2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

Field Lessons from a Zoonotic Disease Study in the 
Nairobi Health Surveillance System
Djesika D. Amendah*, Peterrock Muriuki, Nicholas Ngomi, Martin kavao and Nelson Muhia

African Population and Health Research Center (APHRC), Nairobi, Kenya

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.

Keywords
Zoonotic disease; Health Surveillance; Low-ressource; Kenya

Acknowledgments

Medical Research Council, Natural Environment Research Council, 
Economic and Social Research Council, Biotechnology and Biosciences 
Research Council for funds received through the Environmental & 
Social Ecology of Human Infectious Diseases Initiative (ESEI), Grant 
G1100783/1.
William and flora Hewlett foundation, Bill and Melinda Gates foundation, 
and Sweden International Development Cooperation Agency

References

Emina J, Beguy D, Zulu EM, Ezeh AC, Muindi K, et al. (2011) Monitoring 
of health and demographic outcomes in poor urban settlements: 
evidence from the Nairobi Urban Health and Demographic 
Surveillance System. J Urban Health 88 Suppl 2: S200-218.

APHRC (2002) Population and Health Dynamics in Nairobi’s Informal 
Settlements. Nairobi, Kenya: African Population and Health Research 
Center.

*Djesika D. Amendah
E-mail: damendah@aphrc.org    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e103, 201