Public Awareness, Attitudes, and Practices Toward Digital Health Surveillance in Malawi: Cross-Sectional Study

Digital surveillance systems are increasingly recognized as essential tools for enhancing early outbreak detection, reporting, and response, especially in low-resource settings. The COVID-19 pandemic unveiled the critical role of digital health surveillance systems in timely detection, monitoring, and responses to public health threats. However, successful implementation depends on public awareness, acceptance, and willingness to participate. Limited evidence exists on how the public perceives and interacts with digital surveillance in Malawi.

The aim of the study was to assess the awareness, attitudes, and practices of adult Malawians toward digital surveillance during pandemics and epidemics.

A cross-sectional quantitative study design was used. Data were collected in 10 selected districts (Chitipa, Mzimba South, Kasungu, Lilongwe, Salima, Balaka, Thyolo, Phalombe, Blantyre, and Chikwawa) of Malawi that had high and low levels of cholera and COVID-19 disease burden. The survey recruited 1174 participants who were 18 years or older at the time of data collection. Descriptive statistics were computed using R statistical software. Ethical approval was obtained from the National Health Sciences Research Committee prior to data collection.

A total of 1174 participants were surveyed, 65% (n=768) were female, and the mean age was 36.9 (SD 14.26) years. Only 59% (n=697) demonstrated awareness of digital surveillance systems, though 51% (n=603) had smartphones and 41% (n=477) used mobile phones. A positive attitude was observed in 89% (n=1044) of respondents, with most believing digital reporting could improve outbreak control, and 80% (n=939) were confident in privacy and data security. Practices related to digital reporting were low, with only 18% (n=211) having ever reported health symptoms through any digital platform.

Enhancing digital health surveillance literacy, promoting inclusivity, and ensuring accountability will improve readiness for future pandemics through digital surveillance systems. Hence, there is a need for nationwide community sensitization programs to raise awareness about the benefits of digital health surveillance.