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Viral Infections and Outbreaks Research / Data Driven Disease Surveillance · Journal article
Journal of Interventional Epidemiology and Public Health · September 6, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is an uncontrolled implementation study of a field epidemiology training program in Djibouti that reports improvements in surveillance metrics (timeliness and completeness of disease reporting) and expanded surveillance capacity following program launch. The study uses interrupted time series analysis to attribute changes to the intervention, but lacks a concurrent control and is measured entirely through operational performance indicators rather than clinical or population health outcomes.
Descriptive cross-sectional study with analytical component and interrupted time series analysis. Healthcare workers selected for two cohorts of the FETP Frontline program in Djibouti; 48 enrolled, 42 completed. Study setting includes surveillance sites across Djibouti.. Intervention: Frontline Field Epidemiology Training Program (FETP Frontline) introduced in October 2021; two cohorts of healthcare workers trained in field epidemiology, investigation, and surveillance practices. Djibouti.
Completion rate of 87.5% (42 of 48 healthcare workers graduated from two cohorts) Surveillance sites increased from 30 before implementation to 82 after training Timeliness of weekly mandatory disease reporting improved from 21.7% in 2021 to 80% in 2022 (p < 0.001)
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This report documents operational improvements in public health surveillance infrastructure and capacity following a structured training program in a resource-limited setting. Professionals should recognize this as implementation evidence of system strengthening, not evidence of impact on disease detection or response outcomes; sustained surveillance performance and continued training institutionalization are necessary to assess lasting benefit.
Implementation and descriptive evaluation of a capacity-building program with before-after comparisons and interrupted time series analysis, but no control arm and measured endpoints are operational metrics rather than clinical or health outcomes.
As stated by the source record.
Quoted from the source exactly as published.
This report documents operational improvements in public health surveillance infrastructure and capacity following a structured training program in a resource-limited setting. Professionals should recognize this as implementation evidence of system strengthening, not evidence of impact on disease detection or response outcomes; sustained surveillance performance and continued training institutionalization are necessary to assess lasting benefit.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Introduction: Le renforcement des capacités nationales en épidémiologie de terrain constitue un pilier essentiel de la sécurité sanitaire mondiale et de la mise en œuvre du Règlement Sanitaire International (RSI 2005). Dans les pays à ressources limitées notamment en Afrique, les insuffisances en ressources humaines qualifiées limitent la détection précoce et la riposte efficace aux urgences de santé publique. Le Programme de Formation en Épidémiologie de Terrain de première ligne (FETP Frontline) a été introduit à Djibouti en octobre 2021. L’objectif de cette étude était de décrire le processus d’implémentation du FETP et à évaluer ses effets sur les performances du système de surveillance à Djibouti. Méthodes: Une étude transversale descriptive avec une composante analytique a été conduite de janvier 2021 à septembre 2022 à Djibouti. Les données ont été collectées à partir des rapports programmatiques, des bases de données de surveillance des maladies à déclaration obligatoire (MDO), des rapports d’investigation ainsi que d’entretiens semi-structurés avec les participants, mentors et responsables du programme. Les données ont été analysées à l’aide de statistiques descriptives avec le calcul de proportions et de tests de comparaison avant/après. Une analyse de séries temporelles interrompues (Interrupted Time Series, ITS) a également été réalisée pour évaluer l’effet de l’intervention. Résultats: Au total, deux cohortes ont été mises en œuvre, avec 48 agents de santé sélectionnés dont 42 gradués, soit un taux de complétion de 87,5 % (42/48). Le nombre de sites de surveillance est passé de 30 avant l’implémentation du programme à 82 après la formation. La promptitude et la complétude des rapports hebdomadaires des maladies à déclaration obligatoire se sont améliorées respectivement de 21,7 % et 23,1 % en 2021 à 80 % et 86 % en 2022. Ces améliorations étaient statistiquement significatives (p < 0,001). L’analyse ITS a montré un changement immédiat significatif et une amélioration progressive des tendances après l’intervention. Cinquante-deux (52) investigations de cas ou de flambées et cinq enquêtes sanitaires ont été réalisées par les résidents et gradués. Un bulletin épidémiologique hebdomadaire national et 5 bulletins épidémiologiques hebdomadaires régionaux sont élaborés et partagés à tous les acteurs. Conclusion: L’implémentation du FETP Frontline à Djibouti a permis un renforcement significatif de la surveillance épidémiologique et des capacités opérationnelles de riposte. La poursuite, l’institutionnalisation et l’extension du programme FETP sont essentielles pour consolider les acquis et renforcer durablement la sécurité sanitaire nationale. English abstract Introduction: Strengthening national field epidemiology capacity is a critical pillar of global health security and the implementation of the International Health Regulations (IHR 2005). In resource-limited settings, particularly in African countries, shortages of qualified human resources hinder early detection and effective response to public health emergencies. The Frontline Field Epidemiology Training Program (FETP Frontline) was introduced in Djibouti in October 2021. This study aimed to describe the implementation process of the FETP and evaluate its effects on the performance of the surveillance system in Djibouti. Methods: A descriptive cross-sectional study with an analytical component was conducted from January 2021 to September 2022 in Djibouti. Data were collected from programmatic reports, mandatory notifiable diseases (MND) surveillance databases, investigation reports, and semi-structured interviews with participants, mentors, and program managers. Data were analyzed using descriptive statistics, including proportion calculations and before-and-after comparison tests. An Interrupted Time Series (ITS) analysis was also performed to assess the effect of the intervention. Results: A total of two cohorts were implemented, with 48 healthcare workers selected, including 42 graduates, corresponding to a completion rate of 87.5% (42/48). The number of surveillance sites increased from 30 before program implementation to 82 after the training. Timeliness and completeness of weekly reporting for mandatory notifiable diseases improved from 21.7% and 23.1% in 2021 to 80% and 86% in 2022, respectively. These improvements were statistically significant (p < 0.001). The ITS analysis demonstrated a significant immediate change and a progressive improvement in trends following the intervention. Fifty-two (52) case or outbreak investigations and five public health surveys were conducted by residents and graduates. One national weekly epidemiological bulletin and five regional weekly epidemiological bulletins were produced and shared with all stakeholders. Conclusion: The implementation of the FETP Frontline in Djibouti significantly strengthened epidemiological surveillance and operational response capacities. Continued implementation, institutionalization, and expansion of the FETP program are essential to consolidate achievements and sustainably strengthen national health security.
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