Surveillance System Site Research Articles

Profile: The Kenya Multi-Site Serosurveillance (KEMIS) collaboration

The Kenya Multi Site Serosurveillance (KEMIS) collaboration set out to implement an integrated, nationally representative, population-based program of serological surveillance for past infection for a number of important infectious diseases in Kenya. The project started in December 2021 and built on a portfolio of SARS-CoV-2 research conducted in 2020 and 2021. In this profile paper, we describe the background of the KEMIS collaboration, its aim and objectives, the Health and Demographic Surveillance System sites that were involved in data collection, and the key activities undertaken. We also explain how we established governance and management of the KEMIS collaboration, and reflect on opportunities, challenges, lessons learned, and future directions.

A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during COVID-19 in Kenya, 2018-2022.

The impact of the COVID-19 pandemic on pediatric mortality, including measures to ensure continuity of HIV care, is not well described in Kenya. We evaluated causes of death (COD) among decedents under 5 years of age both before and during the COVID-19 pandemic in Kenya. We analyzed Child Health and Mortality Prevention Surveillance (CHAMPS) data collected in February 2018-March 2022. We describe the proportional contribution of specific conditions in the causal chain of death among decedents aged 28 days to 59 months who underwent minimally invasive tissue (MITS) sampling, had an HIV polymerase chain reaction, and a COD determination. We also calculated all-cause and HIV cause-specific mortality rates using data from two health and demographic surveillance system(HDSS) sites in western Kenya. Results were stratified by time periods: February 2018 to February 2020, and March 2020 to March 2022. Among 269 MITS-eligible decedents, 55.8% died during the pre-COVID period. Of these, 53.7% were infants (28 days to 11 months), and 9.7% were HIV-positive. Leading causes of death for infants included malnutrition (20.5%), pneumonia (17.5%), sepsis (17.1%), and malaria (14.5%). For older children (12-59 months), the predominant causes were malaria (25.6%), malnutrition (21.1%), pneumonia (14.1%), and sepsis (13.1%). All-cause mortality rates did not differ significantly between the periods (53.9 vs. 52.8 per 1,000 live births, p=0.77), but HIV cause-specific mortality rates were significantly lower during March 2020-March 2022 compared to February 2018-February 2020 (1.2 vs. 3.1 per 1,000 live births, p=0.01). Malaria, malnutrition, pneumonia, and sepsis were the leading COD among decedents aged 28 days to 59 months enrolled in CHAMPS between February 2018 and March 2022. These findings may point to the need for urgent, focused efforts to prevent avoidable child deaths. Continued monitoring of HIV-related mortality could provide insights into the ongoing impact of the HIV program in the region.

Prevalence of Self-Reported Chronic Non-Communicable Diseases among Adults in Addis Health and Demographic Surveillance System (Addis-HDSS), Addis Ababa, Ethiopia.

Chronic non-communicable diseases (NCDs) are a global health challenge, causing millions of deaths annually and contributing significantly to the global disease burden. Despite their prevalence in low- and middle-income countries (LMICs), NCDs receive limited global health financing. Ethiopia, like other LMICs, is experiencing a rising burden of NCDs. This study aimed to assess the self-reported prevalence of chronic NCDs and identify associated sociodemographic factors. A population-based cross-sectional study was conducted at the Addis Health Demographic Surveillance System (Addis-HDSS) site in Addis Ababa, Ethiopia. All adults (≥18 years) living in the Addis-HDSS sites were included. Data were collected using a structured electronic questionnaire on self-reported NCDs and sociodemographic variables. Binomial regression model was used to identify sociodemographic factors associated with self-reported NCDs. Overall, 11.5% (95% CI: 11.3%-11.7%) of adults reported at least one NCD. The most prevalent conditions were hypertension (5.9%; 95% CI: 5.7%-6.1%) and diabetes mellitus (3.4%; 95% CI: 3.3%-3.5%). Older age (Adjusted Incidence Rate Ratio (AIRR): 5.47; 95% CI: 5.17-5.79), no formal education (AIRR: 1.58; 95% CI: 1.45-1.72), being formerly married (AIRR: 2.68; 95% CI: 2.47-2.91), and higher wealth quintiles (AOR: 1.16; 95% CI: 1.07-1.26) were statistically significant risk factors associated with NCDs. This study highlights the high burden of chronic NCDs among adults in Addis Ababa. The findings highlight the importance of addressing NCDs as a significant public health challenge. Expanding access to early prevention, diagnosis, and care is critical in urban settings.

