Event-Based Surveillance Reporting by Village Health Teams, Kabarole District, Uganda, July 2022 ̶ March 2023: A Cross-Sectional Study

Abstract Background In July 2022, the Uganda Ministry of Health (MoH) trained Village Health Team (VHT) members in Kabarole District and rolled out the Event-based surveillance (EBS) system with an emphasis on submitting public health signals. We assessed the level of reporting and factors affecting reporting in the EBS system by VHTs in Kabarole District, southwestern Uganda, July 2022 ̶ March 2023. Methods We conducted a cross-sectional study among VHTs and key informants (KI) involved in EBS activities from the district health office and health facilities in March 2022, eight months after the rollout of EBS in Kabarole District. We used multistage sampling to recruit VHTs from sub-county to village levels. Purposive sampling was used to select KIs involved in EBS activities to gain insight into factors influencing EBS reporting. We collected data using an interviewer-administered questionnaire containing socio-demographic and occupational characteristics and a KI interview guide. We assessed the proportion of VHTs who submitted any public health signal in the EBS system from July 2022 - March 2023. Multivariable logistic regression analysis was used to identify factors associated with reporting. Qualitative data were analyzed using thematic content analysis. Results Among 380 participating VHTs from 189 villages, 258 (68%) were female, 262 (69%) had attained secondary school education, and 288 (76%) had worked >5 years as VHT. Mean age was 44±12 years. Ninety-one (24%; 95%CI: 17-38%) respondents had reported a public health signal in the EBS system. Reporting was associated with age >45 years (adjusted odds ratio [aOR]=2.4; 95%CI: 3.3-5.7), being female (aOR=2.8; 95%CI: 2.0-5.7), doing VHT work >5 days per week (aOR=4.4, 95%CI: 1.2-5.1), and having at least secondary school education (aOR=1.1, 95%CI: 1.2-4.8). Factors influencing reporting included remuneration, feedback, and support supervision from the district health authorities. Conclusion A quarter of VHTs in Kabarole District reported public health signals in the EBS system during the eight-month period following implementation. Leveraging older, more experienced VHTs with higher education levels as mentors and providing routine support supervision of VHTs may improve reporting of public health signals in the EBS system.