Design and validation of a digital surveillance support system for febrile illness detection and reporting in primary boarding schools in Uganda: a mixed-methods design science study

Abstract Background Febrile illnesses are an important cause of morbidity and school absenteeism among children in Uganda. Primary boarding schools present particular surveillance challenges because children live in close proximity and school health records are often maintained outside routine digital health information systems. This study aimed to design and validate models for a Febrile Digital Surveillance Support System (FDSSS) to strengthen early detection, reporting and management of febrile illnesses in primary boarding schools in Mukono Central Division, Uganda. Methods A Design Science Research approach was integrated with a cross-sectional mixed-methods design. Structured surveys were conducted among school health and welfare stakeholders, with 36 respondents contributing to assessment of current surveillance practices, 39 to barriers and enablers, 35 to user requirements, and 30 to model validation. Key informant interviews with school and district health stakeholders provided contextual and operational insights. Quantitative data were summarized using descriptive statistics and qualitative data were analysed thematically. Findings from the first three objectives were synthesized into conceptual and system design models, including workflows, use cases, data-flow models, entity-relationship models and interface concepts. The models were validated using a Technology Acceptance Model-based five-point Likert questionnaire. Results All surveyed schools maintained records of febrile cases, but documentation was entirely paper based. Symptom observation was used by 100% of respondents, while temperature checks and self-reporting were each reported by 77.8%. Reporting was predominantly weekly (72.2%) and relied on telephone communication (100%). Cases were commonly reported to headteachers and nearby health facilities (80.6% each), whereas only 11.1% were reported directly to district offices. Major barriers were inadequate ICT infrastructure (92.3%) and limited staff training (79.5%). All respondents expressed willingness to adopt digital surveillance tools. Desired functions included real-time reporting, automated alerts, dashboards, decision support, mobile access, offline capability and interoperability with DHIS2. In validation, perceived usefulness had a 99.3% positive response rate; 93.3% agreed that the system would be easy to learn, 100% intended to use it, and 100% considered the dashboard interpretable and captured data relevant. Facilitating conditions were comparatively weaker, particularly internet connectivity and device availability. Conclusions School-based febrile illness surveillance in the study setting is largely manual, fragmented and weakly connected to district reporting structures. The validated FDSSS models provide a user-centred framework for real-time case capture, alerts, dashboards, response coordination and potential interoperability with DHIS2. Implementation should be preceded by strengthening ICT infrastructure, connectivity, devices, user training and technical support, followed by prospective evaluation of effectiveness, cost and sustainability.