Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 14, 2025
Date Accepted: Apr 1, 2026
Community and National Malaria Surveillance: Implementation Case Study of a Health Center Application in Driving Evidence-based Responses
ABSTRACT
Background:
Cambodia is targeting malaria elimination, requiring robust surveillance systems to ensure rapid case detection, classification and response. In 2017, the national malaria program introduced an Android-based mobile health center app to all malaria-endemic health centers. The app delivers real-time, geo-located, case-based reporting at the primary care level, and is integrated with a web-based Malaria Information System which uploads consolidated data and analytics to the app to drive programmatic responses.
Objective:
To describe the health center app functionality and evaluate its performance and impact on malaria surveillance, including its role in supporting elimination activities.
Methods:
The development and implementation of the health center app are described. The functionality of the system was evaluated using system-generated metadata, national surveillance data, a user experience survey conducted across 761 health centers in 21 provinces and an in-depth structured survey including 9 health centers across 3 provinces. Key metrics included technical performance, data completeness and timeliness, analytical depth and contribution to surveillance targets and user-reported app usability.
Results:
The health center app is technically robust with rapid loading times and resilient data transmission under low-bandwidth conditions. Real-time dashboards enable case management, performance tracking, risk stratification and intervention monitoring. In 2024, data completeness was high at 99% (89/90) of entries. From 1st January to 31st July 2025, 69 malaria cases were reported nationally; 23 locally acquired, 7 domestically imported and 39 internationally imported. Among the 69 cases, 95.7% (66/69) were notified and classified within 1 day. Reactive case detection was completed within 3 days for 21 of 21 eligible cases. Of 19 eligible foci, a foci response was initiated within 7 days for 16, indicating strong surveillance performance. The user experience survey showed that 71.1% (541/761) of health centers were satisfied or very satisfied with the app, 90.1% (686/761) found that technical issues were rare or absent and 71.1% (541/761) thought that system speed was fast or very fast. Although 44.3% (337/761) of health centers confirmed that they needed regular training on the app, 91.7% (698/761) found navigating the app easy or very easy. The main challenges remained limited internet connectivity, transport to remote areas and interruptions in electricity supply. In-depth surveys revealed high uptake, user confidence in reporting procedures and consistent data use, although gaps in local data analysis capacity were identified.
Conclusions:
The Cambodian health center app strengthened malaria surveillance by enabling timely, complete and structured reporting at the point of care. The system supports real-time analysis, targeted response and decentralized decision-making. Further investment in digital literacy, system integration and predictive analytics will enhance pre-elimination activities and enable seamless transition to post-elimination surveillance for preventing the re-establishment of malaria transmission in Cambodia. Clinical Trial: Not applicable
Citation
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