In July 2012, the National Stop Transmission of Polio (NSTOP) program was established to support the Government of Nigeria in interrupting transmission of poliovirus and strengthen routine immunization (RI). NSTOP has approximately 300 staff members with the majority based at the Local Government Area (LGA) level in northern Nigeria.An internal assessment of NSTOP was conducted from November 2015 to February 2016 to document the program´s contribution to Nigeria´s immunization program and plan future NSTOP engagement. A mixed methods design was used, with data gathered from health facility, LGA, state, and national levels, through structured surveys, interviews, focus group discussions, and review of program records. Survey and expenditure data were summarized by frequency and trends over time, while interview and focus group data were analyzed qualitatively for key themes.The majority of the 111 non-NSTOP LGA respondents reported that NSTOP officers supported polio campaigns (100%) and supervised RI sessions (99.1%). Out of 181 respondents at health facility level, the majority reported that NSTOP trainings improved their knowledge (83.3%) and skills (76.2%) on RI, and NSTOP officers regularly supervised their RI sessions (96.7%). Most respondents reported that there would be a negative impact on immunization activities if NSTOP officers were withdrawn.Future implementation of NSTOP should be realigned to (a) give highest priority to mentoring LGA staff to build institutional capacity, (b) ensure increased capacity translates to improved provision of RI services, and (c) improve routine review of program monitoring data to assess progress in both polio and RI programs. In July 2012, the National Stop Transmission of Polio (NSTOP) program was established in Nigeria to support the Government of Nigeria in interrupting transmission of poliovirus and strengthen Routine Immunization (RI). This was based on the need identified in the 2012 National Polio Eradication Emergency Plan (NPEEP) for the health workforce to have management and technical surge capacity to strengthen the Nigerian polio program  but is sThe flagship project of NSTOP was an initiative to locate and vaccinate children < 5 years with Oral Poliovirus Vaccine (OPV) in remote Fulani, nomadic, scattered, and border populations in northern Nigeria. From August 2012 - April 2015, NSTOP conducted field outreach activities in Northern Nigeria where 64,131 children aged < 5 years, who had never received polio vaccination, were vaccinated with OPV [NSTOP works closely with government and partners to achieve its mission of polio eradication and RI strengthening. NSTOP stakeholders include government agencies and departments at national, state, and LGA levels, and partner organizations such as WHO, UNICEF, Bill and Melinda Gates Foundation (BMGF), United States Agency for International Development (USAID), and African Field Epidemiology Network (AFENET). CDC, USAID, and BMGF fund NSTOP. NSTOP has approximately 300 staff, consisting of a National Coordinator (NC), a deputy NC, five Abuja-based Field Coordinators, 19 State Field Coordinators (SFCs) across 11 states, 19 DHIS-2 Implementation Officers, and 216 NSTOP LGA officers (NSLOs). The number of State Field Coordinators (SFCs) in a state ranges from one in most states to four in Kano state. There is usually one NSLO per LGA except for LGAs that receive concurrent polio/RI and malaria support, which have two NSLOs.On the current monitoring system in NSTOP, a calendar of program activities is prepared at the beginning of the year and is updated regularly. The calendar includes NSTOP internal program activities and other activities initiated by government and partners that NSTOP participates in, with the dates of the activities. At the LGA level, NSLOs prepare monthly updates to itemize key activities performed in the previous month. This is sent to the SFC, who reviews and gives feedback to the NSLOs at a joint meeting held at the end of the month. The SFC prepares a monthly summary update that is sent to the national office. At the national level, a monthly summary of key activities is written and included as part of NFELTP monthly update. In order to have in-depth understanding of state and LGA-level activities, a quarterly NSTOP review meeting is held, comprising national and state NSTOP officers.Since NSTOP program´s inception in 2012, no formal evaluation had been conducted. In 2015, an internal assessment of NSTOP was conducted to: a) describe the process of implementation of NSTOP; b) identify strengths, challenges and ways the program could be improved; c) document the contributions of the program to the polio and RI programs in Nigeria, all of which would help inform planning for future implementation of NSTOP. The assessment was designed to gain a deeper understanding of the program´s strengths and challenges rather than quantify the impact of the program, as the many other investments in improving immunization during the same time period make it difficult to tease out the impact of any one initiative. In this paper, we report the findings of the internal assessment of NSTOP conducted by CDC.The internal assessment of NSTOP was conducted between November 2015 and February 2016. The assessment focused on implementation of NSTOP, following CDC´s guidelines for evaluation of public health programs . The quaWe conducted a cross-sectional survey of key immunization technical officers at state, LGA, and Health Facility (HF) levels in 12 NSTOP-supported states and FCT. At the state level, we surveyed 13 State Immunization Officers (SIO). To select LGAs, we stratified the 184 NSTOP-supported LGAs by the three phases of recruitment . We then used simple random sampling proportional to the number of NSTOP-supported LGAs in a state to sample 38 LGAs . We sampFrom November 2015 to February 2016, we collated and reviewed two categories of NSTOP program data that had been collected prior to the commencement of the assessment: (a) RI baseline and follow-up assessment data for the first two phases of NSTOP recruitment. These data included interviews from LGA and HF immunization officers. Of the 100 phase 1 and phase 2 LGAs, only 89 had data collected. Of these 89 LGAs, only 77 had complete data at both baseline and follow-up and were included in the analysis. Data were analyzed at LGA and HF levels to measure changes in RI performance. Paired T-tests, with pairs of the same LGA at baseline and follow-up, were used to compare differences in continuous variables, and McNemar´s chi-squared tests used to compare changes in binary variables using Stata 14.0, with p values of <0.05 treated as statistically significant. (b) NSTOP program expenditure data from the United States Fiscal Years (FY) 2012 to 2015 reported in constant 2015 U.S. dollars. A FY is from October through September of the following year. Program expenditure data were reported by NSTOP program administrators for all funding sources  supporting the program for FY2012-FY2015. Program expenditure data were analyzed in Microsoft Excel.We conducted in-depth interviews with key national, state, and LGA stakeholders in the NSTOP program. We obtained information from several stakeholders at different levels who had contact with NSTOP´s operations and management, in order to make a good judgement of NSTOP´s contribution. At the national level, we interviewed 17 senior immunization program officers sampled purposively from NPHCDA , WHO, UNICEF, USAID, AFENET, and CDC Nigeria). At the state level, we interviewed 78 senior immunization program officers sampled purposively from State Primary Health Care Development Agency (SPHCDA), WHO, UNICEF, and AFENET from all 12 NSTOP-supported states and FCT. In each of the 38 sampled LGAs, we interviewed the Director of Primary Health Care (PHC). At all the levels, we used a pre-tested interview guide to collect data on activities of NSTOP officers, perceived impact of NSTOP support, and likely effects of withdrawal of NSTOP officers.Using a pre-tested guide, seven focus group discussions (FGDs) were conducted with NSLOs to collect data on their experience with supporting immunization activities in the LGAs. One FGD was conducted in each of the following NSTOP-supported states: Kaduna, Jigawa, Zamfara, Kano, Katsina, Sokoto, and Bauchi. Each FGD included 8-10 NSLOs sampled purposively from the pool of NSLOs in those states. The main criterion used for sampling was length of experience. Coding and thematic analysis of all qualitative data were done using ATLAS.ti 7.From a logic model we developed for NSTOP, we identified key program outcome indicators to use in assessing NSTOP program performance. These included (a) change in knowledge and skills of immunization staff, (b) changes in planning and conduct of RI, (c) changes in planning and conduct of SIAs, and (d) vaccination coverage for Oral Polio Vaccine (OPV) delivered through polio campaigns in NSTOP-supported LGAs. Additional output indicators were used to assess extent of mentorship of immunization officers at state and LGA levels by NSTOP staff use of NSTOP program funds.The national polio Emergency Operations Center (EOC) approved the assessment as a non-research programmatic activity. All participants were provided information about the assessment verbally and requested to provide written consent prior to participation.For the survey, there were 181 respondents across 114 HFs, out of which 103 (56.9%) were HF in-charge and 78 (43.1%) RI focal persons. At the LGA level, there were 148 respondents in all, comprising 111 non-NSTOP respondents and 37 NSTOP respondents. Out of the 111 non-NSTOP respondents, 39 (35.1%) were WHO LGA facilitators, 37 (33.3%) LGA immunization officers (LIOs) and 35 (31.5%) UNICEF consultants. All the 37 NSTOP respondents were NSLOs. At the state level, there were 13 respondents, all SIOs. We analyzed baseline and follow-up data for 77 LGAs and 1401 HFs. For FGDs and in-depth interviews, there were 66 and 133 respondents respectively.At the HF level, a majority of respondents (97%) reported that NSTOP officer had supervised at least one RI session, that they had attended NSTOP training (93%), and that the trainings improved their knowledge (83%) and skills (76%) on RI. From NSTOP trainings, the training topic the HF officers remembered most frequently was RI service delivery (49%) and some of the terms respondents used to recall this topic included vaccine introduction, vaccine training, routine immunization and supportive supervision. This topic was followed by vaccine and cold chain management (26%), and some of the terms used to recall the topic include temperature monitoring and vaccine supply.According to NSLOs, the most common factor hindering them from performing their job was lack of security (42%), particularly in the underserved settlements and hard to reach areas in northern Nigeria. NSLOs also reported broader barriers effecting the polio eradication initiative (PEI) in their LGAs which also effected their work. Lack of government ownership (73%), low motivation and commitment among health workers (57%), and poor management of resources (51%) were reported to be the biggest obstacles.When HF officers were asked what additional assistance they would need to maximize their performance, the most commonly mentioned were human resources (38%), logistic (34%) and material incentives (15%). The human resource needs to include request for more RI personnel and refresher trainings. Logistic needs included requests for motorcycles to visit hard-to-reach areas and cold chain equipment for transport of vaccines and related supplies during outreach. NSLOs offered suggestions on methods, in addition to training, to prepare LGA immunization teams for their roles. A majority of NSLOs suggested promotion opportunities (87%) and rewards for good performance (60%) as additional strategies.Health facility officers were asked how NSTOP could improve