Strengthening Global Disease Surveillance and Response through Field Epidemiology Training: Insights from Sri Lanka’s FETP-2025

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The initiative aimed to strengthen national capacity for timely disease surveillance and outbreak response by building a skilled and responsive public health workforce. Methods A two-week FETP was conducted by the Epidemiology Unit of Sri Lanka in collaboration with the World Health Organization (WHO). The programme trained 25 district-level public health officers, including six Regional Epidemiologists and 19 Medical Officers of Health, using a blended learning approach. The curriculum combined interactive lectures, field visits, practical data analysis exercises, and real-world case studies, focusing on core epidemiological concepts, outbreak investigation, vaccine-preventable disease surveillance, and the One Health approach. Pre- and post-training assessments were used to measure knowledge gains, analyzed using the Wilcoxon signed-rank test. Results Participants demonstrated a statistically significant 29.9% improvement in knowledge following the training (p < 0.001). Qualitative feedback and observational assessments also indicated strengthened competencies in surveillance, outbreak investigation, and evidence-based decision-making. Conclusions The FETP 2025 effectively enhanced the skills of public health officers involved in frontline disease surveillance and response. To ensure sustained impact, it is recommended that future iterations of the programme expand in duration, incorporate advanced epidemiological modules, and establish structured post-training mentorship and evaluation mechanisms. These enhancements will further support Sri Lanka’s commitment to IHR (2005) implementation and the development of a resilient, well-prepared public health system. Field Epidemiology Training Programme Disease Surveillance Outbreak Response Sri Lanka Introduction The country context Sri Lanka, a South Asian Island nation has made significant strides in public health and disease control despite being a lower-middle-income country. The country's health system is predominantly government-funded and provides free healthcare services to its citizens through an extensive network of institutions and personnel across national, provincial, district, and grassroots levels The organizational structure of the health system is tiered. At the national level, the Ministry of Health oversees policy, planning, and regulation, supported by specialized units, including the Epidemiology Unit, which plays a central role in communicable disease surveillance, outbreak investigation, immunization programs, and public health preparedness. The Provincial Health Services operate under the authority of Provincial Councils, aligning national policies with local needs. Each district is managed by a Regional Director of Health Services (RDHS), responsible for implementing health programs and coordinating public health activities. Regional Epidemiologist is the (RE) a medical doctor, serves as the key point of contact for all epidemiology-related activities within districts in RDHS office. At the grassroots level, the Medical Officer of Health (MOH), a medical doctor responsible for overseeing public health services within health subunits, areas form the foundation of community health delivery, where field-level staff such as Public Health Inspectors (PHIs) and Public Health Midwives (PHMs) engage directly with the population. The Epidemiology Unit, under the Ministry of Health, serves as the technical focal point for disease surveillance, response coordination, and health information dissemination, working collaboratively with MOH offices and other stakeholders to ensure timely detection and control of health threats. Its role has been critical in managing endemic diseases and responding to emerging public health challenges. The Field Epidemiology Training Programme (FETP), modeled after the U.S. CDC’s Epidemic Intelligence Service, is a critical strategy for building epidemiologic capacity and has been implemented in over 80 countries, including Sri Lanka (CDC, 2011; WHO, 2020). The Sri Lanka FETP is a unique in-service training initiative aimed at strengthening the field epidemiology competencies of Regional Epidemiologists (REs) and Medical Officers of Health (MOHs), aligning with global standards. FETP-trained personnel have significantly enhanced the capacity of the Epidemiology Unit and the wider health system to detect, investigate, and respond effectively to emerging and re-emerging public health threats. According to the International Health Regulations (IHR, 2005), countries are expected to have at least one trained field epidemiologist per 200,000 population (Department of Census and Statistics, 2024). Sri Lanka relaunched its FETP in 2025 after a decade-long pause. The first cohort included 25 participants (6 Regional Epidemiologists, 16 Medical Officers of Health and 3 Community Medicine trainees) and based on the feedback and curriculum improvements the subsequent trainings will facilitate incremental increase of trained field epidemiologists across the country to meet the IHR 2005 targets. Preparatory Phase The relaunch of the FETP in Sri Lanka was a strategically planned initiative, grounded in collaboration, evidence, and capacity-building priorities. Recognizing the critical need to strengthen field epidemiology capacity in the country, the Epidemiology Unit initiated a long-term partnership with the WHO, securing financial support from the Pandemic Fund. This support aligned with national priorities and the global Preparedness Framework, underscoring Sri Lanka’s commitment to pandemic prevention, preparedness, and response (Risk Assessment and Field Epidemiology for Health Security Threats in the WHO South-East Asia Region, 2023). A key early step was the conduct of a WHO scoping mission to Sri Lanka from 2–7 February 2025, which included an international FETP expert. The