title: Non-communicable disease training for public health workers in low- and middle-income countries: lessons learned from a pilot training in Tanzania.
abstract: BACKGROUND
  Non-communicable diseases (NCDs) are increasing worldwide. A lack of training and experience in NCDs among public health workers is evident in low- and middle- income countries.
  
  
  METHODS
  We describe the design and outcomes of applied training in NCD epidemiology and control piloted in Tanzania that included a 2-week interactive course and a 6-month NCD field project. Trainees (n=14 initiated; n=13 completed) were epidemiology-trained Ministry of Health or hospital staff. We evaluated the training using Kirkpatrick's evaluation model for measuring reactions, learning, behavior and results using pre- and post-tests and closed-ended and open-ended questions.
  
  
  RESULTS
  Significant improvements in knowledge and self-reported competencies were observed. Trainees reported applying competencies at work and supervisors reported improvements in trainees' performance. Six field projects were completed; one led to staffing changes and education materials for patients with diabetes and another to the initiation of an injury surveillance system. Workplace support and mentoring were factors that facilitated the completion of projects. Follow-up of participants was difficult, limiting our evaluation of the training's outcomes.
  
  
  CONCLUSIONS
  The applied NCD epidemiology and control training piloted in Tanzania was well received and showed improvements in knowledge, skill and self-efficacy and changes in workplace behavior and institutional and organizational changes. Further evaluations are needed to better understand the impact of similar NCD trainings and future trainers should ensure that trainees have mentoring and workplace support prior to participating in an applied NCD training.
authors.affiliation: Division of Public Health Systems and Workforce Development, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA evelyn.p.davila@gmail.com.
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Davila
authors.affiliation: Field Epidemiology Laboratory Training Program Tanzania, Ministry of Health and Social Welfare, Tanzania.
authors.forename: Zubeda
authors.initials: Z
authors.lastname: Suleiman
authors.affiliation: Field Epidemiology Laboratory Training Program Tanzania, Ministry of Health and Social Welfare, Tanzania.
authors.forename: Janneth
authors.initials: J
authors.lastname: Mghamba
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA.
authors.forename: Italia
authors.initials: I
authors.lastname: Rolle
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA.
authors.forename: Indu
authors.initials: I
authors.lastname: Ahluwalia
authors.affiliation: Field Epidemiology Laboratory Training Program Tanzania, Ministry of Health and Social Welfare, Tanzania.
authors.forename: Peter
authors.initials: P
authors.lastname: Mmbuji
authors.affiliation: Department of International Health, Immunology and Microbiology and Copenhagen School of Global Health, University of Copenhagen, Denmark.
authors.forename: Maximilian
authors.initials: M
authors.lastname: de Courten
authors.affiliation: Deloitte Consulting, Atlanta, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bader
authors.affiliation: GEARS Inc., Atlanta, USA and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, USA.
authors.forename: S Christine
authors.initials: SC
authors.lastname: Zahniser
authors.affiliation: Copenhagen School of Global Health, University of Copenhagen, Denmark.
authors.forename: Marlene
authors.initials: M
authors.lastname: Krag
authors.affiliation: Division of Public Health Systems and Workforce Development, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA.
authors.forename: Bassam
authors.initials: B
authors.lastname: Jarrar
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology*; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D010353:Patient Education as Topic; D011634:Public Health; D013636:Tanzania; D014947:Wounds and Injuries / Q000453:epidemiology
keywords: Chronic disease; Developing nations; Non-communicable disease; Public health worker; Training