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Profile: Health and Demographic Surveillance System in Peri-Urban Gates Open Research Gates Open Research 2018, 2:2 Last updated: 14 JUL 2021 RESEARCH ARTICLE Profile: Health and Demographic Surveillance System in peri- urban areas of Karachi, Pakistan [version 1; peer review: 1 approved with reservations, 2 not approved] Muhammad Ilyas 1, Komal Naeem1, Urooj Fatima1, Muhammad Imran Nisar 1, Abdul Momin Kazi1, Fyezah Jehan 1, Yasir Shafiq1, Usma Mehmood1, Rashid Ali1, Murtaza Ali1, Imran Ahmed1, Anita K.M. Zaidi1,2 1Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan 2Enteric and Diarrheal Diseases Programme, Bill & Melinda Gates Foundation, Seattle, WA, 98109, USA v1 First published: 04 Jan 2018, 2:2 Open Peer Review https://doi.org/10.12688/gatesopenres.12788.1 Latest published: 04 Jan 2018, 2:2 https://doi.org/10.12688/gatesopenres.12788.1 Reviewer Status Invited Reviewers Abstract The Aga Khan University’s Health and Demographic Surveillance 1 2 3 System (HDSS) in peri urban areas of Karachi was set up in the year 2003 in four low socioeconomic communities and covers an area of version 1 17.6 square kilometres. Its main purpose has been to provide a 04 Jan 2018 report report report platform for research projects with the focus on maternal and child health improvement, as well as educational opportunities for trainees. 1. Daniel D. Reidpath , Monash University The total population currently under surveillance is 249,128, for which a record of births, deaths, pregnancies and migration events is Malaysia, Selangor, Malaysia maintained by two monthly household visits. Verbal autopsies for Hyi-Yenn Thoo, Monash University Malaysia, stillbirths, deaths of children under the age of five years and adult Selangor, Malaysia female deaths are conducted. For over a decade, the HDSS has been a platform for a variety of 2. Peter Byass , Umeå University, Umeå, studies including, calculation of the incidence of various infectious diseases like typhoid bacteremia, pneumonia and diarrhea, evaluation Sweden of effectiveness of various treatment regimens for neonatal sepsis, 3. James F. Phillips , Columbia University, assessment of the acceptance of hospitalized care, determination of the etiology of moderate to severe diarrhea, assessment of burden New York, USA and etiology of neonatal sepsis and a multi-centre cohort study Any reports and responses or comments on the measuring the burden of stillbirths, neonatal and maternal deaths. We have also established a bio-repository of a well-defined maternal article can be found at the end of the article. and newborn cohort. Through a well-established HDSS rooted in maternal and child health we aim to provide concrete evidence base to guide policy makers to make informed decisions at local, national and international levels. Keywords Karachi, Heath and Demographic Surveillance System, HDSS, maternal and child health, longitudinal studies. Page 1 of 14 Gates Open Research Gates Open Research 2018, 2:2 Last updated: 14 JUL 2021 Corresponding author: Muhammad Imran Nisar ([email protected]) Author roles: Ilyas M: Conceptualization, Data Curation, Formal Analysis, Methodology, Project Administration, Software, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Naeem K: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing; Fatima U: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing; Nisar MI: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Kazi AM: Conceptualization, Investigation, Methodology, Project Administration, Writing – Review & Editing; Jehan F: Funding Acquisition, Investigation, Supervision, Writing – Review & Editing; Shafiq Y: Investigation, Project Administration, Writing – Review & Editing; Mehmood U: Data Curation, Project Administration, Writing – Review & Editing; Ali R: Data Curation, Project Administration, Software, Visualization; Ali M: Data Curation, Project Administration, Software, Visualization, Writing – Review & Editing; Ahmed I: Project Administration, Resources, Software, Visualization, Writing – Review & Editing; Zaidi AKM: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Review & Editing Competing interests: No competing interests were disclosed. Grant information: Bill & Melinda Gates Foundation [OPPGH5307, OPP1033572]. Dr Imran Nisar and Dr Fyezah Jehan were supported by grant number 1 D43 TW007585-01 from the National Institute of