A comparative cross-sectional evaluation of the Field Epidemiology Training Program-Frontline in Ethiopia

Abstract

Background: The Field Epidemiology Training Program (FETP)-Frontline is a three-month in-service training aimed at improving surveillance officers' capacity to collect, analyze, and interpret surveillance data, and respond to health emergencies. We evaluated the effectiveness of the FETP-Frontline which was introduced in Ethiopia in 2016.

Methods: We conducted a comparative, randomized cross-sectional study to assess surveillance-related knowledge, skills, and performance among trained and untrained officers using a structured questionnaire and observation checklist. We compared the knowledge, skills, and performance scores of trained and untrained officers using the Fisher's Exact test, chi-square test, and t-test at p-value < 0.05 for statistical significance.

Results: We conducted the study among 74 trained and 76 untrained surveillance officers. About three-quarters of all participants were male, and the average age was 34 (± 8.6) years. Completeness and timeliness of surveillance reports were significantly higher among trained than untrained surveillance officers. The trained officers were more likely to have produced epidemiologic bulletins (55% vs 33%), conducted active surveillance six months before the survey (88% vs 72%), provided surveillance training (88% vs 65%), conducted strengths, weakness, opportunities, and threats (SWOT) analysis (55% vs 17%), and utilized Microsoft Excel to manage surveillance data (87% vs 47%). We also observed improved surveillance officers' perceived skills and knowledge, and the availability and quality of surveillance formats and reports among the trained group.

Conclusions: FETP-Frontline trained surveillance officers demonstrated better knowledge, skills, and performance in most surveillance activities compared to the untrained officers. FETP-Frontline can address competency gaps among district surveillance officers in Ethiopia and other countries. Scaling up the program to cover unreached districts can enable achieving the human resource development core capacity requirement of the International Health Regulations 2005.

Keywords: Ethiopia; Evaluation; FETP; Field epidemiology training program; Frontline.

Fig. 1

Ethiopia’s curriculum for the Field Epidemiology Training Program-Frontline, [Adapted from the US Centers for Disease Control and Prevention]. Abbreviations – FW1 Field Work-1, FW2 Field Work-2

Fig. 2

Performance (%) in surveillance activities and computer utilization among FETP-Frontline trained and untrained surveillance officers, September 2019. All differences are statistically significant (p < 0.05) except for case investigation, use of office computer and Microsoft Office program

Fig. 3

Comparison of perceived knowledge, skills and practices among FETP-Frontline trained and untrained district surveillance officers, September 2019. All comparisons between pre-training and post-training and between untrained and trained are statistically significant (p < 0.01). Pre-training and post-training scores are among the trained group, whereas the third score is for the untrained surveillance officers. Self-assessment response ranges are 1: No skill at all, 2: Limited skill, 3: Satisfactory skill, 4: Advanced skill and 5: Expert skill. Responses 4 and 5 were used to compute proportions (in percentage) of those who agreed that they had adequate perceived surveillance knowledge and skills

Fig. 4

Percent availability and quality of surveillance forms and reports by FETP Frontline training status, September 2019. All differences are statistically significant (p < 0.05) except weekly report form, case-based from (general), case-based report, rumor logbook, quality of the weekly report, quality of the case-based report, and quality of outbreak report