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Cohort profile : Bandim Health Project’s (BHP) rural Health and Demographic Surveillance System (HDSS)—a nationally representative HDSS in Guinea-Bissau
  1. Sanne Marie Thysen1,2,3,4,
  2. Manuel Fernandes2,
  3. Christine Stabell Benn1,2,3,
  4. Peter Aaby1,2,
  5. Ane Bærent Fisker1,2,3
  1. 1 OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  2. 2 Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
  3. 3 Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
  4. 4 Center for Global Health, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr. Ane Bærent Fisker; a.fisker{at}


Purpose Bandim Health Project (BHP) monitors health and survival of women and children in a nationally representative rural Health and Demographic Surveillance System (HDSS) in Guinea-Bissau. The HDSS was set up in 1989–1990 to collect data on health interventions and child mortality.

Participants The HDSS covers 182 randomly selected clusters across the whole country. The cohort is open, and women and children enter the cohort, when they move into the selected clusters, and leave the cohort, when they move out or die, or when children reach 5 years of age. Data are collected through biannual or more frequent household visits. At all village visits, information on pregnancies, vital status, vaccination status, arm circumference, use of bed nets and other basic information is collected for women and children. Today, more than 25 000 women and 23 000 children below the age of 5 years are under surveillance.

Findings to date Research from the BHP has given rise to the hypothesis that vaccines, in addition to their targeted effects, have important non-specific effects altering the susceptibility to other infections. Initially, it was observed that mortality among children vaccinated with the live BCG or measles vaccines was much lower than the mortality among unvaccinated children, a difference, which could not be explained by prevention of tuberculosis and measles infections. In contrast, mortality tended to be higher for children who had received the non-live Diphtheria-Tetanus-Pertussis vaccine compared with children who had not received this vaccine. Since the effect differed for the different vaccines, no bias explained the contrasting findings.

Future plans New health interventions are introduced with little assessment of real-life effects. Through the HDSS, we can describe both the implementation of interventions (eg, the vaccination programme) and their effects. Furthermore, the intensive follow-up allows the implementation of randomised trials testing potential better vaccination programmes.

  • health and demographic surveillance system
  • non-specific (heterologous) effects of vaccines
  • community child health
  • maternal mortality

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors PA established the surveillance and implemented the original census in collaboration with MF. SMT and ABF now manage the surveillance and drafted the article. MF, CSB and PA were involved in critical revision of the article. All authors were involved in final approval of the article.

  • Funding BHP has no core funding and the past 28 years of data collection has been financed through grants from many different funders. The original censuses were funded by UNICEF and World Bank.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the BHP’s rural HDSS can be made available on a collaborative basis (

  • Patient consent for publication Not required.

  • Map disclaimer The depiction of boundarieson the map(s) in this article do not imply the expression of any opinionwhatsoever on the part of BMJ (or any member of its group) concerning the legalstatus of any country, territory, jurisdiction or area or of its authorities.The map(s) are provided without any warranty of any kind, either express orimplied.