Prevalence of anemia and its associated factors among under-five children living in Arba Minch Health and Demographic Surveillance System Sites (HDSS), Southern Ethiopia.

Childhood anemia affects around half of under five children and has impacts on physical, mental, and social development, both in the short and long term. The objective of the study was to determine the prevalence of anemia and its associated factors among under-five children living in Arba Minch Health and Demographic Surveillance System Sites (HDSS). A community-based cross-sectional study was conducted among randomly selected under-five children with their caregivers living in Arba Minch HDSS from June to August 2023. The questionnaire was developed to assess sociodemographic, nutrition, healthcare, and environmental characteristics. Hemoglobin concentration was adjusted for altitude of the village. Anemia was defined as the hemoglobin concentration below 11 g/dL. It was further categorized as mild (between 10-10.9 g/dL), moderate (7-9.9 g/dL), and severe (less than 7 g/dL). The analysis of factors associated with anemia was assessed by using logistic regression and significance was determined at p-value <0.05. A total of 332 under-five children with a mean (SD) age of 33(15) months participated. The overall prevalence of anemia among under-five children was 35.3% (95% CI: 30.4, 40.7). The magnitude of mild, moderate, and severe anemia was 12.4% (95%CI: 9.2, 16.4), 22.1% (95%CI: 17.9, 26.9), and 0.9% (95%CI: 0.3, 2.8), respectively. Anemia had a negative association with the advancing age of the children (0.95, 95%CI: 0.93, 0.97) and improvement in the family wealth score (0.86, 95%CI: 0.75, 0.99). Nearly one-third of the under-five children were anemic and childhood anemia is a moderate public health problem in the study area. The magnitude of anemia was negatively associated with the advance in child age and with the increase in the wealth status of the household. It is important to provide due attention to reduce the magnitude of anemia specifically for the youngest children and for those children from poor households.

Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data

Temporal changes in cause of death among adolescents and adults in six countries in eastern and southern Africa in 1995–2019: a multi-country surveillance study of verbal autopsy data

Regulatory problems and associated factors among infants in Arba Minch health and demographic surveillance system sites, southern Ethiopia.

Infant regulatory problems are a common source of concern for parents, and they increase the risk of impaired infant-caregiver bonding. Despite their impact, they are often overlooked in Ethiopia. Hence, this study aimed to determine the prevalence and associated factors of infant regulatory problems in Arba Minch Health and Demographic Surveillance System sites in southern Ethiopia. A community-based cross-sectional study was conducted among 451 mother-infant pairs from February 15 to March 15, 2022. Regulatory problems were assessed using diagnostic interviews for regulatory problems. The data was collected using an open data kit Android application and analyzed with Stata version 17.0. Bivariable and multivariable logistic regression analyses were computed to identify factors associated with each infant regulatory problem. Statistical significance was declared at a p-value < 0.05. In this study, four hundred forty-nine mother-infant pairs were involved, with a response rate of 99.5%. The prevalence of excessive crying, feeding problems, and sleeping difficulties was 14.03% [95% CI: 10.95, 17.59], 20.04% [95% CI: 16.44, 24.05], and 13.59% [95% CI: 10.55, 17.11], respectively. Attending primary education (AOR: 2.54, 95% CI: 1.22, 5.32), high perceived social support (AOR: 0.32, 95% CI: 0.12, 0.89), feeding problems (AOR: 5.0, 95% CI: 2.65, 9.45), and depression, anxiety, and stress (DAS) symptoms (AOR: 2.67, 95% CI: 1.19, 5.98) were associated with excessive crying. In addition, a family size of above five (AOR: 1.82, 95% CI: 1.03, 3.22), excessive crying (AOR: 3.76, 95% CI: 1.85, 7.65), sleeping problems (AOR: 2.29, 95% CI: 1.13, 4.65), comorbid DAS symptoms (AOR: 3.42, 95% CI: 1.64, 7.11), alcohol abuse (AOR: 1.89, 95% CI: 1.04, 3.42), and late initiation of complementary feeding (AOR: 2.67, 95% CI: 1.22, 5.88) were associated with feeding problems. Furthermore, attending primary education (AOR: 2.35, 95% CI: 1.16, 4.77), feeding problems (AOR: 3.47, 95% CI: 1.86, 6.48), and comorbid DAS symptoms (AOR: 3.23, 95% CI: 1.53, 6.84) were associated with sleeping problems. Approximately one-third of infants encountered at least one regulatory problem. Level of education, perceived social support, feeding problems, and DAS symptoms were associated with excessive crying. Large family sizes, excessive crying, sleeping problems, comorbid DAS symptoms, alcohol abuse and, late initiation of complementary feeding increase the likelihood of feeding problems. Moreover, attending primary education, feeding problems, and comorbid DAS symptoms increase the odds of sleeping problems. Continuous guidance and support on infant soothing techniques, cognitive and behavioral therapy, and counselling on appropriate coping strategies for postpartum women are imperative to reduce the burden of infant regulatory problems.

