title: The non-specific effects of vaccines and other childhood interventions: the contribution of INDEPTH Health and Demographic Surveillance Systems.
abstract: Most childhood interventions (vaccines, micronutrients) in low-income countries are justified by their assumed effect on child survival. However, usually the interventions have only been studied with respect to their disease/deficiency-specific effects and not for their overall effects on morbidity and mortality. In many situations, the population-based effects have been very different from the anticipated effects; for example, the measles-preventive high-titre measles vaccine was associated with 2-fold increased female mortality; BCG reduces neonatal mortality although children do not die of tuberculosis in the neonatal period; vitamin A may be associated with increased or reduced child mortality in different situations; effects of interventions may differ for boys and girls. The reasons for these and other contrasts between expectations and observations are likely to be that the immune system learns more than specific prevention from an intervention; such training may enhance or reduce susceptibility to unrelated infections. INDEPTH member centres have been in an ideal position to document such additional non-specific effects of interventions because they follow the total population long term. It is proposed that more INDEPTH member centres extend their routine data collection platform to better measure the use and effects of childhood interventions. In a longer perspective, INDEPTH may come to play a stronger role in defining health research issues of relevance to low-income countries.
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (C
authors.forename: Osman
authors.initials: O
authors.lastname: Sankoh
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Paul
authors.initials: P
authors.lastname: Welaga
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Debpuur
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Charles
authors.initials: C
authors.lastname: Zandoh
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Stephney
authors.initials: S
authors.lastname: Gyaase
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Mary Atta
authors.initials: MA
authors.lastname: Poma
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Martin Kavao
authors.initials: MK
authors.lastname: Mutua
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: S M Manzoor Ahmed
authors.initials: SM
authors.lastname: Hanifi
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Cesario
authors.initials: C
authors.lastname: Martins
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Eric
authors.initials: E
authors.lastname: Nebie
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Moubassira
authors.initials: M
authors.lastname: Kagoné
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Jacques B O
authors.initials: JB
authors.lastname: Emina
authors.affiliation: INDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina FasoINDEPTH Network, Accra, Ghana, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Faculty of Public Health, Hanoi Medical University, Hanoi, Viet Nam, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana, Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana, Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana, African Population and Health Research Centre, Nairobi, Kenya, Chakaria Community Health Project Community Health Division, ICDDRB, Mohakhali, Dhaka, Bangladesh, Bandim Health Project, Bandim, Guiné-Bissau and Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso.
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
mesh_terms: D019587:Dietary Supplements; D006801:Humans; D064789:Immunity, Heterologous / Q000276:immunology; D064887:Observational Studies as Topic; D011159:Population Surveillance / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D014612:Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000276:immunology; D062690:Vaccines, Live, Unattenuated / Q000008:administration & dosage / Q000276:immunology; D014801:Vitamin A / Q000008:administration & dosage / Q000276:immunology
chemical_list: D014612:Vaccines; D015164:Vaccines, Inactivated; D062690:Vaccines, Live, Unattenuated; D014801:Vitamin A
keywords: BCG; DTP; INDEPTH Network; childhood interventions; measles vaccine; non-specific effects of vaccines