Performance of Routine Disease Surveillance in Sub-Saharan Africa (2010-2024): A Systematic Review and Meta-Analysis of Core Reporting and Detection Indicators.

BACKGROUND: Public health surveillance systems are essential for early detection and control of outbreaks. This systematic review and meta-analysis assessed the performance of routine disease surveillance systems in Sub-Saharan Africa (SSA), focusing on reporting completeness, timeliness, detection and reporting of suspected cases of diseases under surveillance. METHODS: We searched PubMed and reference lists for studies published between 2010 and 2024 reporting surveillance indicators in SSA. Studies were included if they reported at least one of the following surveillance indicators: reporting completeness, timeliness, detection rate or reporting rate of suspected cases. A random-effects meta-analysis estimating pooled reporting completeness and timeliness was conducted. Narrative synthesis was used for detection and reporting indicators. RESULTS: Twenty-eight studies were included, and 10 contributed to the meta-analysis. The pooled reporting completeness was 81.97%, and pooled timeliness was 71.27%. Trends suggested improvement in reporting completeness and timeliness over time, with higher performance at the national level. Detection and reporting of suspected cases of diseases under surveillance lacked quantitative estimation in the included studies. However, narrative evidence pointed to under-detection and under-reporting of diseases under surveillance. Investigation of alerts varied widely, often constrained by weak infrastructure and limited laboratory capacity. CONCLUSION: The reporting completeness and timeliness are relatively high across SSA while significant gaps remain in the detection and notification of suspected cases. Future research should focus on standardizing and measuring detection and investigation indicators to improve the region's capacity for early warning and epidemic response.