its trainings. The main recommendations were to increase the frequency of training to about monthly from a need-based approach (35%) and expand the target audience to include other staff members (28%). To improve NSTOP program overall, non-NSTOP LGA officers (32%) and SIOs (50%) recommended that NSTOP should increase human resources such as increase the number of its staff, followed by a recommendation for NSTOP to organize refresher trainings. SIOs (14%) also recommended that logistics for supportive supervision should be provided.The total NSTOP program expenditures from FY 2012 to FY 2015 was $28.8 million in constant 2015 US dollars. The top three program area expenditures were cross-cutting program management, which includes personnel salaries ($13.3 million), training ($3.2 million), and MSTs for polio campaigns ($3.0 million). Program expenditures increased yearly from $0.4 million in FY 2012 to $3.5 million (775%) in FY 2013, $8.7 million  in FY 2014 and $11.0 million  in FY 2015. CDC was the sole funder in FY 2012 and FY 2014 and was the largest funder in FY 2013 ($2.7 million) and FY 2015 ($6.9 million). On activities of NSTOP officers, there was consensus among stakeholders that NSTOP officers carried out their activities among Fulani and other hard-to-reach communities. A state-level respondent said:“The (NSTOP) contributed in reaching the nomadic people. They did a great deal of work in identifying those areas where you have nomadic groups to integrate them and reach them, so they have contributed as part of the team at LGA and at the state level”.A majority of respondents also felt that NSTOP officers improved quality of delivery of RI services, especially through supportive supervision in Fulani and other hard to reach areas. According to a LGA-level respondent:“I used to see the NSTOP officer dropping his car here and carry kabukabu (motorcycle) and go where motor (car) cannot go and sees that he performed the outreach services”.Other activities respondents believed that NSTOP officers carried out include training LGA immunization staff on different RI topics, and participation in microplanning and polio campaign implementation in Fulani and other underserved areas. Few respondents mentioned that NSTOP officers tend to conduct supervision alone, rather than in collaboration with government officers.Regarding NSTOP support at the national level, a majority believed that NSTOP used the platform of the national polio EOC to work with other partners, and assisted PEI efforts through deployment of senior supervisors (“MSTs) to polio high-risk LGAs. Some other fora of active NSTOP involvement according to respondents include the RI Working Group and Interagency Coordination Committee. Individual opinions about NSTOP at this level include use of phrases such as “NSTOP activities have little planning time”, “NSTOP officers are sometimes not involved in the planning stage of activities”, and “NSTOP officers are fault-finders”.As training is a major component of NSTOP support, some terms that respondents used to describe NSTOP trainings include “quality”, “relevant”, and “effective”. A national-level respondent said:“Yes, I have participated in some of the training at the national and some at state levels, at the operational level, during IPDs (polio campaigns). Yes, I have participated. It has been of quality, it is the outcome of those trainings that you are seeing in terms of accountability, in terms of the dashboard before each campaign”.Respondents also believed the trainings contributed to improvement in microplanning and materials from NSTOP training modules helped to train their staff.Similarly, respondents gave opinions on the overall impact of NSTOP support, weaknesses in NSTOP program, and recommendations to improve NSTOP. A majority believed that NSTOP has positively affected Nigeria´s immunization program. The most common weakness that was mentioned is that NSTOP had insufficient staff. By this, respondents meant that NSTOP should have additional officers to work in more hard-to-reach areas. Individual opinions on the weaknesses are that “NSTOP staff has poor capacity in outbreak response and surveillance” and “NSTOP tends to form parallel structures, rather than complement existing structures”. The recommendations given were to address the weaknesses described above.The greatest fear of NSLOs was that the impact of NSTOP support might not continue after their withdrawal. The reasons they cited for this include “poor ownership from LGAs´, and “nobody will focus on Fulani and other hard to reach communities”. The NSLOs were generally satisfied with their work. However, the major challenges they faced were lack of access to RI supportive supervision database and lack of funding for outreach vaccination sessions. Other challenges include inadequate cold chain facilities for outreach vaccination sessions and a weak system for holding health workers accountable.Nigeria´s NSTOP program has provided intensive support for polio campaigns and RI sessions in 184 LGAs with a focus on hard to reach and underserved populations. Across all the levels  where NSTOP officers worked, there was agreement that the NSTOP program has positively influenced the PEI and RI programs in Nigeria. At the state and national levels, respondents indicated that NSTOP officers contributed meaningfully to management decisions, especially at the EOCs and had productive collaboration with other stakeholders. NSTOP had a more pronounced effect at the LGA level where field activities take place. Before NSTOP initiated the flagship project, it was believed that low vaccination coverage in the underserved populations contributed to persistent WPV transmission in Nigeria. Many respondents agreed that NSTOP assisted in improving the quality of polio campaigns in these underserved settlements through improved microplanning and supervision. Respondents at the LGA level believed that the NSLOs worked in line with their TORs. The assessment results indicate that NSTOP support to the polio program at the LGA level is perceived as an integral component of the support provided by other partners and the government. In 2012, it was evident that PEI Nigeria needed all the support it could get from partners to stop the increase in WPV cases. In response to this need, partners mobilized human and financial resources to support several LGAs across northern Nigeria, and NSTOP support was provided within this platform.Another major program activity for which NSTOP was widely commended is in increasing knowledge of health workers on polio and RI. From 2013 to 2015, there was significant financial investment in training by NSTOP staff which provided the opportunity to train entire LGA immunization and surveillance teams along with core HF officers in LGAs where NSLOs worked. Respondents at LGA and HF levels believed that NSTOP training improved their knowledge and skills and were well organized. The knowledge gained through NSTOP-supported training was felt to have contributed to the observed improvement in some RI indicators which related directly to the training topics. These included improvement in microplan availability, staff availability for RI sessions, monitoring and supervision, and reduction in stock outs of vaccines. For example, NSTOP had a training module specific to microplanning and required NSLOs to assist their LGAs to update their microplans quarterly. NSTOP also provided funding for LGAs to hold a meeting to review microplans. Similarly, as part of their TORs, NSLOs are required to conduct a minimum of eight supportive supervisory visits to health facilities holding RI sessions. During these visits, on-the-job training is performed and observed weaknesses are identified for correction. This was felt to have contributed to the improvement in some monitoring and supervision indicators. The decrease in stock out of some vaccines, on the other hand, may not be fully explained by NSTOP training due to the influence of factors outside the control of those trained, such as availability of vaccines globally and nationally.Many respondents indicated that government was not ready to take over NSTOP responsibilities and that withdrawal of NSTOP officers would have a negative effect on several activities. A negative effect in this instance could mean a slowing down or an outright failure of the polio eradication program. At the beginning of the NSTOP program, the goal of government and partners was to ensure that polio was eradicated using all available human, financial, and material resources. Although the duration of NSTOP support was not specified at the beginning of the program, it was meant to be time-limited, with functions transitioned to the government as significant progress was made in the PEI. According to NSLOs, lack of government ownership was the greatest threat to the PEI program. This has been documented in other studies on sustainability of immunization program in Nigeria ,9. NigerThere are some limitations to this assessment. The first is the design which largely involved description of program inputs and outcomes, and before-after comparison rather than using an external comparison group. An external comparison group is ideal to evaluate program as it generates the strongest evidence for attribution and may limit the impact of confounders ,11. ThisThe majority of immunization officers at the LGA and health facility level reported improvement in knowledge and skills from NSTOP trainings. In health facilities served by NSTOP there was improvement in the quality of RI supervision and RI microplanning, and decreased vaccine stock-outs. NSTOP program expenditures increased by 775% in FY 2013, 149% in FY 2014 and 26% in FY2015. Funding was provided by CDC, USAID, and BMGF, with CDC being the largest funder. The top drivers for program expenditures overall were capacity building for RI strengthening, RI data quality improvement, and deployment of MSTs for polio campaigns. Lastly, government and partner staff expressed concern that withdrawal of NSTOP officers at this time will likely have a negative effect on immunization activities at state and LGA levels unless government takes ownership of these activities.In order to improve the future implementation of NSTOP, we propose recommendations in three main areas - capacity building, program monitoring, and transition planning. On capacity building, NSTOP should give highest priority to building skills and institutional capacity beyond merely knowledge acquisition. The focus of capacity building should be on developing the management skills of the LGA team. As the capacity of the LGA team improves, NSTOP should continue to strive to achieve improvements in provision of RI services as measured by vaccine coverage and programmatic indicators. On program monitoring, the monthly review of NSTOP program monitoring data should be strengthened with a monthly analysis of key indicators using a standardized dashboard. Another major recommendation in this area is to ensure routine tracking of program expenditures to promote accountability and transparency. On transition planning, it is recommended that NSLOs continue their current TORs on supporting the polio eradication and RI programs in their LGAs for a maximum period of five additional years. NSLOs should always conduct field visits with at least one government LGA team member to ensure transfer of skills and prudent use of logistic funds. No later than the last year of support to the LGA, NSLOs should use their time to develop and implement a transition plan for the LGA to fully take over NSTOP-supported activities.Lack of government ownership constitutes a threat to the sustainability of interventions designed to improve quality of immunization services in Nigeria.To sustain the impact of immunization interventions in Nigeria, priority should be given to building management skills and institutional capacity at local government level.