mission assessed the country’s training landscape using the WHO South-East Asia Regional Roadmap to Advance Field Epidemiology Capacities (2025–2029) as a guiding framework (WHO, 2025). This comprehensive assessment examined training needs, existing infrastructure, and stakeholder engagement, with the goal of embedding core field epidemiology competencies into the national public health system. A qualitative study exploring how learning occurs within FETPs in Australia, Japan, Mongolia, and Taiwan highlights FETPs as one of the most effective mechanisms for strengthening the public health workforce in preparation for future pandemics (Griffith et al, 2025). A multi-disciplinary team led by the Epidemiology Unit developed a two-week in-service FETP targeting mid-level public health professionals. The programme, informed by prior findings, integrates classroom and field-based learning, with built-in monitoring for continuous improvement. As the first national FETP in over a decade, it marks a significant step toward strengthening Sri Lanka’s public health workforce. Nominations from RDHS The Epidemiology Unit invited nominations for the FETP from all districts across Sri Lanka, requesting the participation of REs and MOHs. Based on recommendations from the respective RDHS, a total of 6 REs and 19 MOHs were selected, ensuring broad geographic representation. As this is a full-time, in-service residential training programme, participants from outside the Western Province were provided with accommodation, meals, and daily transport to the Epidemiology Unit to support their participation. Preparatory Activities Prior to the Commencement of FETP Before launching the FETP, extensive preparations were made to ensure smooth implementation. Participants were to receive course material files containing evaluation tests, lecture notes, evaluation forms, supervision formats, and case scenarios. Evaluation formats were updated to align with the revised curriculum, incorporating feedback from consultants and past participants of the Regional FETP Programme at NCDC India. The inauguration agenda and timetable were drafted and finalized through consultation. Lectures were assigned to relevant trainers, and logistical needs such as venue, meals, and printing were arranged in advance. Participants received invitation letters a week prior, with guidelines and a checklist. A group was also created in an instant messaging app to facilitate communication and resource sharing. During the FETP During the FETP, participants were officially registered at the inauguration ceremony and provided with a course material file containing key documents for easy reference. The event commenced with a warm welcome by the Chief Epidemiologist, Deputy Director General (Public Health Services) I and representatives from the WHO, joined virtually via Zoom, alongside the team from the Epidemiology Unit. Following the inauguration, the training sessions began with a lecture on the importance of epidemiology and disease surveillance in national development. Methodology of teaching The curriculum was designed to provide participants with a well-rounded understanding of key public health concepts and practical skills. It covered a comprehensive range of topics, including the basic principles of epidemiology (20%), disease surveillance systems (8%), and epidemic preparedness and response (5%). Participants were trained in outbreak investigation methodologies (13%) and proper procedures for the collection, storage, and transportation of laboratory specimens (5%). The program also focused on the design and implementation of field-based studies (3%), data analysis (5%) at both institutional and community levels, and effective report writing and presentation skills (3%). Emphasis was also placed on the One Health approach to disease control (8%), highlighting the interconnectedness of human, animal, and environmental health. Participants received technical updates and the latest scientific knowledge (5%) in these areas to ensure alignment with current best practices (3%). The training followed a blended learning approach, combining classroom-based instruction with practical field experience (20%) . The two-week programme included visits to a hospital, MOH office, and laboratory , giving participants valuable hands-on exposure. The following teaching methods were employed: Interactive lectures with integrated discussions (50%) Group activities and participant-led presentations (20%) Field visits to National Hospital, Lady Ridgeway Hospital Colombo, MOH offices and Medical Research Institute Colombo (20%) Real-time data analysis using excel and google sheets, report development, and plenary presentations (10%) In addition to the core training modules, participants were briefed on recent public health events, including the leptospirosis outbreak in Jaffna, Hepatitis outbreak in Polonnaruwa, Food borne outbreak in Matale and the measles outbreak in 2024 . Regional Epidemiologists shared insights into the control measures initiated, including vaccination campaigns and community interventions. As part of the group work, participants delivered presentations focusing on Vaccine-Preventable Diseases (VPDs) , the completeness of disease surveillance returns , and findings from supervisory visits to MOH offices and hospitals within their respective districts. Several invited resource persons served as lecturers, including representatives from WHO SEARO, WHO Sri Lanka and provincial and district epidemiologists from the Central Province and Colombo. Consultant Community Physicians (CCPs) who received training through the FETP in India also contributed to the sessions. This participatory and practice-oriented training model aimed to build the capacity of middle-level public health professionals to effectively manage disease surveillance and outbreak response in their local settings. Summary of Topics Covered The Field Epidemiology Training Programme commenced with foundational sessions introducing the