Determinants of delayed detection and reporting of epidemic-prone diseases in Sub-Saharan Africa: a systematic review and CFIR-guided synthesis.
8 affiliations
- 1Nigeria Centre for Disease Control and Prevention (NCDC), Abuja, Nigeria.
- 2Kaduna State University, College of Medicine, Kaduna State, Nigeria.
- 3African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB 5323, Choba, Port Harcourt, Nigeria.
- 4Department of Public Health, Faculty of Basic and Applied Biological Sciences, Ahmadu Bello University, Zaria, Nigeria.
- 5MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.
- 6African Centre of Excellence for Public Health and Toxicological Research (ACE-PUTOR), University of Port Harcourt, PMB 5323, Choba, Port Harcourt, Nigeria. [email protected].
- 7Department of Public Health, Faculty of Basic and Applied Biological Sciences, Ahmadu Bello University, Zaria, Nigeria. [email protected].
- 8Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa. [email protected].
Abstract
Background
Sub-Saharan Africa (SSA) faces a persistent burden of epidemic-prone diseases, yet health systems consistently struggle with timely outbreak detection and reporting. Despite the use of Integrated Disease Surveillance and Response (IDSR) framework, significant delays persist, which weaken effective outbreak response. This study synthesizes evidence on the determinants of these delays systematically using the Consolidated Framework for Implementation Research (CFIR) 2022.Methods
A systematic review was done using PRISMA guidelines. We searched seven databases and grey literature for empirical studies (2000-2025) on epidemic-prone disease surveillance and reporting in SSA. Forty studies (qualitative, quantitative, and mixed methods) met the inclusion criteria. The determinants identified were synthesized and mapped to the five CFIR domains: Innovation Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Implementation Process.Results
The synthesis revealed that while digital surveillance tools (eIDSR, DHIS2) improve reporting speed, their impact is limited by "Inner Setting" barriers, including chronic workforce shortages, high staff turnover, and a lack of refresher training. "Outer Setting" factors, such as insecurity in conflict zones, geographic distance, and inadequate domestic financing, significantly increase detection-to-notification intervals. Furthermore, "Characteristics of Individuals" specifically, low knowledge of case definitions and poor motivation due to lack of incentives remain critical bottlenecks to early reporting. Implementation is often hindered by dual reporting requirements and a heavy reliance on external partners for surveillance tasks.Conclusion
The delays in detecting and reporting epidemics in SSA is not merely a technical issue but rather a multi-level implementation challenge. Strengthening surveillance requires moving beyond one-off training toward sustainable domestic financing, integrated digital infrastructures, and community-level engagement to reduce "onset-to-first contact" delays.This systematic review was registered in PROSPERO (CRD420261332389).
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BibTeX
@article{nwechi2026determinants,
title = {{Determinants of delayed detection and reporting of epidemic-prone diseases in Sub-Saharan Africa: a systematic review and CFIR-guided synthesis.}},
author = {Vivian Nwechi and Augustine Usman Adaka and Sylvia Adanma Ezenwa-Ahanene and Maryam Abubakar Umar and Oghenetega ThankGod Oweh and Zubairu Dalhatu Zubairu and Polycarp Dauda Madaki},
journal = {BMC public health},
year = {2026},
month = aug,
doi = {10.1186/s12889-026-28831-x},
url = {https://europepmc.org/article/MED/42958175},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Determinants of delayed detection and reporting of epidemic-prone diseases in Sub-Saharan Africa: a systematic review and CFIR-guided synthesis.
AU - Vivian Nwechi
AU - Augustine Usman Adaka
AU - Sylvia Adanma Ezenwa-Ahanene
AU - Maryam Abubakar Umar
AU - Oghenetega ThankGod Oweh
AU - Zubairu Dalhatu Zubairu
AU - Polycarp Dauda Madaki
PY - 2026
DA - 2026/08/01
JO - BMC public health
DO - 10.1186/s12889-026-28831-x
UR - https://europepmc.org/article/MED/42958175
AB - Background Sub-Saharan Africa (SSA) faces a persistent burden of epidemic-prone diseases, yet health systems consistently struggle with timely outbreak detection and reporting. Despite the use of Integrated Disease Surveillance and Response (IDSR) framework, significant delays persist, which weaken effective outbreak response. This study synthesizes evidence on the determinants of these delays systematically using the Consolidated Framework for Implementation Research (CFIR) 2022.Methods A systematic review was done using PRISMA guidelines. We searched seven databases and grey literature for empirical studies (2000-2025) on epidemic-prone disease surveillance and reporting in SSA. Forty studies (qualitative, quantitative, and mixed methods) met the inclusion criteria. The determinants identified were synthesized and mapped to the five CFIR domains: Innovation Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Implementation Process.Results The synthesis revealed that while digital surveillance tools (eIDSR, DHIS2) improve reporting speed, their impact is limited by "Inner Setting" barriers, including chronic workforce shortages, high staff turnover, and a lack of refresher training. "Outer Setting" factors, such as insecurity in conflict zones, geographic distance, and inadequate domestic financing, significantly increase detection-to-notification intervals. Furthermore, "Characteristics of Individuals" specifically, low knowledge of case definitions and poor motivation due to lack of incentives remain critical bottlenecks to early reporting. Implementation is often hindered by dual reporting requirements and a heavy reliance on external partners for surveillance tasks.Conclusion The delays in detecting and reporting epidemics in SSA is not merely a technical issue but rather a multi-level implementation challenge. Strengthening surveillance requires moving beyond one-off training toward sustainable domestic financing, integrated digital infrastructures, and community-level engagement to reduce "onset-to-first contact" delays.This systematic review was registered in PROSPERO (CRD420261332389).
SN - 1471-2458
ER -