The relationship between quantitative anatomic parameters in MRI and patient-reported outcomes (PROs) before and after surgery in degenerative lumbar foraminal stenosis remains unknown. We included 58 patients who underwent transforaminal lumbar interbody fusion (TLIF) for single-level degenerative disc disease with foraminal stenosis between February 2013 and June 2020. PROs were evaluated using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). The foraminal parameters assessed using preoperative MRI included foraminal height, posterior intervertebral disc height, superior and inferior foraminal width, and foraminal area. The correlation between foraminal parameters and PROs before operation, at 1 year follow-up, and change from baseline were assessed. The associations between the aforementioned parameters were examined using linear regression analysis. The analysis revealed that among these parameters, superior foraminal width was found to be significantly correlated with ODI and EQ-5D at the 1 year follow-up and with change in ODI and EQ-5D from baseline. The associations remained significant after adjustment for confounding factors including age, sex, body mass index, and duration of hospital stay. The results indicated that in degenerative lumbar foraminal stenosis, decreased superior foraminal width was associated with better improvement in disability and quality of life after TLIF. Lumbar foraminal stenosis is an important etiology of lumbar radiculopathy. According to the previous literature, the incidence rate of lumbar foraminal stenosis is approximately 8–11% . These cSurgical management of foraminal stenosis involves decompressing the exiting nerve root with or without spinal fusion. Decompression without fusion has the potential risk of reduced disc height after surgery, which may result in recurrent stenosis for which revision surgery may be required . TransfoHowever, there are considerable variations in clinical response to surgical intervention in patients with lumbar foraminal stenosis ,8. MagneThis was a single-center, retrospective cohort study. We enrolled patients who underwent TLIF for single-level degenerative disc disease with foraminal stenosis and symptoms of radicular leg pain in the Department of Orthopedics at our hospital between February 2013 and June 2020. Patients who were admitted for revision and those who had concomitant segmental instability , multi-lIn total, 179 patients received primary single level TLIF for spinal stenosis in our institute. Among these patients, 19 with concomitant segmental instability on plain film were excluded, and 16 patients with multiple level stenosis, 25 patients with lesion at lumbosacral level, and 61 patients with concomitant central stenosis were ruled out after reviewing pre-operative MRI of every included individual. A total of 58 consecutive patients remained and were included in the study. The patient inclusion flow diagram is presented at We measured several quantitative foraminal parameters using preoperative lumbar spine MRI. Foraminal height was defined as the longest distance between the superior and inferior pedicles, while posterior intervertebral disc height was the shortest distance between the adjacent endplates at the posterior half of an intervertebral disc. In addition, superior and inferior foraminal widths were defined as the maximum width of the superior and inferior parts of the foramen, respectively . The forPROs were assessed at baseline (preoperatively) and at the 1-year follow-up; they included the VAS for pain in the back and leg, ODI, and EQ-5D. The VAS (scored from 0 to 10) was used to evaluate patients’ perceived pain intensity (0 = no pain), and the ODI (0–100) was used to assess patients’ functional status (0 = no disability). Further, the EQ-5D was used to assess patients’ quality of life, which was converted to an index score before analyses .p < 0.05.PROs at baseline and at the 1-year follow-up postoperatively were compared using the Wilcoxon signed-rank test. Correlations between anatomic parameters and PROs at baseline and at the 1year follow-up and changes from baseline were assessed using Spearman’s rank correlation. Associations between the aforementioned parameters were examined using linear regression analysis after adjusting for age, sex, body mass index (BMI), and duration of hospital stay. All statistical analyses were performed using Statistical Package for the Social Sciences , and the level of statistical significance was set at Every included patient received surgery of conventional open TLIF. During the procedure, a midline skin incision was made, and the fascia was incised with paravertebral muscles elevated and dissected from the spine. Unilateral facetectomy at the symptom side of the level was performed to allow sufficient decompression of the exiting nerve root. Discectomy and endplate preparation were then performed through Kambin’s Triangle, followed by placement of interbody cage. Bilateral pedicle screw and rod were inserted, and correct screw and cage position was confirmed with intraoperative fluoroscopy.The pedicle screw-rod instrumentation included: 46.5% CD Horizon Legacy , 41.4% Wiltrom spinal fixation system , 8.6% Illico , 22.4% Xia  and 5.2% Sextant . The interbody cages used included: 51.7% Capstone , 34.5% TM-Ardis , and 13.8% SD .Fifty-eight patients were enrolled in the study. All patients underwent unilateral facetectomy and nerve root decompression, followed by single-level TLIF with standard bilateral posterior pedicle screw instrumentation. p < 0.001). The ODI decreased significantly, while the EQ-5D significantly increased at the 1-year follow-up (both p < 0.001).p < 0.01) and EQ-5D  as well as with changes in the ODI  and EQ-5D  from baseline. At the 1-year follow-up, the superior foraminal width was significantly correlated with the ODI  and EQ-5D  as well as with changes in the ODI  and EQ-5D  from baseline.The correlations between anatomic parameters and PROs at baseline, at 6 months follow-up, at 1 year follow-up, and change from baseline are shown in p = 0.003) and EQ-5D  from baseline at 1 year follow up . We also examined the associations in subgroups of sex and age in unadjusted models. The associations were more prominent in female patients and in those aged ≥65 years.The finding of linear regression also revealed the significant association between superior foraminal width and change in the ODI  level were excluded due to the anatomic difference compared to other lumbar levels ; thus, fAnatomic foraminal parameters assessed using preoperative MRI were independently correlated with patient-reported outcomes in degenerative lumbar foraminal stenosis. Decreased superior foraminal width was associated with better improvement in both functional status and quality of life after TLIF.