principles and value of epidemiology and disease surveillance in national development. Participants were oriented to descriptive epidemiology, including the analysis of disease by time, place, and person, and measures of disease frequency. The programme explored disease causation, modes of transmission, and control strategies, along with practical exercises in calculating disease frequency and preparing presentations. These sessions set the stage for understanding the scope and application of epidemiology in real-world health challenges. Midway through the programme, the focus shifted to disease surveillance systems and immunization efforts in Sri Lanka. Participants were introduced to the national e-surveillance system and the Expanded Programme on Immunization (EPI), with emphasis on vaccine-preventable diseases, cold chain management, and Adverse Events Following Immunization (AEFI). Additional sessions covered pandemic preparedness and hands-on data analysis using Excel and Google Sheets. Field experiences included hospital and MOH office visits, followed by participant presentations, allowing for contextual learning through real-life observation and reporting. In the final phase, participants engaged in applied outbreak management training, including report writing, desk reviews, and practical sessions on investigating and managing disease outbreaks. Topics such as leptospirosis control, water and foodborne illnesses, zoonotic diseases, and antimicrobial resistance were also covered. The programme concluded with sessions on risk communication, public health leadership, and the role of laboratories and middle-level managers in disease control. Results At the end of the two-week programme, participants demonstrated a 29.9% improvement in post-test scores (Table 1 ), indicating a significant increase in knowledge following the intervention. The improvement was statistically significant, as confirmed by the Wilcoxon signed-rank test (p < 0.001) (Table 2 ). Table 1 Pre- and Post-Training Knowledge Assessment Scores by District District Pre Total Post Total Difference (post-pre) Kurunegala 14 14 0 Colombo 16 19 3 Matale 12 15 3 Kandy 9 15 6 Ratnapura 12 19 7 Nuwara Eliya 5 13 8 Kalutara 6 13 7 Colombo 14 17 3 Colombo 14 18 4 Colombo 15 14 -1 Matara 15 26 11 Jaffna 10 12 2 Kandy 13 13 0 Kalmunai 19 21 2 Vavuniya 6 9 3 Puttalam 7 11 4 Ampara 12 14 2 Trincomalee 14 17 3 Kegalle 9 15 6 Batticaloa 13 17 4 Monaragala 13 14 1 Kilinochchi 18 19 1 Matale 10 12 2 Kalutara 10 15 5 Kurunegala 8 10 2 Total 294 382 88 (29.9%) Table 2 Comparison of Pre- and Post-Test Scores with Wilcoxon Test Results Metric Value Total Pre-Test Score 294 Total Post-Test Score 382 Percentage Change (%) 29.9% Wilcoxon Test Statistic 0.0 P-value < 0.001 Participant feedback further suggested perceived improvements in skills related to surveillance, outbreak response, and evidence-based decision-making (Annex I). All lecture materials and resources were shared via a cloud-based platform for use in district-level training. A FETP 2025 Alumni group and an existing messaging group were maintained to support ongoing communication, peer learning, and coordination during future public health events. Conclusions The training programme was associated with short-term gains in knowledge and reported improvements in participant confidence, particularly in managing vaccine-preventable diseases and applying public health concepts. Qualitative feedback highlighted increased confidence and enthusiasm for field epidemiology, along with a strong interest in further practical training. Suggestions for programme enhancement included extending the training duration, incorporating more practical and case-based learning activities, simulating real-life outbreak scenarios, improving logistical planning, clarifying roles during field visits, and providing ongoing mentoring support. Participants also expressed a preference for a modular, practice-oriented format with more hands-on training in data analysis, outbreak investigation, and laboratory procedures. Limitations Several limitations should be acknowledged. The study lacked a long-term follow-up component, which limited the ability to assess the sustainability of knowledge retention, translation into daily practice, or impact on real-world job performance. As such, it remains uncertain whether the observed gains were maintained beyond the immediate post-training period or led to measurable improvements in field epidemiology practice. Additionally, the evaluation relied heavily on pre- and post-test scores and participant self-reported feedback. While these tools are useful for capturing immediate learning outcomes and subjective impressions, they may not fully reflect the development of practical skills, critical thinking, or behavioral changes in professional settings. Objective measures such as observed performance assessments, real-time case evaluations, or long-term tracking of workplace impact were not included, limiting the depth of evaluation. The absence of a control group or comparison cohort also limits the ability to attribute improvements solely to the training intervention. Lessons learned Future iterations should consider extending the duration of the programme, integrating more advanced and specialized modules, and formalizing structured post-training mentorship. Additionally, implementing standardized evaluation tools will be essential for tracking long-term outcomes, including the application of skills in real-world settings and contributions to public health systems strengthening. Declarations Clinical trial number Not applicable Ethics approval and consent to participate FETP is an initiative approved by the Ministry of Health. Ethical clearance and publication approval were granted by the Institutional Review Board of the Epidemiology Unit, Ministry of Health ( https://www.epid.gov.lk/ ). Participation in the programme was determined through a selective admissions process, and all individuals participated voluntarily. Informed