Profile: The Kenya Multi-Site Serosurveillance (KEMIS) collaboration

The Kenya Multi Site Serosurveillance (KEMIS) collaboration set out to implement an integrated, nationally representative, population-based program of serological surveillance for past infection for a number of important infectious diseases in Kenya. The project started in December 2021 and built on a portfolio of SARS-CoV-2 research conducted in 2020 and 2021. In this profile paper, we describe the background of the KEMIS collaboration, its aim and objectives, the Health and Demographic Surveillance System sites that were involved in data collection, and the key activities undertaken. We also explain how we established governance and management of the KEMIS collaboration, and reflect on opportunities, challenges, lessons learned, and future directions.

The epidemiology of behavioral risk factors for noncommunicable disease and hypertension: A cross-sectional study from Eastern Uganda.

In light of the suboptimal noncommunicable disease (NCD) risk factor surveillance efforts, the study's main objectives were to: (i) characterize the epidemiological profile of NCD risk factors; (ii) estimate the prevalence of hypertension; and (iii) identify factors associated with hypertension in a peri-urban and rural Ugandan population. A population-based cross-sectional survey of adults was conducted at the Iganga-Mayuge Health and Demographic Surveillance System site in eastern Uganda. After describing sociodemographic characteristics, the prevalence of NCD risk factors and hypertension was reported. Prevalence ratios for NCD risk factors were calculated using weighted Poisson regression to identify factors associated with hypertension. Among 3220 surveyed respondents (mean age: 35.3 years (standard error: 0.1), 49.4% males), 4.4% were current tobacco users, 7.7% were current drinkers, 98.5% had low fruit and vegetable consumption, 26.9% were overweight, and 9.3% were obese. There was a high prevalence of hypertension and prehypertension, at 17.1% and 48.8%, respectively. Among hypertensive people, most had uncontrolled hypertension, at 97.4%. When we examined associated factors, older age (adjusted prevalence ratio (APR): 3.1, 95% CI: 2.2-4.4, APR: 5.2, 95% CI: 3.7-7.3, APR: 8.9, 95% CI: 6.4-12.5 among 30-44, 45-59, and 60+-year-old people than 18-29-year-olds), alcohol drinking (APR: 1.6, 95% CI: 1.3-2.0, ref: no), always adding salt during eating (APR: 1.6, 95% CI: 1.1-2.2, ref: no), poor physical activity (APR: 1.3, 95% CI: 1.1-1.6, ref: no), overweight (APR: 1.3, 95% CI: 1.1-1.5, ref: normal weight), and obesity (APR: 2.0, 95% CI: 1.6-2.4, ref: normal weight) had higher prevalence of hypertension than their counterparts. The high prevalence of NCD risk factors highlights the immediate need to implement and scale-up population-level strategies to increase awareness about leading NCD risk factors in Uganda. These strategies should be accompanied by concomitant investment in building health systems capacity to manage and control NCDs.

