The integrated Demographic and Surveillance System (DSS) captures vital events among 300,000 residents of Kilifi County, linked to morbidity and mortality surveillance at Kilifi County Hospital and integrated with lab diagnostics. We estimate population-level incidences of common diseases (e.g. malaria, rotavirus diarrhoea, pneumococcal disease, epilepsy), test associations between exposures such as vaccination status or genetic risk factors and outcomes such as infectious diseases or mortality, evaluate Non-Communicable Disease incidence such as stroke, diabetes and cancer, and monitor vaccine coverage using serological surveys.
An example of the value of continuous surveillance was our recent analysis of mortality during health worker strikes. Africa has reported few COVID-19 deaths outside South Africa and Northern Africa, but deaths may be underreported. Our continuous DSS data will allow us to estimate excess mortality compared to previous years. Monitoring effectiveness and safety of COVID-19 vaccines will be a critical challenge for LMICs. We will use the DSS to monitor impact and long-term vaccine effectiveness. We have analytical capacity for National and Global Surveillance, including the social and epidemiological determinants of health states and transitions, and access to services and vulnerabilities at fine scales. Nationally, we have mapped child mortality, malaria and malnutrition, and internationally the first sub-Saharan African maps on access to emergency health services and 115 years of malaria transmission in Africa.
Our hospital-based surveillance (CIN) has generated findings that have helped characterise common clinical syndromes such as childhood pneumonia, diarrhoea, malaria, and neonatal conditions prompting policy discussions at WHO towards revising global policy recommendations. Future directions include linking CIN data on severe malaria to malaria ecologies, increased malaria control in the community and changing epidemiology. Throughout 2020, CIN provided near real-time data to the Public Health Emergency Operations Centre on suspected and confirmed COVID-19 cases, and we are developing a hub-and-spoke approach for bacteraemia surveillance in CIN hospitals that can be scaled and embedded in LMIC health systems.