consent was obtained from all participants for the use of their pre- and post-assessment data prior to inclusion in the study. All procedures were conducted in accordance with institutional guidelines and regulations, and aligned with the ethical principles of the Declaration of Helsinki. Consent for publication All included data has been anonymized. Participants whose transcript data are included in the manuscript had the opportunity to review the text and provide consent. Competing interests The authors declare no competing interests. Funding WHO Author Contribution P.K. and A.P. drafted the main manuscript and prepared the tables. All authors contributed technical guidance and reviewed the final manuscript. Acknowledgement We extend our sincere gratitude to the staff of the Epidemiology Unit, Ministry of Health, Sri Lanka, for their invaluable support in organizing and facilitating the Field Epidemiology Training Programme (FETP) 2025. We also thank the World Health Organization (WHO) for their financial assistance. Special appreciation is extended to all FETP 2025 participants for their active engagement, dedication, and valuable contributions throughout the training. Data Availability Available from the corresponding author on reasonable request. References Centers for Disease Control and Prevention (CDC). Strengthening the nation's public health system through a national field epidemiology training program. U.S. Department of Health and Human Services; 2011. https://www.cdc.gov/eis . World Health Organization (WHO). (2020). Field epidemiology training programs (FETPs): Building and sustaining a resilient and skilled public health workforce. https://www.who.int/publications/i/item/9789240012068 World Health Organization. Joint external evaluation tool: international health regulations. (2005). In: Institutional Repository for Information Sharing. 2nd ed: W.H. Organization, Editor; 2018. Department of Census and Statistics. Ministry of Finance, Planning and Economic Development, Census of Population and Housing 2024 Enumeration Stage. Department of Census and Statistics; 2024. Strategic Framework for Action for Strengthening Surveillance, Risk Assessment and Field Epidemiology for Health Security Threats in the WHO South-East Asia Region. (2023). https://www.who.int/publications/i/item/9789290210030 World Health Organization. South-East Asia Regional roadmap to advance field epidemiology capacities: 2025–2029. WHO Regional Office for South-East Asia; 2025. Griffith, M. M., Field, E., Huang, A. S. E., Shimada, T., Battsend, M., Housen, T.,… Kirk, M. D. (2025). How does learning happen in field epidemiology training programmes?A qualitative study. BMC Medical Education, 25(1), 411.. Additional Declarations No competing interests reported. Supplementary Files ANNEXIFETP.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 23 Sep, 2025 Reviews received at journal 17 Sep, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviewers agreed at journal 10 Sep, 2025 Reviewers invited by journal 10 Sep, 2025 Editor assigned by journal 03 Sep, 2025 Editor invited by journal 13 Aug, 2025 Submission checks completed at journal 13 Aug, 2025 First submitted to journal 13 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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The country\u0026apos;s health system is predominantly government-funded and provides free healthcare services to its citizens through an extensive network of institutions and personnel across national, provincial, district, and grassroots levels\u003c/p\u003e\n\u003cp\u003eThe organizational structure of the health system is tiered. At the national level, the Ministry of Health oversees policy, planning, and regulation, supported by specialized units, including the Epidemiology Unit, which plays a central role in communicable disease surveillance, outbreak investigation, immunization programs, and public health preparedness. The Provincial Health Services operate under the authority of Provincial Councils, aligning national policies with local needs. Each district is managed by a Regional Director of Health Services (RDHS), responsible for implementing health programs and coordinating public health activities. Regional Epidemiologist is the (RE) a medical doctor, serves as the key point of contact for all epidemiology-related activities within districts in RDHS office. At the grassroots level, the Medical Officer of Health (MOH), a medical doctor responsible for overseeing public health services within health subunits, areas form the foundation of community health delivery, where field-level staff such as Public Health Inspectors (PHIs) and Public Health Midwives (PHMs) engage directly with the population.\u003c/p\u003e\n\u003cp\u003eThe Epidemiology Unit, under the Ministry of Health, serves as the technical focal point for disease surveillance, response coordination, and health information dissemination, working collaboratively with MOH offices and other stakeholders to ensure timely detection and control of health threats. Its role has been critical in managing endemic diseases and responding to emerging public health challenges.\u003c/p\u003e\n\u003cp\u003eThe Field Epidemiology Training Programme (FETP), modeled after the U.S. CDC\u0026rsquo;s Epidemic Intelligence Service, is a critical strategy for building epidemiologic capacity and has been implemented in over 80 countries, including Sri Lanka (CDC, 2011; WHO, 2020). \u0026nbsp;The Sri Lanka FETP is a unique in-service training initiative aimed at strengthening the field epidemiology competencies of Regional Epidemiologists (REs) and Medical Officers of Health (MOHs), aligning with global standards. FETP-trained personnel have significantly enhanced the capacity of the Epidemiology Unit and the wider health system to detect, investigate, and respond effectively to emerging and re-emerging public health threats.