Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System.
OBJECTIVE
Vital registration is generally lacking in infrastructurally weak areas where health and development problems are most pressing. Health and demographic surveillance is a response to the lack of a valid information base that can provide high-quality longitudinal data on population dynamics, health, and social change to inform policy and practice.
Continuous demographic monitoring of an entire geographically defined population involves a multi-round, prospective community study, with annual recording of all vital events (births, deaths, migrations). Status observations and special modules add value to particular research areas. A verbal autopsy is conducted on every death to determine its probable cause. A geographic surveillance system supports spatial analyses, and strengthens field management.
Health and demographic surveillance covers the Agincourt sub-district population, sited in rural north-eastern South Africa, of some 70,000 people (nearly a third are Mozambican immigrants) in 21 villages and 11,700 households. Data enumerated are consistent or more detailed when compared with national sources; strategies to improve incomplete data, such as counts of perinatal deaths, have been introduced with positive effect. Basic characteristics: A major health and demographic transition was documented over a 12-year period with marked changes in population structure, escalating mortality, declining fertility, and high levels of temporary migration increasing particularly amongst women. A dual burden of infectious and non-communicable disease exists against a background of dramatically progressing HIV/AIDS.
Health and demographic surveillance sites - fundamental to the INDEPTH Network - generate research questions and hypotheses from empirical data, highlight health, social and population priorities, provide cost-effective support for diverse study designs, and track population change and the impact of interventions over time.[image omitted].
Kahn
Kathleen
K
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, South Africa. Kathleen.Kahn@wits.ac.za
Tollman
Stephen M
SM
Collinson
Mark A
MA
Clark
Samuel J
SJ
Twine
Rhian
R
Clark
Benjamin D
BD
Shabangu
Mildred
M
Gómez-Olivé
Francesc Xavier
FX
Mokoena
Obed
O
Garenne
Michel L
ML
D003710:Demography; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011157:Population Dynamics; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D012106:Research; D012423:Rural Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology