From July 2024–February 2025, three-quarters of the districts in Uganda experienced mpox outbreaks, with sustained transmission in urban cities and towns. Following the rise in cases and severe outcomes, there was an urgent need to assess sub-national surveillance capacities to inform improvements in mpox response. This study aimed to assess the strengths, weaknesses, opportunities, and threats to mpox surveillance in Uganda’s high-burden districts and document lessons learned for responding to future outbreaks. We conducted a cross-sectional qualitative study during February–March 2025 in 30 purposively selected districts across five high-burden regions of Uganda. Participants were drawn from regional, district, facility, and community levels, including surveillance officers, clinicians, laboratory personnel, and community health leaders. Data were collected through focus group discussions using semi-structured interview guides. Notes were manually coded by two researchers and analyzed thematically using a SWOT (Strengths, Weaknesses, Opportunities, and Threats) framework. Sub-themes were developed inductively, and written informed consent was obtained from all participants. A total of twenty focus group discussions were conducted across five high-burden regions. Participants identified key strengths in mpox surveillance, including functional regional emergency coordination centers, onsite capacity building in digital tools like Go.Data, dedicated surveillance personnel, prior outbreak response experience, and the presence of trusted community health structures. However, notable weaknesses included inaccurate contact information, delayed laboratory test results, workforce shortages, misdiagnosis at lower health facilities, limited digital capacity, inadequate isolation facilities, and stockouts of essential supplies, food, and personal protective equipment. Key opportunities included scaling capacity-building efforts and enhancing surveillance infrastructure, such as call centers and toll-free lines, while surveillance threats included community fear of isolation and strain of concurrent outbreaks such as Ebola. Uganda’s mpox surveillance revealed key strengths, including functional regional coordination hubs, trusted community health structures, and dedicated surveillance personnel that supported early detection. However, gaps such as limited human resources, delayed laboratory results, stockouts, and fear of isolation hindered effective response. Addressing these challenges through investments in decentralized coordination, digital tools, surge staffing, and supply chain systems could enhance future surveillance efforts.
Mutesi et al. (Thu,) studied this question.