\u003c/p\u003e\n\u003cp\u003eAccording to the International Health Regulations (IHR, 2005), countries are expected to have at least one trained field epidemiologist per 200,000 population (Department of Census and Statistics, 2024). Sri Lanka relaunched its FETP in 2025 after a decade-long pause. The first cohort included 25 participants (6 Regional Epidemiologists, 16 Medical Officers of Health and 3 Community Medicine trainees) and based on the feedback and curriculum improvements the subsequent trainings will facilitate incremental increase of trained field epidemiologists across the country to meet the IHR 2005 targets.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreparatory Phase\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe relaunch of the FETP in Sri Lanka was a strategically planned initiative, grounded in collaboration, evidence, and capacity-building priorities. Recognizing the critical need to strengthen field epidemiology capacity in the country, the Epidemiology Unit initiated a long-term partnership with the WHO, securing financial support from the Pandemic Fund. This support aligned with national priorities and the global Preparedness Framework, underscoring Sri Lanka\u0026rsquo;s commitment to pandemic prevention, preparedness, and response (Risk Assessment and Field Epidemiology for Health Security Threats in the WHO South-East Asia Region, 2023).\u003c/p\u003e\n\u003cp\u003eA key early step was the conduct of a WHO scoping mission to Sri Lanka from 2\u0026ndash;7 February 2025, which included an international FETP expert. The mission assessed the country\u0026rsquo;s training landscape using the WHO South-East Asia Regional Roadmap to Advance Field Epidemiology Capacities (2025\u0026ndash;2029) as a guiding framework (WHO, 2025). This comprehensive assessment examined training needs, existing infrastructure, and stakeholder engagement, with the goal of embedding core field epidemiology competencies into the national public health system.\u003c/p\u003e\n\u003cp\u003eA qualitative study exploring how learning occurs within FETPs in Australia, Japan, Mongolia, and Taiwan highlights FETPs as one of the most effective mechanisms for strengthening the public health workforce in preparation for future pandemics (Griffith et al, 2025).\u003c/p\u003e\n\u003cp\u003eA multi-disciplinary team led by the Epidemiology Unit developed a two-week in-service FETP targeting mid-level public health professionals. The programme, informed by prior findings, integrates classroom and field-based learning, with built-in monitoring for continuous improvement. As the first national FETP in over a decade, it marks a significant step toward strengthening Sri Lanka\u0026rsquo;s public health workforce.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNominations from RDHS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Epidemiology Unit invited nominations for the FETP from all districts across Sri Lanka, requesting the participation of REs and MOHs. Based on recommendations from the respective RDHS, a total of 6 REs and 19 MOHs were selected, ensuring broad geographic representation.\u003c/p\u003e\n\u003cp\u003eAs this is a full-time, in-service residential training programme, participants from outside the Western Province were provided with accommodation, meals, and daily transport to the Epidemiology Unit to support their participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreparatory Activities Prior to the Commencement of FETP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore launching the FETP, extensive preparations were made to ensure smooth implementation. Participants were to receive course material files containing evaluation tests, lecture notes, evaluation forms, supervision formats, and case scenarios. Evaluation formats were updated to align with the revised curriculum, incorporating feedback from consultants and past participants of the Regional FETP Programme at NCDC India. The inauguration agenda and timetable were drafted and finalized through consultation. Lectures were assigned to relevant trainers, and logistical needs such as venue, meals, and printing were arranged in advance. Participants received invitation letters a week prior, with guidelines and a checklist. A group was also created in an instant messaging app to facilitate communication and resource sharing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuring the FETP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the FETP, participants were officially registered at the inauguration ceremony and provided with a course material file containing key documents for easy reference. The event commenced with a warm welcome by the Chief Epidemiologist, Deputy Director General (Public Health Services) I and representatives from the WHO, joined virtually via Zoom, alongside the team from the Epidemiology Unit. Following the inauguration, the training sessions began with a lecture on the importance of epidemiology and disease surveillance in national development.\u003c/p\u003e"},{"header":"Methodology of teaching","content":"\u003cp\u003eThe curriculum was designed to provide participants with a well-rounded understanding of key public health concepts and practical skills. It covered a comprehensive range of topics, including the basic principles of epidemiology (20%), disease surveillance systems (8%), and epidemic preparedness and response (5%). Participants were trained in outbreak investigation methodologies (13%) and proper procedures for the collection, storage, and transportation of laboratory specimens (5%). The program also focused on the design and implementation of field-based studies (3%), data analysis (5%) at both institutional and community levels, and effective report writing and presentation skills (3%). Emphasis was also placed on the One Health approach to disease control (8%), highlighting the interconnectedness of human, animal, and environmental health. Participants received technical updates and the latest scientific knowledge (5%) in these areas to ensure alignment with current best practices (3%).