The Karonga DSS was established in August 2002 with a baseline census to register all individuals and households in the study area. Reporting by village informants on vital events and migrations forms a continuous registration system. The site is located on latitude -10.43° and longitude 34.27° and is bordered by Lake Malawi in the east, Nyika National Park in the west; the north and south demarcation follows village boundaries.

The DSS has a population of about 39,000 individuals based on 2015 mid-year population estimates, most of whom are rural dwellers who depend on subsistence farming and fishing for their livelihood and are scattered over an area of 135 km2. There are two small trading centres and a port and truck depot. The DSS area is served by two hospitals: Karonga District Hospital which is 70 km from the DSS; and Chilumba Rural Hospital which along with four minor health centres, is within the surveillance site.

In the Karonga DSS each village is divided for vital events reporting purposes into smaller geographical area (“clusters”) that represent an average of 35 households. Groups of approximately 10 clusters in a defined geographical area are combined to form the 21 reporting groups, which make up the surveillance area.

Detailed methods of the demographic surveillance are described in a cohort profile in the International Journal of Epidemiology.