Health and demographic surveillance systems in low- and middle-income countries: history, state of the art and future prospects

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ABSTRACT

Health and Demographic Surveillance Systems (HDSS) have been developed in several low- and middle-income countries (LMICs) in Africa and Asia. This paper reviews their history, state of the art and future potential and highlights substantial areas of contribution by the late Professor Peter Byass.

Historically, HDSS appeared in the second half of the twentieth century, responding to a dearth of accurate population data in poorly resourced settings to contextualise the study of interventions to improve health and well-being. The progress of the development of this network is described starting with Pholela, and progressing through Gwembe, Balabgarh, Niakhar, Matlab, Navrongo, Agincourt, Farafenni, and Butajira, and the emergence of the INDEPTH Network in the early 1990’s

The paper describes the HDSS methodology, data, strengths, and limitations. The strengths are particularly their temporal coverage, detail, dense linkage, and the fact that they exist in chronically under-documented populations in LMICs where HDSS sites operate. The main limitations are generalisability to a national population and a potential Hawthorne effect, whereby the project itself may have changed characteristics of the population.

The future will include advances in HDSS data harmonisation, accessibility, and protection. Key applications of the data are to validate and assess bias in other datasets. A strong collaboration between a national HDSS network and the national statistics office is modelled in South Africa and Sierra Leone, and it is possible that other low- to middle-income countries will see the benefit and take this approach.

KEYWORDS:

• HDSS
• Demography
• Longitudinal Population Studies

Responsible Editor

Stig Wall

Responsible Editor

Stig Wall

Acknowledgments

We acknowledge the contribution of the communities hosting HDSS for their active participation in research over many years.

Data availability statement

N/A

Data deposition

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Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

N/A

Paper context

Health and Demographic Surveillance Systems (HDSS) in low- and middle-income countries provide data for the study of the cultural, socio-economic, and demographic characteristics of a population, fundamental to the understanding of, and intervening to improve, the health and well-being of communities. The need for HDSS will continue due to the dynamic nature of the health and socio-economic wellbeing, particularly in the face of global health challenges such as pandemics and climate change.

Additional information

Funding

The authors have no funding to report.

Notes on contributors

Kobus Herbst

KH conceived and drafted the paper outline. All authors contributed to, reviewed, and edited the manuscript. YB drafted the text box on Butajira HDSS, MJ drafted the text box on Farafenni HDSS, NTKC drafted the text box on Filabavi HDSS. SJC produced a preprint from which the methodology and future HDSS developments have drawn extensively [103].