Exploring women’s interpretations of survey questions on pregnancy and pregnancy outcomes: cognitive interviews in Iganga Mayuge, Uganda

BackgroundIn 2021, Uganda’s neonatal mortality rate was approximately 19 deaths per 1000 live births, with an estimated stillbirth rate of 15.1 per 1000 total births. Data are critical for indicating areas where deaths occur and why, hence driving improvements. Many countries rely on surveys like Demographic and Health Surveys (DHS), which face challenges with respondents’ misinterpretation of questions. However, little is documented about this in Uganda. Cognitive interviews aim to improve questionnaires and assess participants’ comprehension of items. Through cognitive interviews we explored women’s interpretations of questions on pregnancy and pregnancy outcomes.MethodsIn November 2021, we conducted cognitive interviews with 20 women in Iganga Mayuge health and demographic surveillance system site in eastern Uganda. We adapted the reproductive section of the DHS VIII women’s questionnaire, purposively selected questions and used concurrent verbal probing. Participants had secondary school education and were English speaking. Cognition was measured through comparing instructions in the DHS interviewers’ manual to participants’ responses and researcher’s knowledge. A qualitative descriptive approach to analysis was undertaken.ResultsWe report findings under the cognitive aspect of comprehension. Some questions were correctly understood, especially those with less technical terms or without multiple sections. Most participants struggled with questions asking whether the woman has her living biological children residing with her or not. Indeed, some thought it referred to how many living children they had. There were comprehension difficulties with long questions like 210 that asks about miscarriages, newborn deaths, and stillbirths together. Participants had varying meanings for miscarriages, while many misinterpreted stillbirth, not linking it to gestational age. Furthermore, even amongst educated women some survey questions were misunderstood.ConclusionsPopulation surveys may misclassify, over or under report events around pregnancy and pregnancy outcomes. Interviewers should begin with a standard definition of key terms and ensure respondents understand these. Questions can be simplified through breaking up long sentences, while interviewer training should be modified to ensure they thoroughly understand key terms. We recommend cognitive interviews while developing survey tools, beyond basic pre-testing. Improving respondents’ comprehension and thus response accuracy will increase reporting and data quality.

Trends and causes of neonatal mortality from 2010 to 2017 at a Health and Demographic Surveillance site in Northern Ethiopia

ABSTRACT Background Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality. Objectives To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017. Methods A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression. Results The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia. Conclusions The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.

Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

IntroductionThe COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in...

Membership dropout rates and associated factors in a community-based health insurance scheme in southern Ethiopia: a mixed method study

BackgroundDropout from community-based health insurance (CBHI) membership is a common problem in low-income countries, even if its implementation leads to substantial improvement in the utilization of essential health services. Few studies have addressed the factors contributing to dropout rates in southern Ethiopia. Therefore, the purpose of this study was to determine the rate of CBHI dropout in southern Ethiopia as well as any contributing factors.MethodsThis mixed-method cross-sectional study was conducted among 460 randomly selected CBHI-enrolled households at the Arba Minch Health and Demography Surveillance System site from November 1, 2021, to April 30, 2022. The quantitative data were collected by an open data kit (ODK). using an interviewer-based structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Multivariable logistic regression was applied to identify significant variables. The qualitative data were used to support the quantitative findings and were gathered through in-depth interviews (by the CBHI coordinator and three purposively selected health extension workers) and focus group discussions (in two randomly selected villages). The qualitative data were analyzed using thematic analysis. Finally, triangulation was used to present both the quantitative and qualitative findings.ResultsThis study found that 92 (21.5%) people stopped their community-based health insurance membership. The presence of sick adults [AOR = 0.281, 95% CI (0.136–0.581)], trust of participants in the contracted health facilities [AOR = 0.227, 95% CI (0.121–0.436)], and poor knowledge of the participants [AOR = 5.518, 95% CI (1.526–19.950)] were significant predictors.ConclusionThe magnitude of the dropout rate was high in this study when compared with the national target. The absence of a sick adult, the absence of trust among participants, and the poor knowledge status of the participants were significant predictors. We suggest that the health facility managers, the CBHI coordinating office, and the district health office give priority to implementing a wide range of knowledge improvement activities and a transparent system in public health facilities. Studies with longitudinal research designs are called for at a wide range of national levels to address the limitations of this study.