\u003c/p\u003e\n\u003cp\u003eThe training followed a blended learning approach, combining classroom-based instruction\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewith\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003epractical field experience (20%)\u003cstrong\u003e.\u003c/strong\u003e The two-week programme included visits to a hospital, MOH office, and laboratory\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003egiving participants valuable hands-on exposure. The following teaching methods were employed:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eInteractive lectures with integrated discussions (50%)\u003c/li\u003e\n \u003cli\u003eGroup activities and participant-led presentations (20%)\u003c/li\u003e\n \u003cli\u003eField visits to National Hospital, Lady Ridgeway Hospital Colombo, MOH offices and Medical Research Institute Colombo (20%)\u003c/li\u003e\n \u003cli\u003eReal-time data analysis using excel and google sheets, report development, and plenary presentations (10%)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIn addition to the core training modules, participants were briefed on recent public health events, including the leptospirosis outbreak in Jaffna, Hepatitis outbreak in Polonnaruwa, Food borne outbreak in Matale and the measles outbreak in 2024\u003cstrong\u003e.\u003c/strong\u003e Regional Epidemiologists shared insights into the control measures initiated, including vaccination campaigns and community interventions.\u003c/p\u003e\n\u003cp\u003eAs part of the group work, participants delivered presentations focusing on Vaccine-Preventable Diseases (VPDs)\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ethe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ecompleteness of disease surveillance returns\u003cstrong\u003e,\u003c/strong\u003e and findings from supervisory visits to MOH offices and hospitals within their respective districts. Several invited resource persons served as lecturers, including representatives from WHO SEARO, WHO Sri Lanka and provincial and district epidemiologists from the Central Province and Colombo. Consultant Community Physicians (CCPs) who received training through the FETP in India also contributed to the sessions.\u003c/p\u003e\n\u003cp\u003eThis participatory and practice-oriented training model aimed to build the capacity of middle-level public health professionals to effectively manage disease surveillance and outbreak response in their local settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of Topics Covered\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Field Epidemiology Training Programme commenced with foundational sessions introducing the principles and value of epidemiology and disease surveillance in national development. Participants were oriented to descriptive epidemiology, including the analysis of disease by time, place, and person, and measures of disease frequency. The programme explored disease causation, modes of transmission, and control strategies, along with practical exercises in calculating disease frequency and preparing presentations. These sessions set the stage for understanding the scope and application of epidemiology in real-world health challenges.\u003c/p\u003e\n\u003cp\u003eMidway through the programme, the focus shifted to disease surveillance systems and immunization efforts in Sri Lanka. Participants were introduced to the national e-surveillance system and the Expanded Programme on Immunization (EPI), with emphasis on vaccine-preventable diseases, cold chain management, and Adverse Events Following Immunization (AEFI). Additional sessions covered pandemic preparedness and hands-on data analysis using Excel and Google Sheets. Field experiences included hospital and MOH office visits, followed by participant presentations, allowing for contextual learning through real-life observation and reporting.\u003c/p\u003e\n\u003cp\u003eIn the final phase, participants engaged in applied outbreak management training, including report writing, desk reviews, and practical sessions on investigating and managing disease outbreaks. Topics such as leptospirosis control, water and foodborne illnesses, zoonotic diseases, and antimicrobial resistance were also covered. The programme concluded with sessions on risk communication, public health leadership, and the role of laboratories and middle-level managers in disease control.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAt the end of the two-week programme, participants demonstrated a 29.9% improvement in post-test scores (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), indicating a significant increase in knowledge following the intervention. The improvement was statistically significant, as confirmed by the Wilcoxon signed-rank test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePre- and Post-Training Knowledge Assessment Scores by District\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistrict\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre Total\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost Total\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDifference (post-pre)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKurunegala\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" 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colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKalutara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColombo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColombo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eColombo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMatara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJaffna\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKandy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKalmunai\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVavuniya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePuttalam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmpara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrincomalee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKegalle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBatticaloa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonaragala\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKilinochchi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMatale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKalutara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKurunegala\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88 (29.