INDEPTH NETWORK

11 Mensah Wood Street, East Legon P. O. Box KD 213, Kanda

Accra, Ghana info@indepth-network.org www.indepth-network.org

Tel.: +233 21 519394 Fax: +233 21 519395

_____________________________________________________________

QUESTIONNAIRE _____________________________________________________________

Application for Full Membership The purpose of this questionnaire is to enable the INDEPTH Board of Trustees and the Executive Director to have sufficient information on the applicant health and demographic surveillance system (HDSS) site as they review the application for full membership into the Network. Please return the fully completed questionnaire to the INDEPTH Secretariat. The questionnaire is in two parts: PART A is the “MAIN QUESTIONNAIRE” and PART B is an additional module: PART B - HUMAN RESOURCE APPRAISAL AT INDEPTH SITES. To consider your application for full membership, it suffices to submit a fully completed PART A. However, the Secretariat would encourage all applicants to complete and submit PART B either together with PART A or at a later date.

PART A – MAIN QUESTIONNAIRE DEFINING INFORMATION REGARDING INDEPTH

INSTITUTIONS

Please note: Responses to these questions should be with specific reference to the health and demographic surveillance system (HDSS) operated at your site, and not to the wider portfolio of research that may be based thereon.

1. Identifying details a) Name of site/project/programme: Kisumu West Health and Demographic Surveillance System (KWHDSS)

Kombewa Clinical Research Center

Walter Reed Project/KEMRI

b) Geographic location: (be as specific as possible i.e. include country, province/region, district/sub-district as appropriate) The Kisumu West HDSS is located in Kenya, Kisumu West District of Nyanza

Province in the western parts of the country. It is situated about 40 km West of

Kisumu city, the administrative capital of Kisumu County. The site covers an

area of about 369km2 bordering the North Eastern shores of Lake Victoria. The

District lies between longitudes 34024’00”E – 34041’30”E and latitude 0011’30” N-

0011’30”S at an average altitude of 1400 m above sea level. The District is divided

into 2 sub-districts (Divisions), each with four (4) further Sub-divisions

(Locations).

The site has a monitored population of 123,477 (KWHDSS Census, 2012).

Females comprise of 54% and Males 46% of the entire HDSS population. The

population is rural and lacks access to many basic healthcare services. Malaria,

HIV, and TB are endemic in this region (western Kenya) with the prevalence of

each being higher than in other parts of the country. Other preventable diseases

(pneumonia, diarrheal disease, schistosomiasis, etc ) are also highly prevalent,

infrastructure is poor and healthcare delivery services are limited. Economic

activities in the area include small scale farming and fishing restricted to

populations bordering the Lake.

KWHDSS GEOGRAPHIC LOCATION

KISUMU WEST HDSS STUDY AREA c) Base institution(s): (e.g. university, Ministry of Health (MOH), research council, etc or multiple of these)

• Kenya Medical Research Institute (KEMRI)

• US Army Medical Research Unit-Kenya (USAMRU-K)

• Kenya Ministry of Health (KMOH)

d) Primary purpose(s) of the HDSS

The overall goal for the program is to provide a unified and exhaustive health

and demographic data set to support USAMRU-K’s work in clinical trials and

disease surveillance.

i) To conduct longitudinal health and demographic surveillance for the

catchment population

ii) To conduct local disease surveillance

iii) To assist in the design of community-based epidemiological studies

iv) To provide a platform for monitoring intervention outcomes in the

community

e) Priority Research Areas

• Malaria Vaccine Clinical Trials

• Malaria Drug Trials

• Tuberculosis Vaccine Trials

• Infectious disease epidemiology and transmission patterns (tuberculosis, diarrheal disease, HIV/AIDS, sexually transmitted infections)

• Human Influenza surveillance

• Maternal and infant health

f) Full contact details (Mailing and email addresses, Tel. and Fax)

The Kisumu West HDSS Walter Reed Project/KEMRI P.O Box 54, 40100 Kisumu, Kenya Telephone: +254-57-20 22942 Fax: +254-57-20 22903 Email: peter.sifuna@usamru-k.org

2. Key descriptive features: surveillance a) Size of population under continuous surveillance: 123,477 b) Year when surveillance was introduced:

2007-Initiation of the project

2008-2010-Cartographic Mapping and Census Piloting

2011- Baseline Census

2012-Round 1 of updates

c) Has there been any interruption? If yes, when was surveillance continued?