This poster presents acceptability data from the Kinto Care Coaching Intervention, an innovative technology-enabled care coaching service for caregivers of individuals with dementia. The 30-day program provides caregiver support and financial information through: 1) an initial one-on-one care coaching meeting; 2) interactive and on-going support and educational resources through an app; 3) access to support groups; and 4) if needed, additional meetings with their care coach. The solution is funded through the NIH’s Small Business Innovation and Research (SBIR) program, with the specific goals of developing mobile technology that is: 1) acceptable and usable for caregivers of all ages and 2) supports cost-effective deployment of the coaching intervention at scale. To assess program acceptability, participants completed a survey after their one-on-one care coaching meeting and after the 30-day program. On average, participants (n=32) were M=51.94 (SD=12.07) years old; 68.8% female; 71.9% White; 75% married; and 56.3% worked full-time. Using a 5-point Likert scale, nearly all participants (96.6%) indicated they ‘agreed’ or ‘strongly agreed’ that their care coach was: helpful in explaining the program; provided useful information; assisted with developing goals; and were supportive. Participants rated the program resources and technology as very helpful with mean ratings ranging from 4.41 to 4.69. When asked about the overall program acceptability, participants indicated they were extremely satisfied with the program , with 100% of participants ‘agreed’ or ‘strongly agreed’ that they were satisfied. Discussion will highlight key program components along with next steps in testing program efficacy.


Toxoplasma gondii, a zoonotic protozoan parasite, has the capacity to infect the fetus if the pregnant woman primarily acquires the infection during pregnancy. We evaluated the prevalence of T. gondii IgG, IgM and IgA antibodies in women of reproductive age residing in Western Romania. We also assessed the value of adding a T. gondii IgA test to the serologic panel for the diagnosis of toxoplasmosis, including the detection of a recently acquired infection. Serologic testing to demonstrate the presence of T. gondii IgG antibodies was conducted in 1317 females aged 15–45 years. T. gondii IgM and IgA antibody tests were performed in those with detectable IgG antibodies and IgG avidity test was performed if IgM and/or IgA screening test results were positive. T. gondii IgG were detected in 607  of 1317 study participants and IgG seroprevalence tended to increase with age from 35.44% (95%CI: 29.89–41.30) in age group 15–24 years to 62.85% (95%CI: 56.57–68.82) in age group 35–45 years, showing a significant age-associated increase (p < 0.001). Of the 607 persons with detectable T. gondii IgG antibodies, T. gondii IgM antibodies were demonstrated in 8.90% (95%CI: 6.88–11.43), T. gondii IgA in 1.65% (95%CI: 0.90–3.01) and both T. gondii IgM and IgA in 0.99% (95%CI: 0.45–2.14). The prevalence of IgA antibodies tended to decrease with increasing avidity, from 75% (95%CI: 19.41–99.37) in samples with low avidity to 11.76% (95%CI: 4.44–23.87) in those with high avidity (p = 0.01). Of the study participants who were positive for both T. gondii IgM and IgA antibodies, 66.67% had low or equivocal IgG avidity test results compared to 6.25% who tested positive for IgM, were negative for IgA and in whom low or equivocal IgG avidity test results were noted (p = 0.001). This study indicates that in Western Romania, T. gondii IgG seroprevalence is high in females of reproductive age and T. gondii IgA antibodies may be rarely detected during a serologic screening. However, in individuals with demonstrable T. gondii IgG and IgM antibodies, testing for T. gondii IgA may improve the rate for the detection of a recently acquired toxoplasmosis. Toxoplasma gondii, a zoonotic protozoan parasite with a worldwide distribution, can infect both humans and all warm-blooded animals, including mammals and birds [T. gondii occurs in a wide variety of vertebrates which serve as intermediate hosts [nd birds ,2. Felidnd birds . Asexualte hosts .T. gondii, by crossing the placenta, has the capacity to infect the fetus if the pregnant woman primarily acquires the infection during pregnancy [T. gondii is transmitted early in the gestation period [T. gondii in pregnant women is estimated at 33.8% and varies widely from 0.7% in South Korea to 92% in Ghana. In European countries, the prevalence rate is 31.2% [T. gondii during pregnancy worldwide, with a prevalence of 0.5% reported in European regions, suggesting that a considerable number of fetuses are at risk of acquiring the infection [T. gondii may cause in these patients, it is important to survey its distribution in females of reproductive age and pregnant women.regnancy . In congn period ,6 and spn period . Choriorn period ,8,9. Theis 31.2% . Approxinfection . Given tT. gondii seroprevalence in children [In Europe, data regarding congenitally infected children are still limited, given that a nationwide epidemiological surveillance system for congenital toxoplasmosis has been implemented only in France and Germany, and in Italy at a regional level . The ratchildren , pregnanchildren  or womenchildren .T. gondii antibodies  and IgG avidity test results usually allows physicians to assess the immunologic status of a patient and to diagnose seroconversion [T. gondii IgA antibody testing might represent a valuable adjunct for determining the timing of the infection, as part of a reference panel for the diagnosis of acute toxoplasmosis [T. gondii IgA was sometimes useful in detecting a recently acquired infection in the absence of T. gondii IgM antibodies [Diagnosis of both acquired and congenital toxoplasmosis is still based on serological methods ,16. The nversion ,18,19, bnversion . The IgGnversion  and recelasmosis . Moreovetibodies ,22.T. gondii IgG, IgM and IgA antibodies in women of childbearing age residing in Western Romania. We also evaluated the value of adding T. gondii IgA test to the serologic screening for toxoplasmosis, including the detection of a recently acquired infection.Therefore, in this study, we assessed the prevalence of T. gondii antibodies. In cases of positive results, serum samples were further transferred to 1.5 mL Eppendorf tubes and stored at −20 °C until T. gondii IgM and IgA antibody tests were performed. A specific IgG avidity test was performed only when the presence of T. gondii IgM and/or IgA antibodies was confirmed.Venous blood samples were collected between 1 February 2018 and 1 February 2019, from 1317 consecutive women of reproductive age (15–45 years), presented for routine check-up, at the Municipal Clinical Emergency Hospital Outpatient Clinic in Timisoara, Romania. Females were residents of Timis county, located in Western Romania, with a total population of 705,113. The age given for each study participant is the age when the blood sample was drawn upon enrolment in the study. Study participants were grouped according to their age in 3 age groups: 15–24 years, 25–34 years and 35–45 years. Peripheral blood samples were collected by venipuncture in 6 mL red-top  tubes and the serum samples were tested for the presence of specific IgG anti-No clinical criteria were used to include subjects in this study.T. gondii IgG with the ADVIA Centaur® XP  electrochemiluminescence Toxo IgG assay. The sensitivity and specificity for IgG detection were both 100% [All serum samples were assessed for anti-oth 100% .T. gondii IgM antibodies and evaluation of IgG avidity . ELFA IgM has a sensitivity of 100% and a specificity of 98.6% [T. gondii infection dating more than 4 months [Enzyme-linked fluorescent assay (ELFA) designed for VIDAS  was used for identification of serum anti-of 98.6% ,25. IgG 4 months .T. gondii IgA antibodies were determined using a solid phase enzyme-linked immunosorbent assay (ELISA)  with a diagnostic sensitivity and specificity of 100% [Serum anti- of 100% .All tests were carried out according to manufacturers’ recommendations regarding calibration and the running of controls.Interpretation of test results was based on each of the manufacturer’s criteria.T. gondii IgG antibody test results were interpreted as follows: <6.40 IU/mL, negative; ≥6.4 to 10 IU/mL, equivocal; >10 IU/mL, positive [T. gondii IgM test results were interpreted as follows: <0.55, negative; ≥0.55 to 0.65, equivocal; >0.65, positive [T. gondii IgA test results were interpreted as negative if the ratio was <0.9; equivocal between 0.9 and 1.0 and positive if the ratio was >1.1 [positive . T. gondpositive . T. gondwas >1.1 . For theThe Vidas IgG avidity test was interpreted as follows: <0.2, low avidity; ≥0.2 to 0.29, equivocal result; ≥0.3%, high avidity .p value of <0.05 was considered of statistical significance.Data were collected using a Microsoft Excel database, version 2011 , and the statistical analyses were performed using Epi Info statistical package, version 3.3.2  and MedCalc for Windows, version 19.4 . Data are presented as number (percentage), mean ± standard deviation (SD), odds ratio (OR) with 95% confidence interval (CI). Mantel–Haenszel chi-square test and Fisher’s 2-tailed exact test were used to compare proportions between groups. A This study was approved by the Victor Babes University Ethics Committee, Timisoara, Romania (no.2 from 8 January 2018). All participants included in the study were thoroughly informed about the study goals and the procedures, and provided written informed consent. For individuals under the age of eighteen, the parents/legal guardians provided the written informed consent.T. gondii IgG antibodies were demonstrated in 607 (46.09%) (95%CI: 43.41–48.78) and tended to increase with age, from 35.44% (95%CI: 29.89–41.30) in age group 15–24 years to 62.85% (95%CI: 56.57–68.82) in age group 35–45 years, showing a significant age-associated increase  , 46–2.06) .T. gondii IgM and IgA antibody tests were performed for the 607 females identified with IgG antibodies and the IgG avidity test was performed subsequently in 58 (9.56%) samples that tested positive for T. gondii IgM and/or IgA antibodies. In 549 (90.44%) of the 607 cases in which the IgG avidity test was not performed, the diagnosis of chronic infection was based on the negative results for both T. gondii IgM and IgA antibodies ) of the 607 IgG positive study participants, IgA in 10  and both T. gondii IgM and IgA in 6 . Of the 54 females with IgM antibodies, only 6 (11.11%) also had IgA antibodies, whereas 6/10 (60%) of study participants with IgA antibodies also had IgM antibodies  had low or equivocal IgG avidity test results compared to 3 of 48 (6.25%) who tested positive for IgM, were negative for IgA and in whom low or equivocal IgG avidity test results were noted (p = 0.001)  had low or equivocal IgG avidity test results: 4 (6.90%) had low IgG avidity test results and 3 (5.17%) had equivocal IgG avidity test results . Of the = 0.001) .p = 0.01).The prevalence of IgA antibodies tended to decrease with increasing avidity, from 75% (3/4) in samples with low avidity (0.0–0.19) to 11.76% (6/51) with high avidity (≥0.3) (p < 0.001) , only 11.76% (6/51) had IgA antibodies compared to 92.16% (47/51) of those in whom IgM antibodies