Evaluation of a community-based intervention package to improve knowledge of obstetric danger signs, birth preparedness, and institutional delivery care utilization in Arba Minch Zuria District, Ethiopia: a cluster-randomized trial

IntroductionMaternal healthcare utilization, particularly the institutional delivery, is disproportionately low in rural Ethiopia. This study aimed to evaluate the effectiveness of an integrated package of community-based interventions on the improved knowledge of obstetric danger signs, birth preparedness, and institutional delivery services utilization in rural areas of Gamo zone, southern Ethiopia.MethodsWe conducted cluster-randomized controlled trial (NCT05385380) from 2019 to 2021 at the Arba Minch Health and Demographic Surveillance System site. We randomly assigned the 10 kebele clusters to intervention and control arm. We used a package of interventions, which included providing information on safe motherhood via video and/or audio with a birth preparedness card for pregnant women, training for community volunteers and health extension workers, and improving maternity waiting home services. Women in the control arm received routine services only. We used generalized mixed-effects logistic regression models to evaluate the effectiveness of the intervention on the outcome variables.ResultsThe study enrolled 727 pregnant women across the 10 clusters, with a 617 (84.9%) successful follow-up rate. The proportion of institutional delivery in the intervention arm was increased by 16.1% from 36.4% (174/478) at the baseline to 52.5% (224/427) at the endline (Adjusted odds ratio [AOR] for McNemar’s Test = 1.5; 95% confidence interval [CI]: 1.1 to 2; p < 0.001). In the control arm, however, there was a 10.3% fall in the proportion of institutional delivery (from 164/249 to 105/190). Pregnant women who received the intervention were significantly more likely to give birth in a health institution than those who did not (AOR 2.8; 95% CI: 1.2, 6.4).ConclusionThe study demonstrates that an integrated community-based intervention package that included video-based storytelling and upgrading maternity waiting homes increased institutional delivery care utilization among rural women. We recommend that audio-visual storytelling, starting during pregnancy and continuing postpartum, be incorporated into routine maternal healthcare services to address access to care inequalities in rural settings.Trial registration: The study protocol was registered in the clinicaltrials.gov with registry number NCT05385380.

Unmet need for modern contraception by HIV status: findings from community—based studies implemented before and after earlier ART initiation program in rural Tanzania

BackgroundTanzania Health policy insists on the need to provide all women access to contraception despite HIV status. We used data from two HIV epidemiologic serological surveys carried out at different periods of ART provision in rural Tanzania to assess the level of unmet need for modern contraception by HIV status and associated factors.MethodsWe performed secondary data analysis of two surveys conducted at the Magu Health and Demographic Surveillance System site, in Mwanza, Tanzania. Information on unmet need for modern contraception was derived from fertility desire and contraception use. Unmet need, HIV status, and socioeconomic and demographic variables were analysed. The percentage of women with unmet needs for modern contraception by HIV status is presented for the 2012 and 2017 surveys. Bivariate and multivariate analyses using logistic regression were used to investigate associated factors showing adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs).ResultsData from 3352 and 3196 women aged 15–49 years collected in the 2012 and 2017 surveys, respectively, were analysed. The percentages of women with unmet needs for modern contraception in the 2012 and 2017 surveys were 30.9% (95% CI 29.4–32.6) and 31.6% (95% CI 30.0–33.3), respectively. The unmet need for modern contraception was 26% lower in HIV-uninfected women in 2012 (aOR = 0.74; 95% CI 0.569–0.973); p = 0.031). Risk factors for unmet need for modern contraception in 2012 were HIV uninfected (adjusted OR = 0.74; 95% CI 0.569–0.973); p = 0.031), married marital status (adjusted OR = 0.768; 95% CI 0.743–0.794); p < 0.0001), higher education (adjusted OR = 0.768; 95% CI 0.743–0.794); p < 0.0001), and taking alcohol (adjusted OR = 0.768; 95% CI 0.743–0.794); p < 0.0001). Only two factors were associated with unmet need for modern contraception in 2017: married marital status (adjusted OR = 0.46; 95% CI 0.305–0.722); p = 0.001) and women who earned for their families (aOR = 0.66; 95% CI 0.494–0.887); p = 0.006).DiscussionNearly one-third of women had an unmet need for modern contraception, which was lower in HIV-uninfected women than in WLHIV-infected women. The study has identified women whose demand for contraception has not been met: WLHIV, post marital women, women with low education and women who were reported to earn money for their families. Family planning interventions should be tailored to these groups of women.