Health’s Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2018 Ilyas M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite this article: Ilyas M, Naeem K, Fatima U et al. Profile: Health and Demographic Surveillance System in peri-urban areas of Karachi, Pakistan [version 1; peer review: 1 approved with reservations, 2 not approved] Gates Open Research 2018, 2:2 https://doi.org/10.12688/gatesopenres.12788.1 First published: 04 Jan 2018, 2:2 https://doi.org/10.12688/gatesopenres.12788.1 Page 2 of 14 Gates Open Research 2018, 2:2 Last updated: 14 JUL 2021 Introduction 14.9 million including peri-urban areas (http://www.pbscensus. Pakistan has a national database for registering vital events, such gov.pk). Located by the Arabian Sea, HDSS was established in as births and deaths, but coverage is sub-optimal with many four peri-urban low income communities in Korangi and Bin births and deaths going unrecorded. Undercounting of these Qasim towns. Of the four peri-urban communities, three are events leads to inaccurate estimates of vital health indicators. This contiguously located along the sea coast of Karachi; Ibrahim inaccuracy hinders setting up of priorities and allocation of Hydri, Ali Akbar Shah Goth and Rehri Goth (Figure 1). The scarce resources at a national level. The Health and Demographic main occupation of people living in these communities is fishing. Surveillance System (HDSS) was established in 2003 by the The fourth community, Bhains colony, is located at the outskirts Department of Paediatrics and Child Health of the Aga Khan of Karachi and the source of their livelihood is cattle rearing. In University, Karachi, Pakistan, in peri urban areas of Karachi, recent years Bhains colony has shown rapid urbanization. with the mandate to ameliorate some of these gaps. The HDSS provided a research platform for both observational and interven- In 2010, the area was digitally mapped using global position- tional studies that could influence decision-making and planning ing system (GPS) techniques and boundaries were constructed. for health strategies at local, national and international levels, as KHDSS lies on the latitude 24.8508° N and longitude 67.0181° and well as research training opportunities for students. covers an area of 17.6 square kilometres. At the outset, various epidemiological studies were conducted Surveillance structure in the area on infectious diseases of children, vaccine coverage The Surveillance sites have been divided into 195 blocks each and the impact of multiple interventions. This article provides containing about 200–250 structures. There are a total of 42,093 detailed information about set up of this surveillance system, data structures where 43,098 households are living. A ‘structure’ is collection methods, studies that were completed, and on-going defined as a building with a single entrance and a boundary. and future plans. These structures can be houses, hospitals, dispensaries, schools, shops, parks etc. Each structure has a unique number assigned to HDSS structure it. A ‘household’ is a group of people living together under a roof What area does it cover? (structure) and sharing the same cooking pot. A ‘resident’ is defined Karachi is the largest metropolitan city, a commercial hub and as a person who stayed for at least six months or intends to stay for a principal port of Pakistan, with an estimated population of more than six months in the community. Figure 1. Map showing location of the Demographic Surveillance System sites in Pakistan, Karachi and Bin Qasim town. Page 3 of 14 Gates Open Research 2018, 2:2 Last updated: 14 JUL 2021 Until 2014, quarterly enumeration was done. After 2014, this a central server at the Paedatrics Research Office, located about was intensified to every two months, to be done by trained com- 25 kilometres from the field sites. A backup is also created. munity health care workers (CHWs). CHWs are women with a secondary level of education and are mostly residents of the same Outputs of the HDSS communities where surveillance is taking place. At each two Since the completion of baseline census in 2010, we have been monthly re-enumeration, CHWs move through the area using recording demographic information about vital events, migra- GIS-derived maps and collect the information from households. tion patterns and various other socioeconomic factors. The
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