Bringing malaria surveillance closer to the people through digitally linking the private health sector in Kisumu Kenya: a prospective cross-sectional implementation study

Malaria is resurging in sub-Saharan Africa due to climate change, emerging drug and diagnostics resistance, new vectors and reduced international funding. More detailed oversight of epidemic dynamics is needed to support timely and targeted interventions. In Kenya, ~40% of malaria cases are managed in the private sector, however data regarding malaria cases and care provided remain largely unlinked to routine public malaria surveillance systems. Here we describe the digital engagement of private community-based providers (ConnDx) to expand malaria case detection and completeness of surveillance data. This cross-sectional study in Kisumu County, Kenya engaged five private health facilities, 25 private chemists, and 50 community health promoters. Providers were supported to perform and report malaria rapid diagnostic tests using an AI-enabled mobile application that captured images of test outcomes and transmitted them to surveillance dashboards. Analyses examined malaria positivity by provider type, demographic patterns of infection, and test outcomes across malaria test brands. Age-stratified analyses were conducted. KHIS comparison quantified ConnDx surveillance contributions. Between July 2024 and June 2025, 26,090 malaria tests were recorded through ConnDx across private health facilities, private chemists, and community health promoters. Overall, 25,993/26,090 (99.6%) test records were valid; 7035/25,993 (27.1%) were positive. Malaria positivity differed significantly by provider type: 1523/3,930 (38.8%) among community health promoters, 3260/9364 (34.8%) among chemists, and 2252/12,699 (17.7%) among private health facilities (p<0.001). Positivity was highest among children aged 0–4 years (29.2%) and 5–17 years (30.5%). Provider-type differences in positivity persisted within every age stratum (all p<0.001). Compared with contemporaneous KHIS public facility data from the same sub-counties, ConnDx real-time capture uncovered 19,816 tests invisible to KHIS monthly reporting—13,445 from unlinked providers and 6371 missed by existing reporters (all p < 0.001). Different malaria rapid diagnostic test brands showed significant heterogeneous positivity across provider types (all p<0.001). Digitally integrating private and community-based providers expands reporting from previously unlinked providers and provides important information for targeted quality improvement of private sector diagnostic performance. ConnDx captured 19,816 tests previously invisible to routine surveillance, demonstrating the population coverage benefit and the completeness gain achievable through real-time digital capture compared to monthly aggregate reporting.