NAVRONGO HDSS,

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UpperUpper EastEast RegionRegion

NavrongoNavrongo DSSDSS areaarea Kassena-NankanaKassena-Nankana DistrictDistrict GG HH AA NN A A

GhanaGhana

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Location of Navrongo HDSS (Monitored Population 149,000)

Brief Introduction to Navrongo HDSS The Navrongo HDSS (NHDSS) site is located in the Kassena-Nankana District of the of Ghana. The district covers an area of 1675 km 2 along the Ghana- border. It measures roughly 55 km x 50 km and has an altitude of 200-400 m above sea level. The land is fairly flat, and passing through it from Burkina Faso is the White Volta River, which feeds Lake Volta (the world's largest artificial lake) in southern Ghana. Located in the Guinea savannah belt, the district is typically Sahelian (hot and dry).

Set up in 1993, the NHDSS was established to support research on the determinants of morbidity, mortality and fertility in Ghana’s northern regions. One of the most important recent changes that the NHDSS has introduced in its data collection system, is to reconfigure the system from the compound as the unit of analysis to the household level as happens in many other DSS sites and also to conform to demographic and health surveys worldwide. To this end, during the last quarter of 2004, the NHDSS started introducing these changes, which became operational in early 2006.

Objectives To date, the NHDSS has fulfilled its role of serving as a resource for the conduct of research at the Navrongo Health Research Centre by

• Accurately documenting demographic dynamics in the Kassena-Nankana district • Serving as a framework for population-based health research that addresses local health priorities • Providing the needed platform for research that informs population and health policy both in Ghana and worldwide

Priority Research Areas • Malaria prevention and control • Reproductive Health • Cerebro-spinal meningitis epidemiology and vaccine studies • Rotavirus epidemiology and vaccine studies • Policy Monitoring and Impact Assessment • Poverty and Equity Studies

Completed Key Projects

Project Name Funder Grant Period The Ghana Vitamin A Supplementation Trial (VAST) British ODA, Ghana 03/1988 – Ministry of Health 12/1991 Impact of Permethrin impregnated Bednets UNDP/World 07/1993 - 06/1995 Bank/WHO-TDR, IDRC (Canada), UNICEF (Ghana), UK Medical Council A randomized, double-blind, placebo-controlled evaluation US Navy 1998 of weekly etaquine for chemo-suppression of Plasmodium falciparum in semi-immune adults living in the Kassena- Nankana district of northern Ghana Epidemiology of Bancroftian filariasis in the Kassena- Danish Bilharzia 08/1992-09/1992 Nankana District of Northern Ghana Laboratories Bancroftian Filariasis in the Kassena-Nankana District British Overseas April 1992 Development Administration (ODA) Filariasis in northern Ghana: Some cultural beliefs and UNDP/WORLD practices and their implications for disease control BANK/WHO-TDR Variation of Malarial Antigens and Malaria Attack Rates in US Navy 04/1996-07/1997 Northern Ghana Assessment of Home Management of malaria in a rural WHO/AFRO 1998 community in Ghana Impact of Community-Based Health and Family Planning African Sustainable 1997 Services on Maternal Mortality: The Navrongo Baseline Development Career Study Award Program, Rockefeller Foundation The Dynamics of Severe Anaemia and Malaria Parasitemia US Navy 08/2001-12/2001 in Young Children during the High (Malaria) Transmission Season in Northern Ghana Migration, Sexual Health, and STD/AIDS: A Three-Country GTZ/RAP, 1995-1998 Study: Burkina Faso, Ghana, and Togo UNAIDS,CCISD/Universite Laval, ActionAid-Ghana Prevalence of P. falciparum Parasitemia in Kassena- US Government 05/2001-11/2001 Nankana district of Northern Ghana Double-blind randomized clinical trial of artesunate rectal UNDP/World 2000-2003 capsules on child survival in the Kassena-Nankana, District Bank/WHO-TDR/ of Ghana Evaluation of the safety and effectiveness of EPI-linked Department of 2000-2003 malaria intermittent chemotherapy and iron International supplementation Development (DFID-UK) Community Health and Family Planning project USAID 1993-2005 Female Genital Mutilation study USAID 1999-2005 Meningitis vaccine trial GSK 06/2004-10-2005