were detected (< 0.001) .T. gondii is generally self-limiting and asymptomatic [In immunocompetent individuals, infection with ptomatic ,31, but ptomatic . The matptomatic . Serologptomatic ,34,35,36T. gondii prevalence in Romanian women. The studies published so far have been carried out on small samples of population and revealed a seroprevalence from 19.5% in girls aged 1–18 years [T. gondii antibodies. The 46.09% seroprevalence of T. gondii IgG in our study group is lower than the 57.6% reported by Olariu et al. in 2008 [T. gondii prevalence recently demonstrated in female blood donors aged between 18 and 45 years from Western Romania [T. gondii in this region, and are consistent with results of previous studies conducted in Europe that confirmed such a decrease in seroprevalence [T. gondii; during transportation, meat is deep-freezed and this can lead to a decrease of consumption of infected meat [There is little information available to the international scientific community regarding 18 years , to 55.8 in 2008  in the s Romania . These revalence ,39,40. Tevalence ; crude vevalence ; the quaevalence ; commercted meat .T. gondii IgA antibodies may be lower than the IgM, during a serologic screening for toxoplasmosis. The prevalence of T. gondii IgA antibodies found in our survey is lower than the 13% and 8.7% seroprevalence reported by investigators in pregnant women from the USA [T. gondii. However, in Brazilian pregnant women selected by convenience when they presented for the antenatal care consultation, the seroprevalence of T. gondii IgA antibodies was 0.82% [T. gondii IgA antibodies [In this study, the prevalence of IgA antibodies was 1.65% compared to the 8.90% prevalence of IgM, suggesting that the detection rate of  the USA  and in m the USA , respectas 0.82% , lower ttibodies .T. gondii IgG, IgM and IgA) were used in our study group, 9.56% (58/607) of females could be suspected to have been recently infected. If IgG avidity and serologic tests  were combined, only 1.15% (7/607) of the females could be suspected of having a recent infection. Similar results were published by Berredjem et al. [When conventional serologic tests  compared to women in whom only IgM antibodies were present (6.25%). This indicates that T. gondii IgA is more likely to be positive if the infection occurred more recently, similar with results of previous studies [T. gondii IgG and IgM antibodies alone is often insufficient [T. gondii IgM, when detected, may also indicate a long-term persistence of these specific antibodies [T. gondii IgA antibodies at the same time with IgM and IgG is in favor of acute infection, given that the IgA test has a higher specificity and positive predictive value for the diagnosis of acute infection [Results of this survey suggest that a recent infection is more likely to be diagnosed in women with both  studies ,43,45,46fficient ,48, becatibodies . Howevernfection .T. gondii IgM, IgA and IgG avidity test results are in line with those recently reported in a study performed in the USA [T. gondii infection, compared to the lower IgM and IgA values found in our study where testing was performed by screening among women of reproductive age. In addition, serum samples with negative results for T. gondii IgG antibodies were not tested further for the presence of specific T. gondii IgM antibodies, and this may also be listed as a limitation of our study. However, cases with detectable IgM antibodies in absence of IgG antibodies are extremely rare [Though our sample size was large, the number of individuals tested for avidity was small and this may be considered a study limitation. However, our assessments regarding the interpretation of  the USA . The higely rare  and it iT. gondii infection frequently focus on pregnant women in order to reduce the risk of miscarriage and congenital infections. However, outbreaks in immunocompetent individuals have been described, which suggests that prevention and control measures, together with health education should also be directed to the general population [In most countries, efforts at preventing pulation .T. gondii prevalence is still high in Western Romania, although a declining trend of the seroprevalence was noted.Results of the present study suggest that T. gondii IgA antibodies may be rarely detected in females living in a Romanian endemic region and in whom a serologic screening has been performed. Therefore, our data suggest that T. gondii IgA test should not be routinely performed for screening purposes. However, in persons with demonstrable T. gondii IgG and IgM antibodies, testing for T. gondii IgA may improve the rate for the detection of a recently acquired toxoplasmosis.This survey indicates that


With a great emphasis on understanding teacher satisfaction in designing and improving professional development programs (PDPs), this study investigated the intrinsic and extrinsic aspects of satisfaction among Malaysian English as a Second Language (ESL) primary school teachers after finishing their first-degree program. A mixed-methods design was employed by using both quantitative methods (by administering survey research) and qualitative methods (through the use of items of the semi-structured questionnaire). The survey questionnaire was adapted from OECD Teaching and Learning International Survey (TALIS) questionnaire to measure the level of intrinsic and extrinsic teacher satisfaction among the samples. Descriptive analysis was used to analyse the survey research data collected from 30 secondary school English language teachers in Kuala Terengganu, east coast of Malaysia. The findings revealed that personal gains did not contribute much to PD activities in relation to the level of the teacher's extrinsic satisfaction after following their first-degree PD program. The study indicates that teachers differ from each other in terms of the source of their motivation for PD, whether intrinsic or extrinsic, and the type of development they aim for. This is hoped to show direction to the policymakers and organizers of PD programs in enhancing the program by taking into consideration of the teacher satisfaction, seniority, and professional background. The quality of professional development program (PDP) influences teacher characteristics of their satisfactions. Teacher satisfaction is achieved once they have fulfilled the needs of their expectations, in terms of the quality of lecturers, the intrinsic and extrinsic needs that had been met, input that they have received, and the new knowledge and skills that they had gained, specifically in the field of teaching and language skills. Hence, it is imperative for educational institutions to identify the teacher satisfaction with their PD to provide quality teacher PDPs in the future.Due to this fact, the Education Ministry of Malaysia established a committee in 1995 to examine teachers' PD in Malaysia in order to increase the teaching profession  and external (or extrinsic) factors Ewen, . InternaThe PD, salary increase, and work conditions are important to inculcate teachers' external motivation  and qualitative methods (by using items of the semi-structured questionnaire). Triangulation was used to strengthen the data collected.The first instrument to collect data for this study is a survey questionnaire, which was adapted from the OECD Teaching and Learning International Survey (TALIS) questionnaire to measure the level of intrinsic and extrinsic satisfaction of the samplings. Five-point Likert-type scale items were used to examine the level of satisfaction among the participants after undergoing the program. Questionnaires were used to gather data on teachers' self-satisfaction after participating in PD activities. The questionnaire is divided into three section, namely Part 1 (demographic data), Part 2 (what are the intrinsic satisfactions on English language teachers after completing a degree for PD on a part-time basis?), and Part 3 (what are the intrinsic satisfactions on English language teachers after completing a degree for PD on a part-time basis?).The second instrument that answers the second research question is a semi-structured interview, which was used to strengthen obtained data from the survey questionnaire. The 10–15 min interview was conducted with purposefully selected participants. The interviews were carried out in each school on a day that was convenient to the participants. A room was chosen where no interruptions would hinder the audio-tapping of the discussion. A digital audio recording device was used to record the interviews. Six semi-structured questions were constructed to examine teacher satisfaction on:i) knowledge and skills obtained,ii) quality of trainers/lecturers,iii) qualification of trainers/lecturers.According to Djamba and Neuman , flexiblA total of 30 in-service English language primary school teachers who had undergone PD and obtained their first degree on a part-time basis were selected. The primary reason for choosing participants with this profile is their provision of richer accounts of the impact that these professional life experiences have on their satisfaction. From the thirty participants, six teachers were chosen for a semi-structured interview. They were chosen based on the diversity of their experiences that further contribute to the richness of the study. It also enables a greater understanding of these teachers' satisfaction with the first-degree program in terms of the quality of the program and the quality of the lecturers, and their qualifications. The six chosen participants of this study have diversity in terms of their age, gender, school location, responsibilities in schools, and teaching experiences. The different backgrounds and varied experiences of the participants had contributed to rich data generation. Refer to t-test and one-way ANOVA to identify any mean difference between groups in the demographic profile.Data obtained from the questionnaire were analyzed using SPSS. The items in the questionnaires required the respondents to indicate responses based on a 5-point Likert-type scale. In this study, participants with a score of 4.0 and above (agree to strongly agree) are considered positive responses, while those with a score of 3.9 and below (disagree to strongly disagree) are considered negative responses. Descriptive analysis was used to analyze the data. The findings obtained are reported in two parts. Part 1 presents the data collected regarding the level of extrinsic satisfaction gained by the ESL teachers after following the first-degree program on a part-time basis. Part 2 shows the intrinsic self-satisfaction of ESL teachers after following the program. In addition, this study also conducted independent samples Following that, Interview Follow-Up Questionnaire (IFUQ) was conducted to further understand the level of the teacher satisfaction after following the program. In this stage, their level of satisfaction about the overall program regarding the academic's quality of teaching, satisfaction on knowledge gained from PDP, as well as their appraisal of the competency of the trainers' and lecturers' teaching the program and the lecturers' level of experience were also gauged.The findings obtained from the demographic data are presented in Results also indicated