Methodological Evaluation and Adoption Rates of Public Health Surveillance Systems in Nigeria: A Randomised Field Trial

"background": "Public health surveillance systems are critical for early disease detection and response in sub-Saharan Africa. However, their effectiveness is often limited by low adoption and inconsistent use by frontline health workers, with a paucity of rigorous field evidence on interventions to improve uptake. ", "purpose and objectives": "This case study aimed to methodologically evaluate and compare the adoption rates of two distinct surveillance system interfaces among primary healthcare workers in a Nigerian state, using a randomised field trial design. ", "methodology": "We conducted a cluster-randomised controlled trial across 60 primary healthcare centres. Centres were randomised to receive either a simplified, mobile-optimised reporting interface (intervention) or the existing standard web portal (control). Adoption was measured as the proportion of weekly reports submitted over a six-month period. The primary analysis used a generalised linear mixed model: \ (P (Y{ij=1) ) = \0 + \1 Xij + ui + eij, where Yij is submission status for centre i at time j, Xij is the intervention indicator, and uᵢ are random cluster effects. ", "findings": "The mobile-optimised interface significantly increased adoption rates. The adjusted odds ratio for complete weekly reporting was 2. 45 (95% CI: 1. 78 to 3. 36; p<0. 001). The absolute difference in mean submission completeness was 28 percentage points (intervention: 89%, control: 61%). ", "conclusion": "A user-centred redesign of surveillance system interfaces substantially improved adoption by frontline health workers under real-world conditions. ", "recommendations": "National and state health ministries should prioritise human-centred design and mobile-first platforms when deploying or upgrading digital surveillance tools. Investment in iterative usability testing with end-users before system-wide rollout is critical. ", "key words": "health surveillance, adoption, randomised trial, human-computer interaction, implementation science,