Approaches, achievements, challenges, and lessons learned in setting up an urban-based Health and Demographic Surveillance System in South Africa

Figures & data

Table 1. Data elements in Soweto and Thembelihle Health and Demographic Surveillance System

Level of data elements		Description
Level 1		The core indicators which are essential towards meeting the CHAMPS objectives. They include age- and sex-specific population size, numbers of births and deaths by age and sex, in-migration and out-migration.
Level 2		Covers the household and individual characteristics (which are important for contextualising CHAMPS results) including: Household socioeconomic status; access to water, electricity and sanitation; cooking fuel; access to healthcare; and living arrangement. Mother characteristics – age, education, marital status, religion, and reproductive history. Children characteristics: antenatal care, delivery, postnatal care, immunization uptake and breastfeeding.
Level 3		Involves enhanced data collection modules that focus on health topics, including biomarkers such as anthropometric and haemoglobin measurements, nutrition assessment, HIV screening and testing, COVID-19 screening, testing and research; as well as food frequency questionnaires or 24-hour dietary recall.

Abbreviation: CHAMPS – Child Health and Mortality Prevention Surveillance COVID-19 – coronavirus disease 2019

Table 2. Selected sub-places/clusters in Soweto with under-5 mortality estimates

S/N	Clusters	Total population	Under-five mortality rate†
1	Braamfishervile Extension 12	4,750	15,426	1,521	51
2	Emdeni	8,527	35,753	3,582	53
3	Mapetla	7,533	23,146	2,031	53
4	Meadowlands Zone 4	3,292	11,739	1,209	58
5	Meadowlands Zone 5	3,162	13,970	1,473	56
6	Mofolo North	2,910	13,014	1,296	84
7	Phiri/Senaone	7,732	30,212	1,422	51
8	Thulani	11,139	40,376	40,376	51
	Total	49,045	183,636	17,166

Source: Statistics SA (2011); †Under-five mortality rates are per 1000 live births based on South Africa’s 2011 census

Figure 1. Map of Soweto/Thembelihle Demographic Surveillance Areas (DSA). The 8 clusters presented are sub-places in Soweto, with Thembelihle neighbouring Soweto

Table 3. Population under surveillance in SaT-HDSS (December 2019)

S/N	Clusters	Number of households	Total population	Total under-5 population (N)
1	Braamfishervile Extension 12	2601	10,347	1226
2	Emdeni	4423	18,322	1806
3	Mapetla	2530	10,476	987
4	Meadowlands Zone 4	1562	7601	723
5	Meadowlands Zone 5	2290	9327	921
6	Mofolo North	2159	8347	816
7	Phiri/Senaone	4190	18,547	1817
8	Thulani	4313	17,939	1993
9	Thembelihle and surrounding informal settlements	7711	23,263	2659
Total		31,779	124,169	12,948

Figure 2. Pyramid of population under surveillance (SaT-HDSS 2019)

Table 4. Percentage distribution of the population under surveillance by selected socio- economic characteristics (SaT-HDSS 2019)

Variable	% of total population under surveillance (N = 124,169)
Male	48.0
Female	52.0
Level of education (population aged 6+)
No formal education	11.4
Primary	22.5
Secondary (up to Grade 11)	34.9
Complete secondary (Matric)	24.0
Undergraduate (university)	2.5
Undergraduate (Tvet, Technical, etc.)	4.4
Postgraduate	0.3
Employment (population aged 15+)
Not currently working	37.0
Full-time employed	24.7
Temporary/contract worker	7.6
Self-employed	6.1
Pensioner/retired	10.4
Student/Learnership	13.8
Home caregiver/Others	0.4
Marital status (population aged 15+) above
Married, living with spouse	13.6
Married, not living with spouse	2.8
Living together with partner	15.7
Divorced	2.1
Widowed	5.5
Never married/never lived with partner	50.0
Currently single, but lived together with partner before	10.3
Catchment area
Soweto	81.7
Thembelihle and surrounding informal settlements	18.3

Table 5. Some key demographic indicators in SaT-HDSS (2019)

Indicators	Soweto (N101,420)	Thembelihle (N = 22,749)	Total (N = 124,169)
Proportion of under-5 children to the total population (%)	8.4	10.9	8.7
Proportion of aged population (>65 years) to the total (%)	7.3	2.1	6.4
In-migration rate (% of individual population)	1.8	1.1	1.8
Out-migration rate (% of individual population)	7.8	4.5	7.9
Sex ratio at birth (%)	96.9	95.9	100.7
Average household size	3.7	4.0	3.0