 10.1080/16549716.2021.1874138.

Authors

Sunday A Adedini^{1

2

3}, Dineo Thaele^{1

2}, Matshidiso Sello^{1

2}, Portia Mutevedzi^{1

2}, Cleopas Hywinya^{1

2}, Nonhlanhla Ngwenya^{1

2}, Nellie Myburgh^{1

2}, Shabir A Madhi^{1

2}

Affiliations

¹ Medical Research Council: Vaccine and Infectious Disease Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa.
² Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa.
³ Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences , South Africa.

Abstract

Reliable civil registration and vital statistics (CRVSs) are essential for estimating mortality rates and population changes, and are critical for public health and socio-economic planning. CRVSs are largely incomplete in Africa, thus Health and Demographic Surveillance Systems (HDSSs) fill gaps in CRVSs, albeit existing HDSSs in South Africa are in rural areas. This limits the generalisability of such data in a country such as South Africa where over 60% live in urban areas, and where there are limitations to access health and social services. We describe the approaches, achievements, challenges and lessons learned in setting up a HDSS site in Soweto and Thembelihle (SaT-HDSS), Johannesburg; which is the first urban-based HDSS in Southern Africa. We also highlight a number of studies being implemented in the HDSS. In 2017-2020, the HDSS has enrolled 124,169 individuals and followed up 95% of this population through 3 rounds of data collection. Several challenges were encountered during the initiation of the HDSS, including difficulties in community mobilisation and entry, stakeholders' engagement and participation, inaccessibility problems and concerns about safety of fieldworkers, and difficulty in getting/recruiting technical staff with requisite experience. Nevertheless, the SaT-HDSS was successfully established through application of several strategies, including continuous community engagement and stakeholders' mobilisation; in-depth training and retraining of all study staff; technical support from well-established HDSS sites across Africa, and international academic collaborations. Despite the challenges of undertaking routine surveillance of a hard-to-reach and highly mobile population, the SaT-HDSS was successfully established with a high-retention rate. The HDSS offers an important lens on morbidity and mortality and serves as a platform for pilots of interventions and programmes aimed at improving health and well-being of an urban population.

Keywords: Public health; child health; demographic surveillance; south Africa; urban.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa, Southern
Humans
Population Surveillance*
South Africa / epidemiology
Urban Health
Vital Statistics*

Grants and funding

The study is funded by the Bill & Melinda Gates Foundation. The funders had no role in the implementation of SaT-HDSS, and collection, analysis and writing of this manuscript. Bill and Melinda Gates Foundation.