No

d) Indicate key variables under continuous surveillance: Y/N Frequency of update (monthly, Quarterly, annually)

•••• Births Y Monthly

•••• Deaths Y Monthly

•••• Migration Y Bi-annually

•••• Other variable(s) under continuous surveillance (please list, including frequency of update)

� Immunization status for children <2 years old (Bi-annually)

� Surveillance of use of bed nets, other interventions (Bi-annually)

� Socio-Economic and educational status surveys (every 2 years)

� Pregnancy and Outcomes (Bi-annually)

e) Do you collect information on cause of death? If Yes, how? Yes. During routine household surveys, deaths that have occurred to registered

HDSS members are recorded using a standard validated questionnaire.

Information captured includes date of death, place of death and cause of death

by broad causes i.e. illness, injuries, and accidents among others. All reported

deaths are then visited by a member of the Vital Events team from 3 weeks after

the death to conduct a Verbal Autopsy to identify a probable cause of death.

f) Verbal Autopsy (VA) is a method used in the absence of clinical autopsy to

elicit information on cause of death [See for details: INDEPTH Network (2002).

Population and Health in Developing Countries. Volume 1, Population, Health and

Survival at INDEPTH Sites. IDRC, Canada. This book is available online at

www.idrc.ca]

i) Are Verbal Autopsies conducted?

Yes. Verbal Autopsy questionnaires are completed electronically and returned to

the data room for downloading. Hard copies of the forms are then produced and

sent to two physicians who review the Verbal Autopsy independently and assign

a probable cause of death. If the resulting two codes are discordant, the VA is

coded by a third physician and the code selected by two physicians is entered

into the database. If there are three discordant codes, the cause is entered as

uncertain.

ii) If yes, are the VAs on all deaths, or a sample? Verbal autopsies are conducted on all reported deaths that occur to registered

HDSS members.

g) Database:

i) Are all individual records linked prospectively within the database? Comment if necessary:

Yes. Individual records are linked to their respective dwelling units. The

individual unique identifiers are contingent to the unique household number.

ii) Give brief details on the type of database used, and whether this was custom-designed or is based on a system used elsewhere (e.g. HRS 1 or 2) Data generated from the KWHDSS is stored on an SQL database which was

custom designed in-house.

iii) Comment on data entry capability (e.g. number of resident data typist(s), contracted out to private sector etc):

• in-house capability; If yes, specify: Yes.

The KWHDSS has employed the use of mobile handheld Personal Digital

Assistants (PDAs) for collecting data. The collected data is downloaded daily by

the data team onto the Database. The PDA’s have been preprogrammed with

Quality Assurance and Quality control measures that have considerably

improved the ease at which data is cleaned and assessed.

• contracted out; If Yes, specify: No.

3. Key results (These results may be preliminary in case the HDSS has just been established. Please attached pages if necessary) a) Population pyramid (include as a separate page) included Attached: Appendix 1 b) Mortality rates*, by age and sex ---

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75

De

ath

s P

er

10

00

Age (Years)

KWHDSS Mortality Rates by Age, Sex

Female Male

Source:Kisumu West HDSS

c) Fertility rates*

d) Include in- and out-migration rates by age and sex (preferably on the same graph) (* with mortality and fertility rates include trend lines, if available, based on retrospective and prospective analyses) Out-Migrations

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80+

Po

pu

lati

on

Pe

r 1

00

0

Age (Years)

Out-Migration By Age and Sex

Female Male

Kisumu West HDSS, 2012

Source: Kisumu west HDSS

In-Migration

In- and out-migration rates by age and sex

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80+

Po

pu

lati

on

in

10

00

Age(Years)

Out-Migration, In-Migration by Age and Sex

Female-Out Migrants

Female-In-Migrants

Male-In-Migrants

Male-Out-Migrants

Source: Kisumu West HDSS

Kisumu West HDSS, 2012

If some or all of the above results are not available, please state reason:

NA

4. Management and human resources

a) Management/accountability structure: please outline

The Kisumu West HDSS is managed by the Kenya Medical Research Institute (KEMRI) and the US Army Medical Research Unit Kenya (USAMRU-K). The KWHDSS is supported by the US DOD through the Department of Emerging Infectious Diseases (DEID).