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Pre- and Post-Test Scores with Wilcoxon Test Results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetric\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Pre-Test Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e294\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Post-Test Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e382\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePercentage Change (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWilcoxon Test Statistic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eParticipant feedback further suggested perceived improvements in skills related to surveillance, outbreak response, and evidence-based decision-making (Annex I). All lecture materials and resources were shared via a cloud-based platform for use in district-level training. A FETP 2025 Alumni group and an existing messaging group were maintained to support ongoing communication, peer learning, and coordination during future public health events.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe training programme was associated with short-term gains in knowledge and reported improvements in participant confidence, particularly in managing vaccine-preventable diseases and applying public health concepts. Qualitative feedback highlighted increased confidence and enthusiasm for field epidemiology, along with a strong interest in further practical training. Suggestions for programme enhancement included extending the training duration, incorporating more practical and case-based learning activities, simulating real-life outbreak scenarios, improving logistical planning, clarifying roles during field visits, and providing ongoing mentoring support. Participants also expressed a preference for a modular, practice-oriented format with more hands-on training in data analysis, outbreak investigation, and laboratory procedures.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eSeveral limitations should be acknowledged. The study lacked a long-term follow-up component, which limited the ability to assess the sustainability of knowledge retention, translation into daily practice, or impact on real-world job performance. As such, it remains uncertain whether the observed gains were maintained beyond the immediate post-training period or led to measurable improvements in field epidemiology practice.\u003c/p\u003e\u003cp\u003eAdditionally, the evaluation relied heavily on pre- and post-test scores and participant self-reported feedback. While these tools are useful for capturing immediate learning outcomes and subjective impressions, they may not fully reflect the development of practical skills, critical thinking, or behavioral changes in professional settings. Objective measures such as observed performance assessments, real-time case evaluations, or long-term tracking of workplace impact were not included, limiting the depth of evaluation.\u003c/p\u003e\u003cp\u003eThe absence of a control group or comparison cohort also limits the ability to attribute improvements solely to the training intervention.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eLessons learned\u003c/h2\u003e\u003cp\u003eFuture iterations should consider extending the duration of the programme, integrating more advanced and specialized modules, and formalizing structured post-training mentorship. Additionally, implementing standardized evaluation tools will be essential for tracking long-term outcomes, including the application of skills in real-world settings and contributions to public health systems strengthening.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eFETP is an initiative approved by the Ministry of Health. Ethical clearance and publication approval were granted by the Institutional Review Board of the Epidemiology Unit, Ministry of Health (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.epid.gov.lk/\u003c/span\u003e\u003c/span\u003e). Participation in the programme was determined through a selective admissions process, and all individuals participated voluntarily. Informed consent was obtained from all participants for the use of their pre- and post-assessment data prior to inclusion in the study. All procedures were conducted in accordance with institutional guidelines and regulations, and aligned with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll included data has been anonymized. Participants whose transcript data are included in the manuscript had the opportunity to review the text and provide consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eWHO\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eP.K. and A.P. drafted the main manuscript and prepared the tables. All authors contributed technical guidance and reviewed the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe extend our sincere gratitude to the staff of the Epidemiology Unit, Ministry of Health, Sri Lanka, for their invaluable support in organizing and facilitating the Field Epidemiology Training Programme (FETP) 2025. We also thank the World Health Organization (WHO) for their financial assistance. Special appreciation is extended to all FETP 2025 participants for their active engagement, dedication, and valuable contributions throughout the training.