that 100% of the respondents were above 30 years, in which 26.7% of the respondents were in the 31–40 age category, 56.7% in the 41–50 age category, and another 16.7% in the above 50 age category. Hence, the participants represent the most mature and senior teachers in their schools where the majority is in the range of 41–50 representing 56.7% of the overall participants in the study, followed by teachers of the age bracket of above 30 years (26.7%) and above 50 categories (16.7%), respectively. Teaching experience was another variable explored in this study. Based on the results displayed in The findings obtained also revealed that all the respondents opted for English as their specialization (91.6%) as compared to those who did not opt for English as their specialization (8.3%). Since primary schools in Malaysia are still seriously lacking proficiency amongst English language teachers, the increasing number of English-option teachers teaching in the schools is very encouraging.The Cronbach's alpha coefficient is the most widely used internal consistency measure. When using Likert-type scales, the test is regarded as the most acceptable measure of reliability. A total of 13 items from the two constructs in the study, i.e., extrinsic and intrinsic satisfactions, were designated for the initial instrument to investigate the intrinsic and extrinsic aspects of satisfaction among ESL primary school teachers after following the first-degree program. The reliabilities of both parameters were high . The reliability coefficient  for extrinsic and intrinsic satisfactions was 0.908 and 0.935, respectively, indicating that the items in the instrument were highly accurate internally. The Cronbach's alpha coefficient for each construct is shown in Based on the results shown in Confidence in teaching skills), 4 (Improving interactions with students), and 6 (New self-identity) have contributed to the most intrinsic satisfaction after following the first-degree program, which recorded the mean of 3.97, followed by Item number 5, which was “Self-efficacy” as the second level of intrinsic satisfaction gained by the teachers which recorded the mean of 3.87 and standard deviation of 0.681, respectively. Item number 2 (Recognition from family members or communities) charted the third-highest . Finally, Item number 3 (Confidence in English language communication) recorded the last position with the mean of 3.70 and standard deviation of 0.750.As shown in The following section reports the findings obtained from the semi-structured interview. It reveals the findings of interview-follow up questionnaire (IFUQ) on teachers' level of satisfaction on the quality of the lecturers and the program.Are you satisfied with the knowledge and skills obtained through the degree that you have completed?Very satisfied. The knowledge and skills are highly relevant and applicable to my teaching. I personally, loves to learn linguistics, the part of how the phrase, the word, the sentence work together. From there, I get to understand how to structure the correct sentences, that's wonderful to help me in teaching language in the classroom. (P1/Q1/IFUQ).The education courses offered by a university have to be relevant and practical for teachers to apply in schools for the benefit of their students. Participant 1 (P1) expressed his satisfaction toward the knowledge and skills that he had collected from the program, where he cited the knowledge and skills he had gained are highly relevant and applicable to his teaching. Based on the interview conducted, the lecturers have generally provided a satisfactory level in terms of the knowledge and skills for the teachers to apply after following the program.Yes. All is good to me. I have been there for four years. Within that time, there was always new things that I had learnt in each semester. I remember that I was always looking forward to the new semester as I felt that each semester opens up the window to what I did not know about education, like technology in teaching where I've been taught about teaching aids, pedagogy, grammar teaching, to name a few.Based on the feedback given by Participant 2 (P2) as shown above, she seems excited to be a part of the program. The knowledge that she had received seemed to benefit her in the field of education. The area that she mentioned that she had learned in the program seems comprehensive and relevant to language teaching. It is essential for a learner to be interested and know what she had received in their PD education program so to enable better contribution and knowledge enhancement. Hopefully, this obtained knowledge would further be beneficial and applicable to her teaching in the classroom.How do you find the trainers/lecturers who trained/taught you throughout the degree?The lecturers were very understanding and friendly. I was very happy with them. They're very competent, experienced and knowledgeable. I think they're also very active in carrying out researches and studies.The quality of trainers or lecturers in one institution plays a vital role in ensuring the production of holistic students who excel academically and non-academically. It is discernible that Participant 3 (P3) expressed his satisfaction toward the nature of the lecturer's code of conduct and maturity in handling matters in the institution while following the program. The lecturers are also observed to be competent, experienced, and knowledgeable, besides being prolific in carrying out their studies.Approachable. I can discuss things with them. Maybe they treat us in such way, since we are adult learners, hahaha01_fmed-09-892205 (grinned). But, somehow it is their professionalism that causing me to respect them more. They treat us as a friend, but at the same time they were firm when it comes to the execution of assignments and tasks given to us during the lecture.The quality of the lecturer is the essence of the institution. An educator needs to know how to effectively teach adult learners. They should not be taught the same way as teaching fresh graduates. As adult learners are usually experienced teachers, the lecturers should have an open discussion, sharing their knowledge during the lesson rather than applying the spoon-feeding approach. The questions given in the form of open-ended are likely to be more suitable for adult learners.Are you happy with their qualification/experience and competency? Why?Yes. They are qualified, based on their knowledge and skill that I observed. Besides, the university must be strict in hiring their staff. I also believed that their experience must be abundance since they are teaching in a well-known local university. I am also not questioning their teaching capabilities since they seem to manage well. Maybe got one or two situations where I am not really happy with, especially during consultation where they tend to always change their opinions on things they asked us to do.UiTM is a public university in Malaysia where the requirement for a qualified lecturer is given serious consideration, where the hiring of lecturers is based on merit. As such, Participant 5 (P5) was satisfied with the qualifications of the lecturers due to that nature. Based on the interview finding, the majority of the participants were satisfied with the program and the quality of the lecturers. They agreed that the program has successfully produced many graduates among adult learners consisting of ESL primary school teachers.I would say yes for many of them, but there were a few that I noticed not up to the par, though, I think (pause). For instance, I noticed that a few old generation of the lecturer are not very skillful on using the technology in teaching, like they would prefer to use old method when giving notes. I mean they don't like it if we were to present our mock teaching by recording and submit it to her online. Well, somehow maybe that wasn't allowed, hihi (cheeky).Based on the perspectives of Participant 6 (P6) shown above, she seemed to be generally satisfied with the qualification of the lecturers. Nevertheless, there were instances where it was noticeable with senior lecturers who lack technological skills. Educators need to upgrade their knowledge and skill in technology by attending courses and getting involved in PD to enhance their teaching, besides preparing themselves to be more technologically skilful lecturers. With the help of computers and Internet, e-learning brings changes to pedagogical strategies and ultimately improves the efficiency of teaching and learning (Omar et al., From the data analysis on extrinsic satisfaction, it was found that personal gains did not contribute much to the teachers after they had completed their PDP. This contradicts the finding found in a study performed by Nasser and Shabti  where exThe finding also shows that DG32 teachers recorded higher extrinsic satisfaction as compared to DG41 teachers, with a significant value of 0.047. The former group of teachers recorded higher satisfaction because the PDP they attended served as a gateway to further education where it has been recorded as the second-highest teacher extrinsic satisfaction based on the descriptive analysis. This group of teachers is also younger than those in the DG41 group. Hence, they must have been more ambitious to continue their studies. More opportunities for PD courses could also be the reason for higher satisfaction being recorded from this group. It also shows that these teachers have accumulated new added knowledge and skills regarding their job which contribute toward the increment of self-satisfaction in teaching students at schools. Networking with teachers from other schools had tremendously helped them in sharing knowledge of related education, teaching skills, and current education issues, and it has been recorded in the descriptive analysis as the highest satisfaction that they had gained from the program.In retrospect of the semi-structured interview, the teachers indicated a general satisfaction of the program in terms of knowledge and skills obtained, besides the lecturers' quality and qualification. This shows that the courses offered were relevant and comprehensive. The organizer of any PDP needs to look into the technological aspects to improve the content of the program as a way to ensure its relevance in catering to the current suitability and practicality to students since there is a rise in online teaching and learning during the current pandemic situation. The universal need for digital technologies requires educators to build on their existing skills where the sophisticated use of technology has taken on greater importance (Omar et al., This study employed data from the Malaysian primary school ESL teachers who were doing their first-degree part-time program. The generalization of the results may be limited to this particular group of teachers. Expansion of study into other categories of groups, such as secondary school teachers, might produce more interesting findings of their satisfactions. The study had also been conducted on only thirty samplings that covered the east coast schools in Malaysia, compared to the larger areas of other states in the country, which would be more comprehensive.Seminars, workshops, and future professionalism programs should be arranged in different areas, based on the target group of the teachers taking into consideration their age, seniority, and professionalism needs. Policymakers and educational administration should plan such programs as suggested by Avidov-Ungar  in orderIdentifying other characteristics that affect satisfaction should be the topic of future research. Concurrently, since PD training is a product of interest to education personnel, further efforts should be made to identify relevant attributes of potential participants and to discover the causes of continuing to participate in PD training.This research reveals the types of teacher satisfaction within a PDP. It is hoped to provide directions for policymakers and organizers of the PDP in enhancing the program by taking into consideration of teacher satisfaction, seniority, and professional background. MOE needs to organize teacher PDPs that take into consideration the quality of the program, the quality of the facilities provided, and the teaching quality of lecturers to ensure teachers benefit from it in accordance with the latter's needs. A successful program will reflect in the intrinsic and extrinsic satisfaction among the teachers, which will further produce a chain effect on their clients, who are their students, in ensuring quality education on the whole.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by UiTM Terengganu. The patients/participants provided their written informed consent to participate in this study.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


