Abstract
Across low- and middle-income countries, there have been calls to expand wastewater and environmental surveillance to include non-sewered sanitation systems. Considering public opinion, understanding, and acceptance, as well as any related privacy and personal health information concerns, is important in this context. This study used an in-person survey to learn more about the perceptions of Malawian and Malawi refugee camp residents regarding wastewater and environmental surveillance as public health tools, as well as their views on privacy and personal health information. A 15-question survey was conducted from May to July 2024 at three locations in northern, central, and southern Malawi, including a refugee camp (N = 536). Some respondents (n = 30) also completed a board game and a post-game survey. The results indicated high public support for surveilling communicable diseases, deadly diseases, environmental toxicants, healthy eating, illegal drugs, mental illnesses, and prescription drugs. Respondents were less supportive of surveillance that might expose their lifestyle behaviors and alcohol use. Regarding sampling locations, the surveillance of an entire city or of camps and schools had the highest acceptance. Some opposition to surveillance in business and religious organizations was noted. If surveilled, respondents wanted the results of the data analysis to be communicated back to them. Our findings suggested that Malawian and Malawi camp residents supported, with little concern, ongoing wastewater and environmental surveillance for public health. Considering privacy thresholds and participant autonomy regarding public health surveillance tools, along with cultural relevance, is important for future policy development and investment.