Implementing Serosurveys in India: Experiences, Lessons Learned, and Recommendations

Hasan, Alvira Z.; Kumar, Muthusamy Santhosh; Prosperi, Christine; Thangaraj, Jeromie Wesley Vivian; Sabarinathan, R.; Velusamy, Saravanakumar; Duraiswamy, Augustine; Kaduskar, Ojas; Bhatt, Vaishali; Deshpande, Gururaj; Ullas, Padinjaremattathil Thankappan; Sapkal, Gajanan; Sangal, Lucky; Mehendale, Sanjay; Gupta, Nivedita; Moss, William J.; Hayford, Kyla; Murhekar, Manoj

doi:10.4269/ajtmh.21-0401

Cited by 4 publications

(4 citation statements)

References 23 publications

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“…The findings are consistent with other published studies. For example, a study in India found that households not listed in the sampling frame were more difficult to physically access (e.g., terrain or living in residential complex), which likely resulted in unbalanced socio-demographic characteristics [ 35 ]. However, it is unclear whether these imbalances resulted in biased estimates of measles and rubella seroprevalence or other outcomes.…”

Section: Discussionmentioning

confidence: 99%

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022

Kostandova,

Mutembo,

Prosperi

et al. 2024

PLOS Glob Public Health

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Community-based serological studies are increasingly relied upon to measure disease burden, identify population immunity gaps, and guide control and elimination strategies; however, there is little understanding of the potential for and impact of sampling biases on outcomes of interest. As part of efforts to quantify measles immunity gaps in Zambia, a community-based serological survey using stratified multi-stage cluster sampling approach was conducted in Ndola and Choma districts in May—June 2022, enrolling 1245 individuals. We carried out a follow-up study among individuals missed from the sampling frame of the serosurvey in July—August 2022, enrolling 672 individuals. We assessed the potential for and impact of biases in the community-based serosurvey by i) estimating differences in characteristics of households and individuals included and excluded (77% vs 23% of households) from the sampling frame of the serosurvey and ii) evaluating the magnitude these differences make on healthcare-seeking behavior, vaccination coverage, and measles seroprevalence. We found that missed households were 20% smaller and 25% less likely to have children. Missed individuals resided in less wealthy households, had different distributions of sex and occupation, and were more likely to seek care at health facilities. Despite these differences, simulating a survey in which missed households were included in the sampling frame resulted in less than a 5% estimated bias in these outcomes. Although community-based studies are upheld as the gold standard study design in assessing immunity gaps and underlying community health characteristics, these findings underscore the fact that sampling biases can impact the results of even well-conducted community-based surveys. Results from these studies should be interpreted in the context of the study methodology and challenges faced during implementation, which include shortcomings in establishing accurate and up-to-date sampling frames. Failure to account for these shortcomings may result in biased estimates and detrimental effects on decision-making.

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Section: Discussionmentioning

confidence: 99%

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022

Kostandova,

Mutembo,

Prosperi

et al. 2024

PLOS Glob Public Health

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“…Here we focus on the survey conducted in Palghar District, Maharashtra conducted from April to June 2019, about 3 months after the MR campaign. The detailed study methods have been reported elsewhere [ 8 ]. Briefly, 30 villages or wards were first selected from the district based on the 2011 census, then one census enumeration block or cluster was randomly selected from each village.…”

Section: Methodsmentioning

confidence: 99%

Experiences of sharing results of community based serosurvey with participants in a district of Maharashtra, India

Salvi¹,

Itta

Lachyan³

et al. 2022

PLoS ONE

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A growing number of organisations, including medical associations, recommend that research subjects should be given the option of being informed about the general outcome and results of the study. We recently completed a study involving nine serosurveys from 2018 to 2020 in five districts of India among three age groups (children 9 months to < 5 years; 5 to < 15 years of age, and women 15 to < 50 years of age before and after the measles and rubella (MR) vaccination campaigns). In Palghar district of Maharashtra all individuals in 30 selected clusters were enumerated, and 13 individuals per age group were randomly sampled. We established the procedures to return the results to the respondents for each stage of the survey. Of the 1,166 individuals selected for the measles and rubella serosurvey, 971 (83%) agreed to participate and were enrolled. Participants were informed that they will only be contacted if they test seronegative for measles and/or rubella antibodies. Overall, 140 individuals enrolled in the survey tested seronegative for IgG antibodies to measles and/or rubella viruses; were provided the reports and informed to seek medical advice. Upon follow up by phone, 10% (14) of the 140 participants reported to have been vaccinated. In this paper we discuss the procedures, experiences and considerations in returning results to participants in a community-based measles and rubella serosurvey. Although the lessons learned are specific to post measles-rubella vaccine campaign serosurvey in India, they might be helpful to those contemplating sharing results to participants of large scale survey settings.

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“…However, there are still considerable personnel and transport costs to visit communities to conduct data and specimen collection, even in a nested design. This is especially relevant for surveys using multi-stage sampling which typically require multiple days to map and enumerate the community prior to enrollment (8,9). An alternative approach to save costs is to nest a survey within delivery platforms such as supplemental immunization activities (SIAs) where caregivers are already bringing their under five children to receive services.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and acceptability of collecting dried blood spots (DBS) from children after vaccination during Supplementary Immunization Activities to estimate measles and rubella seroprevalence

Carcelen,

Prosperi,

Hamahuwa

et al. 2024

Preprint

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Nested serosurveys within routine service delivery platforms such as planned supplemental immunization activities (SIAs) provide an opportunity to collect information that can be used to answer valuable questions on the effectiveness and efficiency of the delivery model to inform future activities. However, integrating research data collection in SIAs is rarely done due to concerns it will negatively impact the program. We conducted a serosurvey nested within the November 2020 measles-rubella SIA integrated with the Child Health Week activities in Zambia to evaluate this approach. In-depth interviews with the study teams and vaccination campaign staff at the vaccination sites were conducted. Recorded interviews were transcribed, transcripts were coded and then grouped into themes based on a process evaluation framework. A multi-methods analytical approach was used to assess the feasibility and acceptability of collecting dried blood spots from children during the SIA. This included a quantitative assessment of participant enrollment. The serosurvey successfully enrolled 90% of children from Child Health Week due to close coordination and teamwork between the vaccination teams and serosurvey team, in addition to substantial social mobilization efforts. Continually adjusting the sampling interval that was used to select eligible children allowed us to enroll throughout the SIA and capture a representative sample of children in attendance although it was challenging for the staff involved. As vaccination programs aim to tailor their approaches to reach the hardest-to-reach children, embedding research questions in SIAs will allow evaluation of the successes and challenges and compare alternative approaches. Lessons learned from this experience collecting data during an SIA can be applicable to future research activities embedded in SIAs or other delivery platforms.

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Implementing Serosurveys in India: Experiences, Lessons Learned, and Recommendations

Cited by 4 publications

References 23 publications

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022

Experiences of sharing results of community based serosurvey with participants in a district of Maharashtra, India

Feasibility and acceptability of collecting dried blood spots (DBS) from children after vaccination during Supplementary Immunization Activities to estimate measles and rubella seroprevalence

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