The Use of Public Health Digital Surveillance Systems for Infectious Disease Detection at Hajj

Abstract

Background: Mass gatherings (MGs) such as the Hajj present unique public health challenges, with millions of pilgrims from diverse backgrounds performing rituals within constrained spatial and temporal settings. These conditions amplify the risk of infectious disease transmission, while posing operational difficulties for surveillance and rapid response. Despite growing interest in digital health tools, existing initiatives at Hajj have lacked empirical validation, cost-effectiveness analysis (CEA), or structured integration into surveillance systems. Aim: This thesis aims to evaluate the feasibility of wearable sensor bracelets (WSBs) for presymptomatic infectious disease detection during Hajj, addressing gaps related to scalability, real-time data analysis, data security, user acceptance, and cost-effectiveness Methods: A mixed-methods research design comprising four interlinked studies was employed. Study 1, a systematic review, synthesised evidence on digital surveillance systems used at mass gatherings and identified gaps in design, implementation, and evaluation. Study 2 involved qualitative interviews with Hajj stakeholders, exploring perceptions of WSBs and practical considerations for adoption. Study 3 surveyed pilgrims to assess attitudes, trust, and willingness to pay (WTP), providing population-level insights into acceptance. Study 4 applied a systems approach, including system dynamics modelling and cost-effectiveness analysis, to evaluate operational feasibility and potential public health impact. Results: Findings highlight a set of interdependent technical, organisational, and user-related factors shaping feasibility. Stakeholders identified uncertainty around infrastructure readiness, inter-organisational coordination, and policy support. Pilgrims reported generally high acceptance, though cost and affordability were significant barriers. Systems modelling demonstrated that WSBs could reduce infection transmission and achieve cost-effectiveness under realistic implementation scenarios, contingent on reliable real-time data systems, coordinated triage protocols, and supportive policies. Conclusions: This thesis contributes new evidence on the feasibility of digital surveillance tools at Hajj by integrating technical, organisational, and behavioural perspectives. It underscores the promise of WSBs as a scalable surveillance innovation, while emphasising the need for future work on algorithm development, pilot deployments, and long-term integration into national and global surveillance strategies to ensure sustainable implementation and impact.