SARS-CoV-2 seroprevalence and implications for population immunity: Evidence from two Health and Demographic Surveillance System sites in Kenya, February-December 2022.

We sought to estimate SARS-CoV-2 antibody seroprevalence within representative samples of the Kenyan population during the third year of the COVID-19 pandemic and the second year of COVID-19 vaccine use. We conducted cross-sectional serosurveys among randomly selected, age-stratified samples of Health and Demographic Surveillance System (HDSS) residents in Kilifi and Nairobi. Anti-spike (anti-S) immunoglobulin G (IgG) serostatus was measured using a validated in-house ELISA and antibody concentrations estimated with reference to the WHO International Standard for anti-SARS-CoV-2 immunoglobulin. HDSS residents were sampled in February-June 2022 (Kilifi HDSS N= 852; Nairobi Urban HDSS N= 851) and in August-December 2022 (N= 850 for both sites). Population-weighted coverage for ≥1 doses of COVID-19 vaccine were 11.1% (9.1-13.2%) among Kilifi HDSS residents by November 2022 and 34.2% (30.7-37.6%) among Nairobi Urban HDSS residents by December 2022. Population-weighted anti-S IgG seroprevalence among Kilifi HDSS residents increased from 69.1% (65.8-72.3%) by May 2022 to 77.4% (74.4-80.2%) by November 2022. Within the Nairobi Urban HDSS, seroprevalence by June 2022 was 88.5% (86.1-90.6%), comparable with seroprevalence by December 2022 (92.2%; 90.2-93.9%). For both surveys, seroprevalence was significantly lower among Kilifi HDSS residents than among Nairobi Urban HDSS residents, as were antibody concentrations (p< 0.001). More than 70% of Kilifi residents and 90% of Nairobi residents were seropositive for anti-S IgG by the end of 2022. There is a potential immunity gap in rural Kenya; implementation of interventions to improve COVID-19 vaccine uptake among sub-groups at increased risk of severe COVID-19 in rural settings is recommended.

Psychosocial effects of adverse pregnancy outcomes and their influence on reporting pregnancy loss during surveys and surveillance: narratives from Uganda.

In 2021, Uganda had an estimated 25,855 stillbirths and 32,037 newborn deaths. Many Adverse Pregnancy Outcomes (APOs) go unreported despite causing profound grief and other mental health effects. This study explored psychosocial effects of APOs and their influence on reporting these events during surveys and surveillance settings in Uganda. A qualitative cross-sectional study was conducted in September 2021 in Iganga Mayuge health and demographic surveillance system site, eastern Uganda. Narratives were held with 44 women who had experienced an APO (miscarriage, stillbirth or neonatal death) and 7 men whose spouses had undergone the same. Respondents were purposively selected and the sample size premised on the need for diverse respondents. Reflexive thematic analysis was undertaken, supported by NVivo software. 60.8% of respondents had experienced neonatal deaths, 27.4% stillbirths, 11.8% miscarriages and almost half had multiple APOs. Theme one on psychosocial effects showed that both women and men suffered disbelief, depression, shame and thoughts of self-harm. In theme two on reactions to interviews, most respondents were reminded about their loss. Indeed, some women cried and a few requested termination of the interview. However, many said they eventually felt better, especially where interviewers comforted and advised them. In theme three about why people consent to such interviews, it was due to the respondents' need for sensitization on causes of pregnancy loss and danger signs, plus the expectation that the interview would lead to improved health services. Theme four on suggestions for improving interviews highlighted respondents' requests for a comforting and encouraging approach by interviewers. Psychosocial effects of APOs may influence respondents' interest and ability to effectively engage in an interview. Findings suggest that a multi-pronged approach, including interviewer training in identifying and dealing responsively with grieving respondents, and meeting needs for health information and professional counselling could improve reporting of APOs in surveys and surveillance settings. More so, participants need to understand the purpose of the interview and have realistic expectations.

