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Wednesday, 26th of September 2012 Print

Full text is at http://ije.oxfordjournals.org/content/41/3/579.full?etoc

The International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) Network is an umbrella organization for a group of independent health research centres operating health and demographic surveillance system (HDSS) sites in low- and middle-income countries (LMICs). Founded in 1998, it brought together a number of existing HDSS sites, and since then has encouraged newer HDSS sites to join.1

The purpose of this Editorial is to set the scene for a series of profiles from INDEPTH HDSS member sites, the first examples of which are published in this edition of IJE.2–5 All these profiles will follow a set pattern, to facilitate a systematic understanding of the multiplicity of HDSS sites involved in the Network and the various ways in which they are operated by their parent institutions. This Editorial therefore, follows the same general pattern as the individual profiles, but seeks to explore the epidemiological basis on which the HDSSs operate in general, and the role of the Network, rather than dealing with site-specific issues.

At the central level, the INDEPTH Network operates from its base in Accra, Ghana, as an international NGO and is also registered as a not-for-profit entity in the USA. The emphasis on the Network’s position as a Southern-led and -based organization was an important founding tenet, and this is very welcome in a world where vestiges of colonialism still occasionally surface in relation to health data and policy. Day-to-day operations are led by the Executive Director (O.S.), and governance and oversight are provided by an international Board of Trustees and a Scientific Advisory Committee (chaired by P.B.).

Why was the INDEPTH Network set up and what does it cover now?

The raison d’être behind the emergence of the Network was the apparently intractable lack of reliable population-based data on health across many LMICs in Africa, Asia and Oceania. Recognizing that there are no quick fixes in terms of achieving universal individual registration of populations in LMICs,6 the Network represents a medium-term attempt to break the link between material and data poverty.7 Epidemiology in many LMICs suffers from a dual lack of reliable population data and human capacity to make use of them. The immediate consequence is that health policy making often lacks its essential evidence base, with the possible effect of failing to use scarce resources effectively in some of the world’s poorest countries.

There are considerable global disparities in terms of epidemiological research output per population. Figure 1 shows the countries of the world shaded by a crude measure of this, namely the number of PubMed hits for a search on (‘epidemiology’ and ) per 1000 population. Much of Africa and Asia falls under the level of 0.05 per 1000, corresponding to rates which represent less than one-twentieth of some of the world’s leading countries in terms of epidemiological output. Superimposed on the map in Figure 1 are the current 43 HDSS sites run by 36 member centres of the INDEPTH Network. Although the locations of these sites are somewhat serendipitous, rather than being strategically planned, it is evident that there is considerable coverage across the areas of the world that lack substantial epidemiological output. Thus, it is clear that the INDEPTH Network, through these 43 sites in 20 countries, collectively following a population of 3.2 million people, does indeed offer possibilities for filling some of the global gaps in epidemiology.

       Expand+International Journal of Epidemiologyije.oxfordjournals.org

First published online: April 28, 2012


Int. J. Epidemiol. (2012) 41 (3): 650-657. doi: 10.1093/ije/dys062


  1. 1.   J Anthony G Scott1,2,3,*, Evasius Bauni1,3, Jennifer C Moisi1,2, John Ojal1, Hellen Gatakaa1,

Christopher Nyundo1, Catherine S Molyneux1,2, Francis Kombe1, Benjamin Tsofa1,

Kevin Marsh1,2, Norbert Peshu1 and Thomas N Williams1,2,3


+ Author Affiliations

  1. 1.    1Kenya Medical Research Institute, Wellcome Trust Research Programme, Kilifi, Kenya, 2Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK and 3INDEPTH Network, Accra, Ghana
  2. *Corresponding author. KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi 80108, Kenya. E-mail: ascott@ikilifi.org

       Accepted March 21, 2012.

Abstract below; full text, http://ije.oxfordjournals.org/content/41/3/650.long


Summary The Kilifi Health and Demographic Surveillance System (KHDSS), located on the Indian Ocean coast of Kenya, was established in 2000 as a record of births, pregnancies, migration events and deaths and is maintained by 4-monthly household visits. The study area was selected to capture the majority of patients admitted to Kilifi District Hospital. The KHDSS has 260 000 residents and the hospital admits 4400 paediatric patients and 3400 adult patients per year. At the hospital, morbidity events are linked in real time by a computer search of the population register. Linked surveillance was extended to KHDSS vaccine clinics in 2008.

KHDSS data have been used to define the incidence of hospital presentation with childhood infectious diseases (e.g. rotavirus diarrhoea, pneumococcal disease), to test the association between genetic risk factors (e.g. thalassaemia and sickle cell disease) and infectious diseases, to define the community prevalence of chronic diseases (e.g. epilepsy), to evaluate access to health care and to calculate the operational effectiveness of major public health interventions (e.g. conjugate Haemophilus influenzae type b vaccine). Rapport with residents is maintained through an active programme of community engagement. A system of collaborative engagement exists for sharing data on survival, morbidity, socio-economic status and vaccine coverage.



Amelia C Crampin1,2,3,4,*, Albert Dube1, Sebastian Mboma1, Alison Price1,2,

Menard Chihana1,2, Andreas Jahn1,2,5, Angela Baschieri2,6, Anna Molesworth1,7,

Elnaeus Mwaiyeghele1, Keith Branson2, Sian Floyd2, Nuala McGrath1,8,

Paul E M Fine1, Neil French1,2,9, Judith R Glynn2,4 and Basia Zaba2,3,4

+ Author Affiliations

1Karonga Prevention Study, Chilumba, Malawi, 2London School of Hygiene and Tropical Medicine, London, UK, 3INDEPTH network, Accra, Ghana, 4ALPHA network, London, UK, 5Central Monitoring and Evaluation Division / Department for HIV and AIDS, Ministry of Health, Lilongwe, Malawi, 6School of Social Science, University of Southampton, UK, 7National CJD Research and Surveillance Project, Edinburgh University, UK, 8Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Africa and 9Institute of Infection and Global Health, Liverpool University, UK

*Corresponding author. Karonga Prevention Study, PO Box 46, Chilumba, Malawi. E-mail: mia.crampin@lshtm.ac.uk

Accepted May 9, 2012.

Int. J. Epidemiol. (2012) : dys088 doi: 10.1093/ije/dys088

Abstract below; full text is at


The Karonga Health and Demographic Surveillance System (Karonga HDSS) in northern Malawi currently has a population of more than 35 000 individuals under continuous demographic surveillance since completion of a baseline census (2002–2004). The surveillance system collects data on vital events and migration for individuals and for households. It also provides data on cause-specific mortality obtained by verbal autopsy for all age groups, and estimates rates of disease for specific presentations via linkage to clinical facility data. The Karonga HDSS provides a structure for surveys of socio-economic status, HIV sero-prevalence and incidence, sexual behaviour, fertility intentions and a sampling frame for other studies, as well as evaluating the impact of interventions, such as antiretroviral therapy and vaccination programmes. Uniquely, it relies on a network of village informants to report vital events and household moves, and furthermore is linked to an archive of biological samples and data from population surveys and other studies dating back three decades.