Design and validation of a digital surveillance support system for febrile illness detection and reporting in primary boarding schools in Uganda: a mixed-methods design science study
This mixed-methods design science study developed and validated a user-centered digital surveillance support system for febrile illness detection in Ugandan primary boarding schools, revealing that while current manual reporting is fragmented and hindered by infrastructure gaps, the proposed system demonstrates high potential for adoption and effectiveness in enabling real-time, interoperable disease monitoring.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, the school day is not just a time for learning, but a critical moment for public health. When children live together in boarding schools, sleeping in the same dormitories and sharing meals, they create a unique environment where illnesses can spread quickly. If a fever starts in one child, it can ripple through the entire population within days. For decades, health officials have relied on systems to track these outbreaks, often using digital tools to collect data from clinics and hospitals. However, a gap often exists between the school gates and the district health office. In many places, the moment a child feels sick, the information is written on a piece of paper, kept in a notebook, and perhaps spoken about over a phone call. This manual process is slow, prone to errors, and often fails to alert authorities until an outbreak has already grown. The challenge is not just about having technology, but about creating a reliable path that connects the first sign of sickness in a classroom to the experts who can stop a disease from spreading.
A team of researchers in Uganda set out to solve this specific problem by designing a new way to track fevers in primary boarding schools. They focused on the Mukono Central Division, where they studied ten boarding schools to understand how illness was currently being reported. They found that while the schools were diligent about noticing sick children, the system was entirely paper-based. Every school kept records of fever cases, but these were handwritten in registers. The staff, who included nurses, matrons, and teachers, relied heavily on watching for symptoms like shivering or fatigue, and sometimes checking temperatures. When a child was found to be sick, the information traveled mostly by telephone. Reports were sent to the headteacher and nearby health clinics, usually once a week. Very few schools reported directly to the district health office, and almost no one used digital tools like text messages or online forms. The researchers identified that the biggest hurdles were a lack of computers and internet connections, as well as a shortage of staff trained to use digital tools. Despite these obstacles, every single person they spoke to expressed a strong desire to switch to a digital system.
To bridge this gap, the researchers used a method called design science research. Instead of simply buying an existing app and trying to force it into the schools, they started with the real-world problems they observed. They interviewed staff, mapped out exactly how they currently worked, and listened to what they needed. From these conversations, they built a custom blueprint for a digital support system. This proposed system was designed to be simple and practical. It would allow staff to enter data about a sick child directly into a mobile device, even if the internet was not working at that moment. The system would automatically check the data for errors and, if it saw a pattern that suggested an outbreak, it would send an immediate alert to the school and the district. It also included a visual dashboard, a screen that would show trends and help leaders see the big picture of health in the school. Crucially, the design included a plan to eventually connect with the national health database, so that school-level data could flow seamlessly into the country's wider health monitoring network.
The researchers then tested their blueprint with the very people who would use it. They gathered thirty stakeholders, including school administrators and health officials, to review the proposed system. They asked if the design made sense, if it would be easy to learn, and if it would actually help them do their jobs. The response was overwhelmingly positive. Nearly everyone agreed that the system would be useful for catching fevers earlier and reporting them faster. They felt confident that they could learn to use it quickly and that it would fit naturally into their daily routine. The visual dashboard was seen as clear and easy to understand, and the alerts were considered actionable. Most importantly, every single participant said they intended to use the system once it was built. However, the group also noted that while the idea was sound, the physical conditions needed to make it work were not yet perfect. They pointed out that without reliable internet, enough devices, and ongoing training, the system would struggle to succeed.
The study concludes that while the schools are already doing a good job of noticing sick children, the way they share that information is outdated and disconnected. The new digital models offer a clear path forward, turning a fragmented, paper-heavy process into a coordinated, real-time network. The design is ready, and the people who need it are eager to adopt it. But the work is not finished. Before this system can save lives by stopping outbreaks, the physical foundation must be laid. This means providing the schools with the necessary computers and internet connections, training the staff thoroughly, and ensuring technical support is always available. The researchers emphasize that the success of this project depends on building these conditions first. Only then can the digital tools be deployed to transform how fevers are tracked, ensuring that when a child in a boarding school gets sick, the warning reaches the right people instantly, allowing for a faster and more effective response.
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