JMIR Publications

ABSTRACT

Background:

Zimbabwe currently faces a rapidly escalating burden of non-communicable diseases (NCDs) concurrently with persistent communicable disease challenges, resulting in profound epidemiological differences between rural and urban populations. To effectively address this evolving epidemiological landscape and guide evidence-based public health interventions, reliable and high-quality longitudinal data are essential for capturing temporal shifts and contextual determinants often overlooked by conventional health information systems.

Objective:

This protocol details the methodology for establishing a Health and Demographic Surveillance System (HDSS), a longitudinal, population-based cohort designed to continuously monitor the prevalence, incidence, and key determinants of NCDs, specifically cardiovascular diseases and diabetes and their associated risk factors in selected rural (Mt Darwin) and urban (Bindura) sites in Mashonaland Central Province over a five-year period (2024–2029).

Methods:

The HDSS utilizes a stratified multi-stage sampling design to recruit adults (aged18 years above) residing across two rural and two urban wards. Initial activities include comprehensive community profiling and household mapping, followed by a rigorous baseline survey, with systematic follow-ups scheduled every year. Data encompass essential domains such as vital events, migration patterns, detailed social determinants of health, health behaviors, self-reported and clinically assessed NCDs, physical examinations (including height, weight, BP, waist/hip circumference), biochemical markers (fasting glucose, lipid profiles, urine sodium/creatinine), and standardized verbal autopsies. Data capture will employ use of RedCAP to facilitate real-time data entry and validation. The protocol is underpinned by rigorous quality assurance procedures, continuous community engagement, and comprehensive ethical oversight.

Results:

The HDSS aims to generate critical longitudinal data distinguishing urban and rural settings, focusing on common NCDs specifically cardiovascular diseases and diabetes among conditions. The baseline survey quantifies the prevalence of NCDs and key risk factors including obesity, physical inactivity, unhealthy diet, tobacco, and alcohol use through physical and biochemical assessments. It also assesses social determinants impacting NCD epidemiology. Baseline data collection was completed in late 2024 and early 2025. Longitudinal follow-ups, are planned annually for five years starting in 2026 (pending funding), will monitor incidence, demographic changes, and shifts in health behaviors, enabling robust comparisons between rural and urban populations.

Conclusions:

This community HDSS addresses a critical evidence deficit within Zimbabwe’s national health information infrastructure. By implementing an ethical, sustainable, and community-engaged research methodology, the HDSS serves as a potent regional model. It is designed to generate actionable, policy-relevant data for national health authorities and stakeholders, thereby accelerating the country's NCD prevention and control agenda while simultaneously acting as an enduring platform for academic innovation, capacity building, and policy translation efforts targeting both rural and urban health disparities.