peer review
Recurrent outbreaks of Ebola virus disease in the Democratic Republic of the Congo present critical health security challenges for neighbouring Uganda. A systematic review evaluated seventy-one peer-reviewed and grey-literature sources published between 2000 and 2026 to assess regional preparedness capacities, vulnerabilities, and priorities. Existing evidence heavily focuses on border surveillance, point-of-entry measures, contact tracing, infection prevention, and cross-border coordination. Key initiatives deployed across the region include mobility mapping, traveller screening, healthcare workforce training, and laboratory network strengthening. While substantial operational capacity has been established over two decades in disease surveillance, laboratory readiness, and bilateral cooperation, significant challenges remain. Critical gaps persist regarding long-term preparedness sustainability, interventions in humanitarian contexts, and emerging response domains, highlighting the necessity for integrated and durable regional health systems.
Infectious disease outbreaks frequently cross national borders, making regional cooperation essential for containment. By synthesizing two decades of evidence from Uganda and the Democratic Republic of the Congo, this review provides public health agencies and international partners with clear insight into which biosecurity measures work, where vulnerabilities remain, and how to allocate resources effectively to prevent future regional epidemics.
The abstract does not indicate a commercialisation pathway, as it focuses entirely on public health policy, regional governance, and institutional surveillance systems.
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Background Recurrent Ebola virus disease (EVD) outbreaks in the Democratic Republic of the Congo (DRC) continue to pose substantial cross-border health security risks to neighbouring countries, particularly Uganda. Although numerous preparedness initiatives have been implemented to prevent, detect, and respond to cross-border Ebola transmission, evidence on their effectiveness, strengths, and persistent gaps remains fragmented across peer-reviewed and grey-literature sources. This review synthesized available evidence on cross-border Ebola preparedness in Uganda and the DRC and identified key capacities, challenges, and priorities for strengthening regional health security. Methods A systematic review was conducted in accordance with PRISMA 2020 and reported using the Synthesis Without Meta-analysis (SWiM) framework. PubMed, Scopus, Web of Science, African Journals Online (AJOL), and major grey-literature sources were searched from January 2000 to 18 May 2026. Findings were synthesized across nine predefined preparedness domains. Results Seventy-one evidence sources were included, comprising 32 primary studies and 39 grey-literature documents. Evidence was most concentrated in border surveillance and point-of-entry preparedness (24 sources), contact tracing and rapid response (22 sources), cross-border mobility and importation risk (18 sources), infection prevention and control (17 sources), and regional governance and coordination (17 sources). Preparedness activities included mobility mapping, traveller screening, healthcare-worker training, laboratory strengthening, risk communication, and cross-border coordination mechanisms. The synthesis identified substantial preparedness capacity across surveillance systems, laboratory readiness, healthcare-facility preparedness, and regional collaboration. However, important gaps persisted in some major preparedness domains. Conclusions Cross-border Ebola preparedness in Uganda and the DRC has expanded considerably over the past two decades through investments in surveillance systems, laboratory networks, healthcare-worker preparedness, and regional coordination. Nonetheless, persistent vulnerabilities remain in humanitarian settings, preparedness sustainability, and emerging preparedness domains. Strengthening integrated, sustainable, and cross-border health-security systems will be critical for mitigating future Ebola threats and enhancing epidemic preparedness across East Africa.
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DOI: 10.5256/f1000research.204774.r516225
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