Determinants of time to first marriage and birth intervals among women of child bearing age in Dabat Health and demographic surveillance system site, Northwest Ethiopia.

Event histories such as marriage and birth have been used to study fertility behavior of women. Understanding the timing of these events provide insight to reproductive patterns of the population. Thus, the aim of this study was to assess the timing of marriage and durations of birth intervals and their associated factors, and and to examine their effects on the current fertility among women in Dabat health and demographic surveillance system site, Northwest Ethiopia. A community based cross-sectional survey was carried out in the beginning of 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. The parametric survival analysis was employed to estimate the relationships among socioeconomic and demographic variables with outcome variables, the timing of age at first marriage and duration of birth intervals. This study confirmed that median age at first marriage was the lowest estimated at 15 years which was below the national and regional average. The result of the study also revealed that married women waited almost a median duration of three years for their first, second, third and fourth child which was increased to nearly four years for three years preceding the survey. The parametric survival analysis showed woman's education, occupation, and current age were the predictors of age at first marriage. divorce experience, women empowerment and marriage cohort were the determinant factors of first birth interval; women education, child death, and ideal number of children were the predictors of second and third birth intervals; and media exposure and child death experience of women were predictors of fourth birth interval. The study indicated that median age at first marriage was the lowest though the successive birth intervals were longer. The survival analysis identified women's education, occupation, child death and ideal number of children affected the timing of age at first marriage and duration of birth intervals. Hence, encouraging women for higher education and giving opportunity to women in employments may contribute for delaying age at first marriage and increasing the duration of birth intervals which in turn slowing down the fertility of women.

Measuring Contraceptive Autonomy at Two Sites in Burkina Faso: A First Attempt to Measure a Novel Family Planning Indicator.

There is growing consensus in the family planning community around the need for novel measures of autonomy. Existing literature highlights the tension between efforts to pursue contraceptive targets and maximize uptake on the one hand, and efforts to promote quality, person-centeredness, and contraceptive autonomy on the other hand. Here, we pilot a novel measure of contraceptive autonomy, measuring it at two Health and Demographic Surveillance System sites in Burkina Faso. We conducted a population-based survey with 3,929 women of reproductive age, testing an array of new survey items within the three subdomains of informed choice, full choice, and free choice. In addition to providing tentative estimates of the prevalence of contraceptive autonomy and its subdomains in our sample of Burkinabè women, we critically examine which parts of the proposed methodology worked well, what challenges/limitations we encountered, and what next steps might be for refining, improving, and validating the indicator. We demonstrate that contraceptive autonomy can be measured at the population level but a number of complex measurement challenges remain. Rather than a final validated tool, we consider this a step on a long road toward a more person-centered measurement agenda for the global family planning community.

Community Dynamics and Engagement Strategies in Establishing Demographic Development and Environmental Surveillance Systems: A Multi-Site Report from India.

Six diverse Demographic Development and Environmental Surveillance System (DDESS) sites were established in urban slum, urban resettlement, peri-urban, rural, and tribal areas located in Northern, North-East, Eastern, and Southern regions of India from June 2020 to March 2022. Understanding the community dynamics and engaging people in the community is critically important in the process of establishing DDESS. We ascertained the barriers, challenges, and facilitators during the establishment of multiple DDESS sites across India. This was a cross-sectional descriptive mixed-methods study. Multiple barriers and challenges encountered were reported in the process of community engagement (CE), such as geographical inaccessibility, language barriers, adverse weather, non-responsiveness due to perceived lack of individual benefit or financial gain, fear of contracting COVID-19, COVID-19 vaccine hesitancy, etc. Facilitators in the CE process were pre-existing links with the community, constitution of community advisory boards, community need assessment, concomitant delivery of outreach health services, and skill-building facilities. Most community barriers in the development of DDESS sites in resource-limited settings can be overcome through a multipronged approach, including effective community engagement by focusing on demonstrating trust at the local level, enlisting community mobilization and support, utilizing pre-existing community linkages, initiating community diagnosis, and meeting perceived community health needs.