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eAvailable from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention (CDC). Strengthening the nation's public health system through a national field epidemiology training program. U.S. Department of Health and Human Services; 2011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/eis\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/eis\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). (2020). Field epidemiology training programs (FETPs): Building and sustaining a resilient and skilled public health workforce. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240012068\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240012068\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Joint external evaluation tool: international health regulations. (2005). In: Institutional Repository for Information Sharing. 2nd ed: W.H. Organization, Editor; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDepartment of Census and Statistics. Ministry of Finance, Planning and Economic Development, Census of Population and Housing 2024 Enumeration Stage. Department of Census and Statistics; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStrategic Framework for Action for Strengthening Surveillance, Risk Assessment and Field Epidemiology for Health Security Threats in the WHO South-East Asia Region. (2023). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789290210030\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789290210030\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. South-East Asia Regional roadmap to advance field epidemiology capacities: 2025\u0026ndash;2029. WHO Regional Office for South-East Asia; 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGriffith, M. M., Field, E., Huang, A. S. E., Shimada, T., Battsend, M., Housen, T.,\u0026hellip; Kirk, M. D. (2025). How does learning happen in field epidemiology training programmes?A qualitative study. BMC Medical Education, 25(1), 411..\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Field Epidemiology Training Programme, Disease Surveillance, Outbreak Response, Sri Lanka","lastPublishedDoi":"10.21203/rs.3.rs-7230814/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7230814/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIn alignment with the International Health Regulations (IHR, 2005) and the WHO South-East Asia Regional Strategic Framework for Action (2023), Sri Lanka relaunched its Field Epidemiology Training Programme (FETP) in 2025 after a decade-long hiatus. The initiative aimed to strengthen national capacity for timely disease surveillance and outbreak response by building a skilled and responsive public health workforce.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA two-week FETP was conducted by the Epidemiology Unit of Sri Lanka in collaboration with the World Health Organization (WHO). The programme trained 25 district-level public health officers, including six Regional Epidemiologists and 19 Medical Officers of Health, using a blended learning approach. The curriculum combined interactive lectures, field visits, practical data analysis exercises, and real-world case studies, focusing on core epidemiological concepts, outbreak investigation, vaccine-preventable disease surveillance, and the One Health approach. Pre- and post-training assessments were used to measure knowledge gains, analyzed using the Wilcoxon signed-rank test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eParticipants demonstrated a statistically significant 29.9% improvement in knowledge following the training (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Qualitative feedback and observational assessments also indicated strengthened competencies in surveillance, outbreak investigation, and evidence-based decision-making.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe FETP 2025 effectively enhanced the skills of public health officers involved in frontline disease surveillance and response. To ensure sustained impact, it is recommended that future iterations of the programme expand in duration, incorporate advanced epidemiological modules, and establish structured post-training mentorship and evaluation mechanisms. These enhancements will further support Sri Lanka\u0026rsquo;s commitment to IHR (2005) implementation and the development of a resilient, well-prepared public health system.\u003c/p\u003e","manuscriptTitle":"Strengthening Global Disease Surveillance and Response through Field Epidemiology Training: Insights from Sri Lanka’s FETP-2025","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 10:42:39","doi":"10.21203/rs.3.rs-7230814/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-23T05:45:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-17T17:10:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62536827226606351570972071150723378462","date":"2025-09-17T12:47:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"23300067423611125731609738520491513956","date":"2025-09-15T17:46:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204847649385687378439908964947354318004","date":"2025-09-15T06:39:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177361220856231630059350445308271647838","date":"2025-09-10T22:39:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265968971743036556613183280525337593762","date":"2025-09-10T21:45:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286616614330975111658115390109754549126","date":"2025-09-10T19:28:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-10T09:21:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T06:54:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-13T09:52:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-13T04:27:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-13T04:24:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c88616a-1358-45e3-a11a-b19108e77b3f","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-17T10:42:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 10:42:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7230814","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7230814","identity":"rs-7230814","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}