MITS PROJECT
The Minimally Invasive Tissue Sampling (MITS) procedure was developed as an approach to reduce uncertainty surrounding cause of death determination in high mortality settings, where clinical and postmortem diagnoses are nearly always unavailable. The procedure uses biopsy needles to obtain post-mortem samples of lung, brain and liver for histopathology, microbiologic, and molecular examination for cause-of-death determination.
This 3-year project commenced in March 2023 at Iganga main hospital and the HDSS community, with the aim of tracking the causes of under-5 mortality and stillbirths in about 300 cases through epidemiologic surveillance of under-5 deaths and stillbirths utilizing MITS, laboratory diagnostics including conventional and advanced histopathology and molecular screening of various pathogens, verbal autopsy, and available clinical and demographic data. The study operates in Iganga general hospital and the IMHDSS catchment area.
MITS samples are collected and initial microbiology tests performed in Iganga before they are transported to Mulago national hospital laboratory in Kampala for comprehensive histopathology and other microbiology tests. A select team of professionals meets on a quarterly basis to analyse clinical history, verbal autopsy and laboratory findings results and to assign the most probable cause of death.
MITS Specialists performing MITS at Iganga hospital
IDAIR CITIZEN SCIENCE PROJECT
Citizen Science is a practice of public participation and collaboration in all aspects of scientific research to increase knowledge and build strategies towards pandemic preparedness and response. The COVID-19 pandemic showed that the global lack of accurate, real-time data on outbreaks and a collective science-based response framework causes the world to struggle to contain the pandemic in a timely and effective manner.
An explanatory design, using a mixed methods approach was applied to interview participants in the IMHDSS between May and June 2023. Quantitative data was collected electronically using ODK software and analysed in STATA 15. Focus Group Discussions were conducted with community members collecting qualitative data to understand the barriers and facilitators. Audio clips were transcribed verbatim, data was coded and analyzed in Atlasti version-9 using thematic content analysis.
UPDATE ROUND 22
Since inception, the IMHDSS regularly updates core surveillance data of birth, death and migrations twice and sometimes once every year. Currently, MUCHAP is conducting update round 22 which started on 8th May 2023 and is projected to end in September 2023. The current population cohort under surveillance is 95,000 individuals that occupy 17,500 households in 65 villages of Iganga and Mayuge districts.
ADOLESCENT HEALTH (ARISE) SURVEY
This ‘ARISE’ end-line survey was conducted in July 2023 as a follow-up to the base line that was conducted in January 2022. The study determined the reproductive life-style of adolescents, substance use and nutrition practices. Body weight, height and hemoglobin level of participants was measured. The study targeted 1,200 adolescent boys and girls in the age group of 10-19 years who are resident in 8 selected parishes of Iganga and Mayuge districts.
EMERALD QUANTITATIVE STUDY
This study is targeting 5,000 women of reproductive age that are resident in the surveillance area and who have had a pregnancy in the last 2 years. Nested to the IMHDSS update round 22, the study assesses the health-care capacity of women; with specific interest in disability and rehabilitation. Data collection commenced on 8th May 2023 and is expected to be completed by the end of September.
ELECTRONIC MORBIDITY SURVEILLANCE
This longitudinal study involves monitoring morbidity patterns, trends and prevalence of disease in a selected population of Iganga district that is served by Busowobi Health Centre III. The morbidity surveillance system networks laboratory, maternity and OPD data for patients that seek health care in this facility and who are residents of the HDSS surveillance population.
EXCESS MORTALITY STUDY
This work is part of the excess mortality project Funded by the Bill & Melinda Gates Foundation. The goal of this initiative was to characterize all-cause (and cause-specific) mortality rates and trends, by age and sex, across a range of rural and urban sub-Saharan African and South and Southeast Asian settings under continuous health and demographic surveillance in order to understand the excess mortality of the COVID-19 pandemic in key low and middle-income country (LMIC) settings.
In this project, the investigators planned to leverage a carefully selected group of up to 10 well-functioning population-based sites/centers and networks (HDSS or comparable) across sub-Saharan Africa and South and Southeast Asia to document the total numbers of deaths each year from 2015-2019 as pre-COVID years, 2020 as a key COVID year-1 (retrospective), and 2021 as a second pandemic year (prospective). This ‘numerator’ information, when combined with accurate ‘denominator’ information on the population under continuous surveillance, makes possible the calculation of mortality rates and trends across age-sex groups. Data specialists/ managers at each site extracted data from their site’s operating databases into a common standard format with assistance from the project technical leads
VERBAL AUTOPSY
MUCHAP monitors mortality and cause-of death performed through Verbal Autopsy (VA). Verbal autopsy is a standardized method of ascertaining cause of death based on the prevailing social circumstances at the time of the last illness that caused the death of an individual. Reported death cases are followed up by a team of trained research assistants to perform verbal autopsy interviews. Inter-VA algorithm is used to establish the most probable cause of death, based on WHO International Classification of Disease profile. Between June 2022 and June 2023 about 700 verbal autopsy interviews were conducted and cause of death was determined respectively.
