A COMPREHENSIVE EVALUATION OF THE "E-ALERT" MHEALTH SYSTEM FOR EARLY OUTBREAK DETECTION IN RURAL GHANA: A MIXED-METHODS IMPLEMENTATION STUDY

Abstract

Background: Timely detection of infectious disease outbreaks remains a major challenge in resource-limited settings, particularly in rural Sub-Saharan Africa, where surveillance systems are hindered by delays in reporting and limited infrastructure. In Ghana, the Integrated Disease Surveillance and Response (IDSR) system often requires 7–14 days for outbreak data transmission, creating critical delays in public health response. Mobile health (mHealth) technologies present an opportunity to improve real-time surveillance; however, evidence on their effectiveness in routine health system contexts remains limited. This study aimed to evaluate the impact of the “e-ALERT” mHealth system on outbreak detection timelines and its implementation dynamics in rural Ghana.

Methods and Materials: A sequential explanatory mixed-methods design was employed, combining a quasi-experimental nonrandomized controlled before-and-after study with qualitative inquiry. Six intervention districts implementing the e-ALERT system were compared with six matched control districts using standard IDSR processes over a 12-month period. Quantitative outcomes included time-to-detection, reporting completeness, and system performance metrics, analyzed using survival analysis and comparative statistics. Qualitative data were collected through 35 in-depth interviews and 6 focus group discussions with stakeholders and analyzed using the Consolidated Framework for Implementation Research (CFIR) to explore implementation barriers and facilitators.

Results: The e-ALERT system significantly reduced the mean time-to-detection from 11.7 days in control districts to 2.3 days in intervention districts, representing an 80% improvement (p < 0.001). Reporting completeness reached 98% in intervention areas compared to 67% in controls. The system successfully generated early alerts for cholera and measles outbreaks, providing 7–9 days of additional response time. Qualitative findings revealed increased motivation and empowerment among community health workers, alongside challenges such as parallel reporting systems and infrastructure limitations, including unreliable electricity and network connectivity.

Conclusion: The e-ALERT mHealth system demonstrated substantial effectiveness in improving outbreak detection timeliness and reporting performance in rural Ghana. However, sustainable implementation requires addressing broader socio-technical challenges, including infrastructure development, workflow integration, and policy alignment. mHealth surveillance systems have significant potential to strengthen early warning systems and enhance global health security when supported by comprehensive system-level investments.