Demographic and Health Survey framework can be used as a population surveillance strategy for COVID-19, researchers say

S V Subramanian and K S James from the Centre said that in the absence of universal testing, a random-sample-based population surveillance framework is urgently needed.

3 min readPuneMay 1, 2020 10:07 PM IST

A vegetable vendor sets up his shop at NIBM annex during the lockdown.

Researchers at the Harvard Center for Population Development and Studies in the US have said a demographic and health survey framework can help as a population surveillance strategy for coronavirus.

S V Subramanian and K S James from the Centre said that in the absence of universal testing, a random-sample-based population surveillance framework is urgently needed. They have proposed using the well-established Demographic and Health Survey (DHS) framework as a solution to ascertain the true prevalence of COVID-19.

In the April 29 issue of The Lancet Global Health, the duo have said that testing for COVID-19 is mainly being done among at-risk individuals — like those with influenza-like symptoms, people who have had contact with an individual testing positive for COVID-19, healthcare professionals, or those with travel history to an affected region.

“Hence an accurate value for how many individuals are truly infected is not known. Since at-risk individuals are not representative of the general population, it is impossible to obtain the true prevalence of COVID-19 in the population. Yet, establishing this value is vital to understand the morbidity and mortality risk in the population, particularly in low-income and middle-income countries (LMICs) such as India, which cannot absorb the socioeconomic and public-health fallout resulting from national shutdowns,” Subramanian said.

In 2002, India was projected to have 25 million HIV-positive individuals with a prevalence of HIV in adults of 3–4 per cent. These estimates were based on extrapolation of infection rates among selected at-risk individuals. India used the National Family Health Survey (NFHS) to test for HIV in the general population, and estimates were sharply reduced to 2·5 million, with a prevalence of HIV in adults (aged 15–49 years) of 0·28 per cent. This discrepancy showed the shortcomings of selective testing of at-risk individuals as the basis for understanding disease prevalence in a population, the researchers said.

The NFHS has state-of-the-art infrastructure with a ready sampling framework. Layering a coronavirus-focused data-collection effort onto the NFHS infrastructure would keep operational costs low, with the major expense being laboratory costs for testing samples. They have estimated the minimum required sample of individuals who would need to be tested under three scenarios of anticipated COVID-19 prevalence in the population.

Under a scenario of 0·5 per cent prevalence, only a sample of at least 3,000 individuals would be needed for tests. The minimum required sample size increases to just over 15,000 under a rarer scenario of 0·1 per cent prevalence and decreases to 1,500 if the anticipated prevalence is 1 per cent. If the anticipated prevalence of COVID-19 be higher than 1 per cent, the minimum sample size needed to reliably estimate the true prevalence would be smaller and, therefore, fewer resources would be required, the researchers said.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

Click here to join Express Pune WhatsApp channel and get a curated list of our stories

Loading Recommendations...

Mar 07: Latest News

Live Blog