BackgroundAnatomy education in this context refers to the training of anatomists particularly in the university or college setting with an emphasis on equipping them with skills to be biomedical researchers and scientists, educators, and providers of applied or allied health services. There has been a recurring call to carefully evaluate and scrutinize biomedical science programs in Nigerian universities. This study considered the anatomy curriculum in representative Nigerian institutions with an emphasis on their philosophy, program design, program objectives, and program contents among other considerations.Materials and methodsStructured and validated questionnaires, electronic, were administered to collect quantitative and qualitative data from heads of the anatomy department in representative institutions. Head of anatomy departments in 11 representative institutions returned their properly completed questionnaires, representing over 60% return rate of the target representative institutions. Quantitative data sets were analyzed and presented as tables, charts, and figures. Qualitative data in the form of free responses were analyzed and presented based on themes.ResultsDegree programs, including bachelor's, master's, and doctorate degrees, are currently offered in respondents’ universities. The curricula are generally robust in scope and depth of content as they address all the main domains of anatomy or anatomical sciences, especially gross anatomy, histology, embryology, neuroscience, and physical anthropology in many instances. The average duration for the bachelor’s program (BSc) is 4 years, master's 2 years, and PhD (Doctor of Philosophy) 3-5 years. Analysis of the main methods of training indicated that the programs include significant coursework at every level as well as the main research project leading to the presentation of a dissertation or thesis. We also identified gaps in training, with emphasis on transferable skills, which must be addressed in line with modern realities in basic medical sciences.Conclusion We consider it a necessity to equip graduates at all levels of training with competencies that are directly and clearly aligned with the roles that graduates of the program should play in workplaces. We, therefore, recommend that curricula be reviewed to emphasize competencies in scientific investigations, transferable skills, and science education. Specific cutting-edge skills and research methods should be included in alignment with overall program objectives and deliverables.  BackgroundThis research was carried out to contribute to knowledge in the field of anatomy or anatomical science education, especially in Nigeria and Africa. This is evident from the fact that the Anatomical Society of Nigeria devoted three consecutive conferences and the annual general meetings, between 2017 and 2019, to themes and topics that revolved around anatomy education in Nigeria. It is also important to note that the body of anatomists in Nigeria was one of the foremost and largest professional basic medical science (BMS) bodies on the continent of Africa. Over the years, Nigerian institutions have trained a significant number of anatomists who work and practice within the country and many others who are providing educational and research services in institutions across the world with significant impacts. Despite the relatively significant successes that have been recorded over the years, the call for a thorough review of curricular philosophies, contents, and methods of training is in line with the global realities in medical sciences. This also needs to be done in line with the changes that have characterized education globally and more specifically BMS training. This is to ensure that the practices and the processes of training basic medical scientists are best aligned with global best practices and professional roles as determined by job requirements and governing policies of employment. To achieve this, it was clear that empirical data would be of immense benefit, hence the need to conduct this study.About anatomy educationNeed for Change and AdvancementsAnatomy, the science, as well as anatomy education has no doubt evolved globally, due to the advancements in sciences generally, but more specifically due to advancements in methods of scientific investigations that have provided the avenue for a better and advanced appreciation of the human body from several perspectives ,2. In thPrevious Work on TrainingA few studies, including ours, in the past, have attempted to examine the training regimen for anatomists, particularly in the Nigerian educational system ,6. Some Previous Work on EmployabilityThere has also been previous work that evaluated the job and career prospects, including the employability of graduates of anatomy programs at various levels including bachelor's, master's, and PhD ,6-8. ThePrevious Work on Policies and Practices Policies and work-related practices have also been considered in relation to how graduates of anatomy programs have fared in the relevant sectors as well as factors that have influenced employability and job satisfaction among other considerations. One major factor that has stood out is the need to consider the existing policies that define the role of anatomists in the relevant sectors and workplaces. This, by extension, would also include policies that guide the practice of anatomical sciences in academia, the health sector, and other relevant industries. In the Nigerian case, for example, efforts have been made to reconsider the Anatomy Act of 1934 in line with modern realities and as such define the roles of Nigerian anatomists within their sphere of professional influence which includes educational, medical, and relevant biomedical industries as well as public offices. There is an urgent and important need to put in place proper policies and work-related regulations that will enable Nigerian anatomists to optimally contribute their professional quota toward national development -8.A Review of Global Best PracticesThe world is not only becoming more of a global village but a closer one at that which buttresses the fact that it is becoming increasingly important to consider global or international best practices with respect to program design and training regimens. In this instance, the training of anatomists is not an exception. Nigerian anatomists are no doubt robustly trained and have been found to be very adaptable and highly resourceful both in the national and international arenas . There iMixed methodsThis study used a structured questionnaire to collect both quantitative and qualitative (free response) information from the respondents. A structured and validated questionnaire was administered to the heads of departments who were required to supply information based on the design and implementation of the anatomy programs - Bachelor's, Master’s, and PhD - as applicable to their department. The initial sections, which constituted the larger part of the questionnaire, required largely quantitative data. The latter part had open-ended questions to which the heads of the departments were required to respond. These provided a suitable avenue for the respondents to provide information in qualitative formats.Questionnaire structureA structured and validated questionnaire on anatomical education curriculum analysis was designed based on a standard reference  to invesQuestionnaire administrationQuestionnaire administration lasted a month during which respondents were required to return the properly completed questionnaire. The questionnaire was adapted to a Google form template and delivered to the target respondents through their valid email addresses. An accompanying message in the form of an email or a phone call was added to specifically request the participation of the respondents on behalf of their institutions. Ethical considerationsThis study requested and obtained official ethical approval from Babcock University Research Ethical Committee (BUHREC: 701/18). The development, validation, and administration of the questionnaire followed all ethical considerations, requirements, and guidelines. All respondents indicated their informed consent. Data and information from respondents were all treated with strict adherence to ethical standards with respect to research data management. Responses were coded and saved anonymously. Analysis was also done without any specific references to respondents’ identities and confidential records. Program descriptionDiploma/Pre-school/Prelim1/2 years. The maximum also ranged between one and three years with the average being two years. It is important to note that certain schools in the country offered pre-degree programs that might also involve certain other science disciplines, hence we decided to investigate the structure and the duration of such programs. Where applicable, the minimum duration ranged between one and two years with the average being 1Undergraduate/Bachelor’s Programs We considered the minimum and maximum stipulated durations for the undergraduate/bachelor’s programs with an emphasis on the duration. The minimum duration ranged between two and five years with the modal value being three years and the average being 3.5 years. In terms of the maximum duration, the modal value was four years, the range being 4-6 years and the average being five years; nine of the universities that participated indicated that they offered bachelor's degree programs in human anatomy. Postgraduate - Master'sThe minimum duration for the master’s program ranged between one and three years with the modal value being two years. The maximum duration ranged between two and three years with the average being 2.5 years. Out of 13 universities, four indicated