2018 - DTA - Gambia (at LSH&TM)
Medical Research Council
London School of Hygiene and Tropical Medicine
In developing societies characterised by complete absence of vital registration systems, the continuous demographic surveillance (DSS) approach to data collection provides the best opportunity to generate the quantitative and qualitative evidence of disease burden needed for the formulation and/or adjustment of health policies. Against this background and with the aim of providing robust research platforms for the design and evaluation of interventions to reduce mortality and morbidity, the Medical Research Council, The Gambia runs two such demographic surveillance sites, namely the Farafenni and Basse DSS sites. The Farafenni site, established in October 1981 with the aim of monitoring the impact of village-based Primary Health Care on mortality, is located on the north bank of the river Gambia, about 120 km from the capital city of Banjul, and currently has a total population of over 45,000 under surveillance. The Basse DSS site was established in 2007 and covers all residents of the two eastern-most districts of the country south of the river − over 175,000 people. With the long term goal of serving as a platform for multi-disciplinary population-based investigations on tropical infectious diseases, this site currently facilitates the estimation of the burden of diarrhoea and pneumonia. The available data from both Farafenni and Basse surveillance areas reveal dramatic recent declines in under-5 mortality. In fact, the trends suggest that the Farafenni area reached its Millennium Developing Goal 4 target in 2008, well before the planned date in 2015. Mortality has mainly decreased in older children, while neonatal mortality is stubbornly resistant to change, with the consequence that the proportion of neonatal deaths among children under 5 years has steadily increased. Similar trends were also reported from Niakhar DSS site in Senegal and Navrongo DSS site in northern Ghana. Considering that reliably detecting newborn deaths is a major challenge, the problem may be even worse than we realize. Therefore, improving our techniques of measuring neonatal and infant mortality is an urgent priority. Indeed, this is important to determine the most common causes of death and formulate adequate interventions to decrease the burden. The Child Survival Theme in conjunction with the Disease Control and Elimination Theme plans to build on and go beyond the sound track record of mortality data that exists in The Gambia to achieve the highly robust information on levels and causes of neonatal mortality data that we need. Goal and Scope of Work The goal of the proposed PhD project is to: 1. Adopt a methodological strategy to improve the measurement of neonatal and infant mortality at national and regional levels to accurately reflect the magnitude of the burden. One such approach is the intensive follow-up of identified women up to the completion of their pregnancies and beyond; and of their offspring up to 12 months of age. 2. Investigate the extent to which a childhood mortality transition is evident in the West African sub-region and identify the key health and socio-cultural practices or changes in practices that are driving the phenomenon; as well as the factors sustaining the level of neonatal mortality. The approach will be mainly through quantitative analysis of DSS data from sites in The Gambia, with the possibility of broadening the scope to include DSS data from other West African countries, especially the Sahel region. Demographic and Health Survey (DHS) data from countries in the region with at least one such dataset, and other nationally representative local surveys may also be used to complement the analysis. Where possible and deemed necessary, reasonably scaled qualitative approaches can be adopted to answer questions or establish linkages that quantitative methods may not readily provide.
HRCS Research Uncodeable / Studentship