The KWHDSS is also supported in part by all the studies taking place at the Kombewa Clinical Research Centre.

http://usamrukenya-deid.org/ and http://usamrukenya.org/

b) Project /director/Manager Mr. Peter Sifuna Project Manager, Kisumu West HDSS Walter Reed Project/KEMRI P.O Box 54, 40100 Kisumu, KENYA Email: peter.sifuna@usamru-k.org Tel: 0724 500 607

c) Alternate contact persons

Dr. Walter Otieno, MBChB, M.Med (Paeds) PhD

Site Leader, Kombewa Clinical Research Center, Walter Reed Project/KEMRI P.O Box 54, 40100 Kisumu, KENYA Email: wotieno@wrp-ksm.org Tel: +254 733 905494, +254 714 481488

c) Senior research staff (provide a brief list only. To provide a detailed list, please complete PART B. For PART A, the purpose is to grasp the senior research capability available to the project)

CATEGORIES NUMBER

Senior Research Scientists (Masters and PhD) 11

Clinical Officers/Physician Assistants 18

Nurses 20

Clinical Research Coordinators 8

Pharmacist (1), Pharm Techs (4) 5

Administration Assistants 2

Records 6

GIS Experts 2

IT Analyst 3

Field Supervisors 6

Lab technicians 24

Field Workers 60

Assistant Research coordinators 1

5. Funding sources / Collaborators a) Current main funders/donors (please list)

• Department of Emerging Infectious Diseases (DEID)

• PATH-Malaria Vaccine Initiative (MVI)/GSK

• Walter Reed Project (WRP)

• Kenya Medical Research Institute (KEMRI) b) Future potential funders/donors (list)

WRP/HJF PEPFAR All future studies that will take place at WRP-KEMRI facility c) Funding is guaranteed until? (Year…) (if funding is likely though not guaranteed, please clarify) Year 2014 and beyond (The management of WRP/KEMRI has instituted a Standard Operating Procedure that requires studies utilizing the KWHDSS platform to set aside a percentage of their respective budgets for purposes of meeting the programs running costs). The HDSS steering committee is charged with the responsibility of reviewing percentage to be charged to each study. Currently, 3 studies running on the DSS platform contribute a significant percentage of their budgets to the program. This is in addition to the programs baseline funding received from the US DoD through the Department of Emerging Infectious Disease d) Who are your collaborators? (Other institutions and researchers)

• Kenya Ministry of Health (KMOH)

• US Department of Defense (DOD)

• Wageningen University, Netherlands

6. Role/contribution of an international network of field sites Focus first on what would be of particular benefit to your own site and its work; thereafter, if appropriate, consider some of the broader roles and contributions such a network might make. a) Contributions of the Network to particular site/project

The INDEPTH Network provides an ideal platform for pooling data generated by the site and other HDSS sites worldwide. This pooling of knowledge leads to greater impact on policy formulation. The KWHDSS envisages that the technical support and leveraging of strengths through this network partnership will further strengthen our young site and will improve the quality of the nested studies we conduct in the future. The site also anticipates competing for multi site studies and trials within the INDEPTH membership.

b) Broader contributions

We hope that joining the network allows data from the KWHDSS to be pooled together with data from other network members for extrapolation. This will be helpful in disseminating results from our HDSS. As a member of the INDEPTH network, our data will have a larger audience and the data generated will be more broadly utilized.

c) What contributions do you envisage your site to make to the Network?

The KWHDSS will share results, research findings and publications within the network under the established framework. The KWHDSS will participate in the INDEPTH scientific conferences (By attendance, posters and oral presentations), Annual General Meetings (AGM) and interest/working groups within the network. The KWHDSS welcomes any cross site studies or data analysis by interested members and will also provide technical support to new members. The Centre will jointly with the others on the platform formulate joint proposals to answer cross site demographic and health issues

d) The INDEPTH Network is keen on taking the lead on public access to data that we generate. Tools are being developed for data access to be possible at various levels to ensure that we strike the right collaborations as well as ensure our work has the greatest impact. Please share with us your thoughts on public access to data that you are generating at your site.

We are favorable to the sharing of HDSS data with the public once the various ethical issues that guarantee the rights and privacy of the participants and their communities are addressed. The centre will be willing through our regulatory team to review and provide any input on the tools being developed for data sharing.

8. Publications a) Please list at most five (5) key publications that have resulted from your

HDSS. (Provide full details of publications and enclose copies if possible.)

i) Oyieko J, Andagalu B, Sifuna P, Otieno A, Otsyula N, Ogutu B, Otieno L,

Otieno W; Using the HDSS to link bacteremia in hospitalized children to the community(To be published)

ii) Sifuna Peter, Carol Tungwony, John Waitumbi; Spatial Analysis of Pediatric Malaria in western Kenya (To be published)

iii) Milton Omondi, Everlyne Nyagaya, Maria Bovill, Shon Remich, George Kodak, Peter Sifuna; Mapping of HIV/AIDS Occurrence in Kisumu West District, Kenya (To be published)

b) Please include your latest annual report. Attached

9. Other considerations Although this enquiry does not aim to be comprehensive, it may be that we have omitted certain key issues or concerns. If so, please list or describe these in this section.

PART B: INDEPTH HUMAN RESOURCE APPRAISAL

See attached Appendix