Integrating the crowdsourced image-based morbidity hotspot surveillance for neglected tropical diseases (CIMS-NTDs) into Nigeria's healthcare system: a mixed methods study

Abstract

BACKGROUND: Traditional surveillance systems for neglected tropical diseases (NTDs) often suffer from underreporting, delays and limited reach, hindering effective disease control. This study describes the integration process of crowdsourced image-based morbidity hotspot surveillance for NTDs (CIMS-NTDs) into the government-led NTD program and assesses its operational performance and stakeholder experience. METHODS: A mixed methods study embedded in an implementation research framework was conducted in Ondo State, Nigeria. A quasi-experimental design was used to compare CIMS-NTDs with the existing surveillance approach, while key informant interviews were used to explore stakeholder perceptions. Quantitative data were analysed using descriptive statistics and the Mann-Whitney U test, and qualitative data underwent reflexive thematic analysis. RESULTS: The training session had in attendance of 30 NTD personnel from the state, local government areas and wards. Results showed a >400% improvement in CIMS-NTDs knowledge following the training session. CIMS-NTDs outperformed traditional surveillance, with 62 confirmed case reports versus only 3 under the conventional system (p=0.023). Onchocerciasis was the most frequently reported NTD (62.9%). Key informants highlighted improved community engagement, data accuracy and reporting efficiency but noted challenges such as digital accessibility and funding constraints. CONCLUSIONS: Integrating digital surveillance into national NTD programs enhances case detection, reporting and intervention strategies. Sustainable adoption requires government funding, capacity building and expanded digital infrastructure to improve accessibility and impact.