Rationale.
The Iganga Mayuge Health and Demographic Surveillance Site (IMHDSS) which is run by Makerere University Centre for Health and Population Research (MUCHAP) was established by Makerere University. The purpose of the HDSS is to generate population-based information that is useful to guide policy and the decision-making process at district and national level. IMHDSS/MUCHAP registers key demographic events in a monitored population involving registration of pregnancies, births, deaths, and migrations.
Registration of birth outcomes is important in measuring population indicators like fertility rate, level of live births, still births and miscarriages in women of reproductive age. Death registration is vital in determining health indicators like crude death rate, maternal mortality rate; child, infant and neonatal mortality. Death registration is also vital in supporting Verbal Autopsy for cause-of-death determination. Measuring population indicators is important in generating evidence-based information to guide policy makers in taking appropriate decisions and it also informs researchers on areas for further research.
Research Objectives.
The primary objectives of setting up the IMHDSS/MUCHAP research Centre were to:
- Provide a platform for conducting community-based research, and research training for students and faculty at Makerere University, as well as other researchers from within and outside Uganda
- Register and monitor important health and demographic population indicators that can be used at local and national level planning for population development
- Conduct essential household level policy relevant research tailored to inform local and national policy formulation.
- Conduct Verbal Autopsy interviews for all registered deaths to establish cause of death
- Establish and monitor an electronic morbidity surveillance system in a selected Health Centre IV under the IMHDSS cohort platform
Current Literature.
About MUCHAP
IMHDSS/MUCHAP covers 65 villages distributed in Iganga and Mayuge districts in Eastern Uganda. It covers a population of approximately 99,004 individuals resident in about 17,000 households. It is located in Eastern Uganda; about 120 kilometers east of the capital city Kampala along the Uganda–Kenya highway. Since the inception of IMHDSS in 2005, bi-annual and sometimes, annual data-update rounds have been regularly conducted through routine home visits by trained Field Assistants (FAs) to register pregnancies, births, deaths, and migrations. Other population variables like education status, marital status, screening for injury and disability, vaccination coverage, household social-economic status are also periodically measured under this research platform.
The population has an average household size of 5 individuals, and it is predominantly rural with subsistence agriculture as the main occupation. Sex distribution is almost equal with 51% Female. The population is largely young with about 40% of it below 18 years. Majority of the population (40%) are not educated. The dominant religion is Islam while 42% of the population is married or living together with their spouses. The cohort population is predominantly of a rural setting (58%).
Pregnancy, birth and death registration
MUCHAP registers an estimated 1,500 pregnancies, about 2,000 live births and 500 deaths annually. Birth and death registration for the routine census update round is supplemented by village volunteers known as scouts who were assigned this role to improve on birth and death registration.
All-cause mortality is determined by conducting Verbal Autopsy (VA) interviews with care-takers of the deceased that were present during the last illness that caused the death. Information on how health care was sought, signs and symptoms presented, duration of illness and general social circumstances that could have influenced the death is recorded using a semi-structured questionnaire. Physicians review this data and assign the most probable cause of death using WHO standardized instruments; with the International Classification Disease (ICD) profile given for selection.
Morbidity Surveillance
MUCHAP established an electronic morbidity-surveillance system based at Busowobi HC III in Iganga district. This system links population and health facility data under the MUCHAP cohort research platform. It is an on-going study which was established in 2017 with the aim of monitoring morbidity patterns, health seeking behavior and burden of disease in a selected population that is linked to a health facility. Each individual who reports to the health facility is entered in the data base and his/her HDSS unique identification number is given a bar code for continuous monitoring. Morbidity surveillance was established under the SIDA funds provided by the Swedish government as part of the HDSS support for demographic surveillance.
Summary of Adverse Events/ Side Effects:
There are no side effects experienced in this research since its inception. There are no side effects or harm involved in conducting this study. A typical interview session lasts about 45 minutes. Caretakers of the deceased residents are given a mourning period of 4-6 weeks before they are visited to provide information about the deceased persons.
Results to date:
The MUCHAP population pyramid, 2022
Population Social demographic characteristics
Gender distribution is almost equal with 51% female and 49% male. Majority of the population (40%) are not educated. The dominant religion is Islam while 42% of the population is married or living together with their spouses. The cohort population is predominantly of a rural setting (58%).
Future Plans/ Activities:
Iganga Mayuge HDSS under MUCHAP continues to track pregnancies, birth outcomes, morbidity patterns and mortality with plans to implement the 23rd update round of data collection in the cohort. This research Centre supports research and research training from Makerere University and its collaborating institutions abroad. The plan is to collaborate with various Universities in the country other than Makerere University to maximize research outputs and also build adequate research capacity in Uganda.
There is also a plan to link the whole HDSS population to an electronic morbidity surveillance platform scaled up to the entire cohort population to monitor disease burden and patterns. A laboratory is under construction at MUCHAP house to support bio-medical research that links the population to other biomarkers. There are intentions to hold conversations with data collectors (RAs), Scouts and some members of the community to get ideas on how we can improve the operations of the research site, to serve them better. We shall also collaborate with other Civil Registration and Vital Statistics (CRVS) institutions like NIRA and their stakeholders to improve mortality surveillance and the quality of reporting other events.
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