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Author Notes:

Correspondence to Dr Florian Marks; fmarks@IVI.INT

GDP and AHH contributed equally.

GDP, JKP and UP conceptualised the initial study concept of the HPAfrica study.

HWS and GHJ developed the tools ’HPA Collect' and ’HPA Web' for electronic data collection with primary support of UP and AH.

IO and JA supported the development and finalising of the data collection tools ’HPA Collect' and ’HPA Web'.

MR and RR supported the development and finalisation of the HPAfrica study forms.

The appendices were conceptualised by GDP, JKP, YC, JI, TT, AHH and UP.

IO, JA, RB, LMCE, JI, HJJ, SPL, OL-M, WMW, ODM, INO, EO-D, SEP, OP, HJS, ABS, MT, TT, MR and RR supported the further development of the initial study protocol and appendices.

FM, YC and CGM participated in the finalisation of the study protocol, including appendices.

AH wrote the first draft of the manuscript.

GDP, HWS, IO, JA, RB, LMCE, MH, JI, GHJ, HJJ, SPL, OL-M, WMW, ODM, INO, EO-D, JKP, SEP, OP, HJS, ABS, MT, TT, YC, MR, RR, CGM and FM critically reviewed and revised the manuscript draft.

GDP, AHH, HWS, IO, JA, RB, LMCE, MH, JI, GHJ, HJJ, SPL, OL-M, WMW, ODM, INO, EOD, JKP, SPL, OP, HJS, ABS, MT, TT, YC, MR, RR, CGM, FM and UP agreed and approved the final manuscript as submitted.

The authors would like to thank David Kauderer for the support and advice in computer engineering, Dr Paul M Tshiminyi for the support in proofreading French study materials and Soo Young Kwon and Ji Hyun Han for administrative support.

The authors would also like to thank community leaders and site representatives for their assistance and facilitation in properly approaching household members for our study.

Competing interests: None declared.


Research Funding:

This study was supported by the Bill & Melinda Gates Foundation (OPP1127988).

The International Vaccine Institute acknowledges its donors, including the Republic of Korea and the Swedish International Development Cooperation Agency (Sida).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
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The HPAfrica protocol: Assessment of health behaviour and population-based socioeconomic, hygiene behavioural factors - a standardised repeated cross-sectional study in multiple cohorts in sub-Saharan Africa

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Journal Title:

BMJ Open


Volume 8, Number 12


, Pages e021438-e021438

Type of Work:

Article | Final Publisher PDF


Introduction The objective of the Health Population Africa (HPAfrica) study is to determine health behaviour and population-based factors, including socioeconomic, ethnographic, hygiene and sanitation factors, at sites of the Severe Typhoid Fever in Africa (SETA) programme. SETA aims to investigate healthcare facility-based fever surveillance in Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar and Nigeria. Meaningful disease burden estimates require adjustment for health behaviour patterns, which are assumed to vary among a study population. Methods and analysis For the minimum sample size of household interviews required, the assumptions of an infinite population, a design effect and age-stratification and sex-stratification are considered. In the absence of a population sampling frame or household list, a spatial approach will be used to generate geographic random points with an Aeronautical Reconnaissance Coverage Geographic Information System tool. Printouts of Google Earth Pro satellite imagery visualise these points. Data of interest will be assessed in different seasons by applying population-weighted stratified sampling. An Android-based application and a web service will be developed for electronic data capturing and synchronisation with the database server in real time. Sampling weights will be computed to adjust for possible differences in selection probabilities. Descriptive data analyses will be performed in order to assess baseline information of each study population and age-stratified and sex-stratified health behaviour. This will allow adjusting disease burden estimates. In addition, multivariate analyses will be applied to look into associations between health behaviour, population-based factors and the disease burden as determined in the SETA study. Ethics and dissemination Ethic approvals for this protocol were obtained by the Institutional Review Board of the International Vaccine Institute (No. 2016-0003) and by all collaborating institutions of participating countries. It is anticipated to disseminate findings from this study through publication on a peer-reviewed journal.

Copyright information:

© Author(s) (or their employer(s)) 2018.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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