Identify Traditional Communication Strategies for Reaching Bill and Melinda Gates 2006-2007 Rural Adolescents with Reproductive Health Information: A Institute for qualitative Study Reproductive Health, Johns Hopkins University Maternal Health Study The World Bank 2005-2006 Integrating Home-Based Care for PLWA into the Ghana AIDS Commission 2005-2006 Community-Based Health Planning and Services (CHPS) of the Ghana Health Service Efficacy of sulphadoxine-pyrimethamine and amodiaquine Gates Malaria 2004-2006 alone or in combination as intermittent preventive Partnership treatment in pregnancy in the Kassena-Nankana district of Ghana: a randomized study. A Phase II/III Randomized Double-Blind Comparative Trial Pfizer 2005-2006 of Azithromycin plus Chloroquine versus Mefloquine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Adults in Africa Study on Ageing and Adult Health in the Kassena-Nankana INDEPTH Network 2007 District

Ongoing Key Projects

Project Name Funder Grant Period The Navrongo Demographic Surveillance System No current funding 1994-Date Adolescent Sexual and Reproductive Health project Rockefeller Foundation 2002- date Home Management of Malaria in Urban Northern Ghana: WHO 2006- date A Case Study of Municipal Area. Using community-based volunteers to reach non- The Schistosomiasis 2006 - date enrolled school-age children through community- Research Program at the directed treatment of schistosomiasis in school-age DBL-Institute for Health children in rural northern Ghana Research and Development Home management of acute febrile illnesses in northern WHO 2007 to date Ghana using artesunate-amodiaquine combination: The role of rapid malaria diagnostic testing Malaria Mortality and Morbidity in the First Five Years of NIAID/NIH, USA 2006-2011 Life in a Birth Cohort of Children in Northern Ghana. Genotype Studies of Se vere Malaria and Malaria University of Oxford 2006 to date Candidate Ge ne D iversity in t he Kassena-Nankana District of Northe rn Ghana Efficacy, Safety, and Immunogenicity of RotaTeq among MERCK and PATH 2007 to 2009 infants in Asia and Africa Acceptability of Intermit tent preventive Treatment in University of Barcelona 2007-2009 Infants (IP Ti) for th e contro l of malaria and anaemia i n Ghana A phase 2/3 open label randomized comparative trial of Pfizer 2008 to 2009 Azi thromycin plus Chloroquine versus mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in Children in Africa A phase 11, double-blinded, randomized, controlled, Serum Institute of India 2008 to 2011 dose ranging study to evaluate the safety, (SIIL) and PATH immunogenicity, dose response and schedule response of a Meningococcal A Conjugate Vaccine administered concomitantly with local EPI vaccine in healthy infants.

Human Resource at the site

CATEGORY NUMBER Data Managers 7 Computing/Statistics 2 Clinical Research Officers 8 Demographers 2 Research Fellows 5 Research Officers 20 Epidemiologists 2 Assistant Research Officers 18 Clinical Laboratory 5 Accounting / Admin 9 Data collectors 172 Other support staff 47

Funders Ghana Ministry of Health, National Institutes of Health (NIH), Rockefeller Foundation, Bill and Melinda Gates Foundation, MERCK, PATH, Serum Institute of India(SIIL), UNDP/World Bank, WHO-TDR, UNICEF (Ghana), Danish Bilharzia Laboratories, DFID, British ODA, US Navy, Pfizer, VW Foundation.

Collaborators London School of Hygiene and Tropical Medicine (LSHTM), Kwame Nkrumah University of Science and Technology, (KNUST), Noguchi Memorial Institute for Medical Research, INDEPTH Network, U.S. Naval Medical Research Unit #3, Naval Medical Research Institute, US Army Medical Material Development Activity (USAMMDA), Swiss Tropical Institute, MVP, iGATE, AARSH.

KEY PUBLICATIONS (2007/2008)

1. Hodgson A, Forgor AA, Chandramohan D, Reed Z, Binka F, et al. (2008) A phase II, randomized study on an investigational DTPw-HBV/Hib-MenAC conjugate vaccine administered to infants in Northern Ghana. PLoS ONE. 2008 May 14; 3(5):e2159.

2. Awo D. Osafo-Addo, Kwadwo A. Koram, Abraham R. Oduro, Michael Wilson, Abraham Hodgson, AND William O. Rogers. HLA-DRB1*04 Allele Is Associated with Severe Malaria in Northern Ghana. Am. J. Trop. Med. Hyg., 78(2), 2008, pp. 251-255.

3. AR Oduro, RA Aborigo, D Amugsi, F Anto, T et al. Understanding and Retention of informed consent process among Parents in a Rural Northern Ghana. BMC Medical Ethics, 2008.

