preprint · medRxiv
Between May 2021 and May 2025, public health surveillance systems were evaluated across four counties in Kenya to assess the sensitivity and timeliness of disease outbreak detection and response. Using the global 7-1-7 benchmark, which targets detection within seven days, notification within one day, and response within seven days, the evaluation analysed 28 confirmed outbreaks. Event-Based Surveillance detected 57.1 percent of the outbreaks, successfully achieving seven-day detection in all instances and one-day notification in 81.3 percent of cases. Indicator-Based Surveillance demonstrated higher completion rates for early response activities within seven days at 75.0 percent, compared to 68.8 percent for Event-Based Surveillance. Overall, just over half of all outbreaks met all 7-1-7 targets. Enablers included community health promoters and digital dashboards, whilst reporting downtime, transport deficits, and laboratory delays presented significant operational bottlenecks.
Early containment of infectious disease outbreaks prevents widespread transmission, economic loss, and human suffering. By measuring surveillance performance against international timeliness standards, this evaluation clarifies where public health systems succeed and where operational gaps remain. Understanding the complementary strengths of community-driven event reporting and structured indicator systems provides health authorities with clear evidence to optimise emergency preparedness and allocate response resources effectively.
This study evaluates real-world public health operational workflows rather than a commercial product. However, it indicates clear operational demand for digital reporting tools, hotlines, and dashboard information systems among public health authorities and disease surveillance teams. Technology developers creating digital disease tracking platforms, laboratory logistics software, or emergency communication tools could target these operational bottlenecks, though the research itself reflects applied health systems evaluation rather than technology commercialisation.
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Abstract Background Timely detection and response to public health threats are essential to mitigating outbreaks. Kenya adopted a phased rollout of Event-Based Surveillance (EBS) in May 2021 to complement Indicator-Based Surveillance (IBS). We evaluated the sensitivity of EBS and the timeliness of both EBS and IBS systems for confirmed outbreaks across four Kenyan counties. Methods We conducted a retrospective analysis of outbreak data from May 2021 to May 2025 in four counties in Kenya. We administered a structured questionnaire with the following variables: confirmed disease outbreak, dates of emergence, detection, notification, and initiation of each early response action, and the surveillance system that detected it. We also included bottlenecks and enablers for timely detection, notification, and response. The EBS sensitivity was summarized as a proportion, with the numerator being the outbreaks detected through EBS and total outbreaks as the denominator. Timeliness was measured using the 7-1-7 target, a global benchmark for measuring the timeliness of outbreak detection and response, where outbreaks should be detected within 7 days of disease emergence, notified within 1 day of detection, and initial response actions completed within 7 days of notification. The bottlenecks and enablers were summarized in a table. Results We recorded a total of 28 confirmed outbreaks across the four years, of which 16 (57.1%, 95% C.I.: 34–72%) were detected through EBS. A total of 15 (53.6%) met the full 7-1-7 metrics. Among EBS-detected outbreaks: 100.0% were detected within 7 days of emergence, 81.3% were notified within 1 day after detection, and 68.8% had initial response activities completed within 7 days after notification. For IBS, 83.3% were detected within 7 days, 75.0% notified within 1 day, and 75.0% had initial response activities completed within 7 days. Five of the seven (71.4%) Anthrax outbreaks met all the metric targets. Detection and notification were enabled by community systems (trained health promoters, linkages, and awareness), information systems (hotlines, dashboards, and digital reporting), and response systems (sample referral, and rapid response teams). Bottlenecks included limited reach, low suspicion, stigma, reporting downtimes, delayed escalation, and constrained response capacity due to funding, transport, personnel, and laboratory delays. Conclusion The results demonstrate that EBS contributes significantly to outbreak detection and notification, while IBS contributes more to response. Therefore, there is a need to leverage EBS’s strength in early detection and notification, and IBS’s better timeliness in response for a more timely system.
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DOI: 10.64898/2026.08.06.26359848
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