Publication: Field Lessons from a Zoonotic Disease Study in the Nairobi Health Surveillance System
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2015-02
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Online Journal of Public Health Informatics
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Abstract
Objective
Disseminate field lessons from a zoonotic disease study nested
on the Nairobi Urban Health and Demographic Surveillance System
(NUHDSS). The study investigates the emergence and introduction
of zoonoses in urban areas
Introduction
About 60% of Nairobi residents live in slums with higher poverty,
population density prevalence diseases and lower health access than
the city average. Some residents own livestock or in are in contact
with its products. Most slums dwellers work outside slums. Thus,
health surveillance in slum area is vital because of potential disease
outbreaks and spread. Yet, little is known on practice/challenges of
health surveillance in resource-limited slums.
Methods
The African Population and Health Research Center established the
NUHDSS in two slums (Korogocho and Viwandani) in 2003 and has
since collected routine information on birth, deaths, cause of deaths,
migration thrice a year. Currently, about 78000 persons living in ~
25,000 households are in NUHDSS. On this NUHDSS framework
was nested a maternal and child health (MCH) longitudinal study
collecting socio-economic characteristics, childhood diseases,
vaccination status, access to care, anthropometrics and other
information among ~3000 mother-child pairs. Babies<7 months born
to resident mothers are recruited and followed-up till 5 years. The
Urban Zoonoses case-control study was nested on the MCH. E.choli
is used as examplar of emerging pathogen with multiple hosts. From
August 2013 to April 2014, we collected additional information
on hygiene practices, and diarrhea risk factors in the MCH study.
Moreover, we collected fecal, food and water samples from about 200
children with diarrhea and 400 randomly selected controls to explore
diarrhea-causing pathogens in laboratories.
Results
Here are the main lessons
Sustaining Community Participation: Most residents are poor
and highly mobile and do not benefit individually from participation
in the surveillance which could contribute to attrition. So we ensure
their communities benefit by offering health camps with free care,
upgrading health facilities, schools and by disseminating research
results locally. We also use the NUHDSS platform for intervention
research to improve knowledge while benefiting study participants.
Engaging Gatekeepers Some heads of local organizations,
opinion leaders, etc. may act as gatekeepers blocking access to the
community. We get their “buy-in” with sensitization, community
leadership meetings to explain methods and objectives prior to, and
during studies.
Hiring Local Fieldworkers We hire as fieldworkers educated
slums residents who know local codes and people. We train and give
education benefits for skills improvement and retention.
Engaging with Mothers The main respondents are women so we
employ a female-only collection team. When respondents are casual
workers with odd hours, interviews are conducted at a time and
place convenient for mothers which stresses the importance of local
fieldworkers and flexibility.
Keeping Employees and Material Safe Despite employing
local residents, “no-go” areas exist. We hire additional security
to accompany fieldworkers to collect data there and when bulky
equipment is used for anthropometrics.
Collecting Sample Obtaining samples was easier from children
with diarrhea than from the control group. We dedicated fieldworkers
to collect sample among the latter and carry them to the labs.
Offering Clinical Care Clinical officers using lab results offer
treatment to children with diarrhea, and others in all households
involved in the zoonotic study and referral when needed. These
services increase the community’s acceptance of the study
Conclusions
Accounting for local context is vital for a successful population
surveillance system and the zoonotic study nested on it.