4. Bazzano AN, Kirkwood BR, Tawiah-Agyemang C, Owusu-Agyei S, Adongo PB. Beyond symptom recognition: care-seeking for ill newborns in rural Ghana. Trop Med Int Health. 2008 Jan;13(1):123-8

5. P. B. Adongo; C. Kendall; B. Kirkwood. 2008. Malaria Research Trends: (Devin A. Flanigan edited) Chapter VI - Malaria Control and the Domestic Context: The Influence of Human Behavior on the Effectiveness of Insecticide Treated Nets Use (ITNS) in Northern Ghana; Nova Science Publishers, New York. pp. 179-196.

6. A. Bazzano; B. Kirkwood; Charlotte Tawiah-Agyemang; S. Owusu-Agyei; P. B. Adongo; (2008) Social cost of skilled attendance at birth in rural Ghana. International Journal of Gynecology and Obstetrics doi: 10.1016/j.ijgo.

7. Cairns M, Carneiro I, Milligan P, Owusu-Agyei S, Awine T, Gosling R, Greenwood B, Chandramohan D. Duration of protection against malaria and anaemia provided by intermittent preventive treatment in infants in Navrongo, Ghana. PLoS ONE. 2008 May 21; 3(5):e2227.

8. Tindana PO, Singh JA, Tracy CS, Upshur REG, Daar AS, et al. (2007) Grand Challenges in Global Health: Community Engagement in Research in Developing Countries. PLoS Med 4(9): e273 doi:10.1371/journal.pmed.0040273.

9. Brian Wells Pence, Philomena Nyarko, James F Phillips, Cornelius Debpuur. The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project. Scand J Public Health. 2007 Jun 22:1-10 17852975. 10. Le imkugel J, Hodgson A, Forgor AA, Pf luge r V. Dangy JP, S mith T, Achtman M, Gagneux S. Pluschke G. Clonal wavea of Neisser ia colonization a nd disease in the African Meningitis belt : eight-year longitu dinal study in northern Ghana. PloS Med . 2007 Mar 27; 4(3) :el0l . PMID: 17388665.

Minimum Datasets

Mortality Person Years Deaths Basic vital statistics Both Both Age sexes Male Female sexes Male Female Rates <1 3698 1856 1842 199 105 94 Crude birth rate 26.2 1-4 14610 7423 7187 147 76 71 Total fertility rate 4 5-9 18952 9640 9312 36 18 18 Crude death rate 10.4 10-14 18828 9839 8989 30 19 11 Neonatal mortality rate 19.9 Post neonatal mortality 15-19 17235 9076 8159 24 11 13 rate 31.6 20-24 12608 6390 6218 30 13 17 Infant mortality 51.5 25-29 8893 4331 4562 28 14 14 Child mortality rate(1-4) 10.1 30-34 7181 3233 3948 45 31 14 Underfive mortality 89.5 Crude rate of natural 35-39 6869 2776 4093 50 31 19 increase 15.8 40-44 7002 2839 4163 49 32 17 In-migration rate 75 45-49 7394 2890 4504 71 41 30 Outmigration rate 89.4 50-54 5541 2159 3382 82 49 33 Net migration -14.4 55-59 5293 2082 3211 111 62 49 Growth rate 1.4 60-64 4810 1746 3064 114 60 54 65-69 3844 1575 2269 170 94 76 70-74 2115 932 1183 127 72 55 75-79 1607 731 876 117 56 61 80-84 572 307 265 45 19 26 85+ 494 274 210 63 34 29

Cause of death by broad age groups (2005) Age group 65- Cause <1 1-4 5-14 15-44 45-64 84 85+ Total Malaria 38 67 7 3 14 12 3 Infectious diseases 94 86 19 75 106 127 23 530 Non-communicable 30 4 6 72 133 133 35 413 Maternal causes 0 0 0 5 0 0 0 5 Injuries 5 8 11 33 15 12 2 86 Unknown 109 66 41 103 170 197 28 714 Total 238 164 77 288 424 469 88 1748

Fertility Age Women Births (both) Male Female ASFR 15-19 8159 422 218 204 51.72 20-24 6218 984 505 479 158.25 25-29 4562 862 423 439 188.95 30-34 3948 676 352 324 171.23 35-39 4093 515 251 264 125.82 40-44 4163 289 151 138 69.42 45-49 4504 134 78 56 29.75

SITE CONTACT DETAILS Site leader: Dr Abraham Hodgson Tel: (+233)-742 -22310 /22380 Fax: (+233)-742-22320 Email:[email protected] Website: http://www.navrongo.org