Determinants of delayed detection and reporting of epidemic-prone diseases in Sub-Saharan Africa: a systematic review and CFIR-guided synthesis

Abstract

Sub-Saharan Africa (SSA) faces a persistent burden of epidemic-prone diseases, yet health systems consistently struggle with timely outbreak detection and reporting. Despite the use of Integrated Disease Surveillance and Response (IDSR) framework, significant delays persist, which weaken effective outbreak response. This study synthesizes evidence on the determinants of these delays systematically using the Consolidated Framework for Implementation Research (CFIR) 2022. A systematic review was done using PRISMA guidelines. We searched seven databases and grey literature for empirical studies (2000–2025) on epidemic-prone disease surveillance and reporting in SSA. Forty studies (qualitative, quantitative, and mixed methods) met the inclusion criteria. The determinants identified were synthesized and mapped to the five CFIR domains: Innovation Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Implementation Process. The synthesis revealed that while digital surveillance tools (eIDSR, DHIS2) improve reporting speed, their impact is limited by "Inner Setting" barriers, including chronic workforce shortages, high staff turnover, and a lack of refresher training. "Outer Setting" factors, such as insecurity in conflict zones, geographic distance, and inadequate domestic financing, significantly increase detection-to-notification intervals. Furthermore, "Characteristics of Individuals" specifically, low knowledge of case definitions and poor motivation due to lack of incentives remain critical bottlenecks to early reporting. Implementation is often hindered by dual reporting requirements and a heavy reliance on external partners for surveillance tasks. The delays in detecting and reporting epidemics in SSA is not merely a technical issue but rather a multi-level implementation challenge. Strengthening surveillance requires moving beyond one-off training toward sustainable domestic financing, integrated digital infrastructures, and community-level engagement to reduce "onset-to-first contact" delays.This systematic review was registered in PROSPERO (CRD420261332389).