that they did not offer master’s degree programs. Postgraduate - DoctorateThe minimum duration for the doctorate program (PhD or Doctor of Philosophy) was generally three years. The maximum duration ranged between four and five years with the average being five years. Out of 13 universities, four indicated that they did not offer doctorate programs. The nomenclature of the doctorate was also always a Doctor of Philosophy - PhD, in anatomy.Postgraduate - PostdoctorateOnly five respondents indicated that they had a place for postdoctoral training. The duration indicated for a postdoctoral training is one year generally. Program philosophy and mission statementIn terms of philosophy and mission statement, Nigerian institutions trained anatomists as medical scientists, with primary prospects of working as medical scientists and educators, providing services primarily in the educational sectors, including universities and other institutions that offer anatomy, medical, and allied health programs. They are also trained to provide services that might require their competencies as medical scientists in the relevant industries. In both program philosophy Figure  and missStructure of programsCurriculum review showed that anatomy, as offered in the Nigerian context, was primarily human anatomy, as a basic medical or biomedical science program Table . SignifiProgram descriptionThe program duration, based on the information obtained during this study, shows that the average duration for a bachelor's program in anatomy ranges between four and five years. This is in line with the regulations of the National University Commission of Nigeria, in which case a degree program will run between three and five years. The option of having a degree program within three years is only possible if the entrant would come in with advanced A-Level qualification or an ordinary national diploma (OND) from an appropriate institution such as the polytechnic. The conventional duration is therefore four years, while under certain circumstances such as in the universities of technology, the standard program duration could be five years due to their policies and institutional standards. This duration, in line with global best practices, will be adequate to obtain a bachelor's degree from a university. It is also important to note that the structure of the program requires that students are trained with adequate depth in all primary domains including knowledge, skills, and attitude. With such program durations for the anatomy programs, it is evident that there would be adequate time for not just knowledge acquisition but also quality research. What, therefore, becomes equally important is the need to emphasize research while training students or trainees during these stipulated durations.Generally, respondents indicated that the program is offered in human anatomy, and in the context of BMSs. A critical look at the course contents might indicate extensions and expansions into comparative and applied anatomy. However, the core course contents revolve around human anatomy in the context of biomedical science or BMS, whereas the domains, phenomena, and bodies of knowledge that involve interactions between the human body milieus with other life-forms such as microorganisms, the plant kingdom as well as lower forms of life even within the animal kingdom are considered. These observations, altogether, therefore point to the fact that the programs are typically very robust, offering the graduates the versatility and potential to apply their knowledge of anatomy and skills to a very broad range of fields of endeavor. This equally points to the need to expand the career prospect for graduates, especially in terms of policies, career programs, and orientation.The minimum duration for the master's program range between one and three years while the maximum range is between two and three years. It is also clear that this is in line with global best practices especially since the program structure incorporates both theoretical courses as well as practical training and research skill acquisition in addition to a comprehensive research project leading to the development and defense of a thesis or dissertation. The minimum duration for the PhD is generally placed at three years with a maximum range between four and five years. This is also in line with global best practices, noting that this in many instances also includes training and teaching that include theoretical concepts, practical application of theories as well as specific research skills and competencies. It is, therefore, clear that the duration is adequate to provide students with the opportunity to be grounded in all the required domains. What has become, therefore, very important for emphasis is the need to utilize this duration optimally to acquire quality competencies especially as it relates to integration into communities of practice and learning. While this was not specifically explored, it is important to emphasize the need to integrate postgraduate trainees into communities of practice and learning to continue their professional growth and development through quality exposure, professional networking, and collaborations. Poor quality of supervision has been a bane of doctorate programs. In response, there have been programs and recommendations, including the need to adopt creative and effective approaches to students’ supervision mentorship . Few of Program philosophy and mission statementA common theme that runs through the respondents’ statements in terms of the mission statement and philosophy of the program included the fact that students who enroll in their anatomy programs are trained as medical scientists and educators. It is also clear that this is in line with the mainstream philosophy of why programs in anatomy or biomedical sciences are offered in Nigerian universities . Many grNotably, there is an important industry that appears to be undervalued in terms of how much emphasis is laid on the potential contributions of anatomists. This observation also underscores the need to consider the roles of anatomists beyond the teach-train-and-do-research roles in mainstream academia of tertiary institutions. This industry includes the education industry as it bothers with the provision of educational services and the developing of educational materials. For example, anatomists who proceed to become neuroscientists, which is typical in Nigeria and Africa, can contribute significantly to the educational neuroscience field by exploring concepts such as human memories and learning methods and mechanisms, and by promoting the application of knowledge and evidence to support evidence-based policies and practices. Another vital example is the development of educational materials such as anatomical and medical illustrations. Being anatomical and medical illustrators is another example of services that an anatomist might provide. More than ever before, the need to produce and provide very accurate anatomical, medical, and scientific illustrations is being emphasized. In fact, this goes beyond the artistic drawings, to include dynamic illustrations as well as three-dimensional (3D) representations of the human body systems, organs, and structures as well as concepts and phenomena. Anatomists who serve as anatomical, medical, and scientific illustrators will, therefore, be needed in the educational industries either as practicing illustrators or as specialists who oversee illustration projects, validating representations, and providing consultancy services. It is also important to emphasize that beyond the university, anatomists can also provide health science education teaching to pre-university students such as A-level or high school or college pupils, especially with additional training or competence in health science education. Several industries might need applied anatomical knowledge and skills, such as in the aspects of ergonomics and system designs. This might range from the clothing and fashion industries to the automobile and computer technology industries, and anatomists could provide expert guidance and design guidelines based on human morphology, kinetics and gestures, postures and behaviors on visualization, fitness-for-use, comfort-related design considerations, and movement and body-shape-related design considerations. While the basic training for an anatomist might not offer all the requisite skills and competencies, it remains fundamental and foundational, such that the applied training and skills can help to provide such services. The training regimen should, therefore, consider these realities in terms of its philosophy, approach, and methods.It is interesting to note the relatively consistent undertone that defines the kind of laboratory services in terms of anatomists’ roles as merely supportive or ancillary. It is, however, important to emphasize that while this might be true in certain instances, the anatomist, being trained as a medical or biomedical scientist, can always serve in a principal role in relevant laboratories. This undertone might be a residual mindset from a historical background that places certain categories of health professionals and scientists in ancillary categories. This line of thought has so far become obsolete. There remains a vital need to disabuse this mindset as it is important to emphasize that with adequate training biomedical scientists when qualified do serve in principal roles while providing relevant laboratory services. It is also important to further emphasize that every trained anatomist, as a biomedical scientist, is capable of providing quality laboratory services in academic laboratories, and when qualified and certified in specific relevant service laboratories. Stakeholders should be aware of this and should take responsibility for correcting this anomaly that is typically observable and could be prevalent in certain instances. Structure of programsIn terms of structure, all programs including bachelor's, master's, and doctorate include both significant theoretical learning as well as practical and applied training. It is important to note that this is in line with the prevalent philosophy of training in the country and Africa in general . GraduatPersonal and professional insightsThe free responses of participants were thematically analyzed. The key themes (see Figure The research was also highlighted. Respondents believed that training programs should better emphasize cutting-edge research, not just in curricular philosophy but also in training. A vital consideration would be that trainees should acquire adequate transferable research skills. Also, to enshrine a culture of research, adequate funding should be provided to equip laboratories and drive engagements in cutting-edge research. Respondents also emphasized the need to ensure better job prospects for program graduates. It is noteworthy that curricular philosophies generally indicated that program graduates would be medical scientists, educators, researchers, and service providers in relevant industries and sectors. As such, recognition should be given to anatomists in association with those defined roles. It was believed that this would motivate trainees. It was also believed that awareness for both learners and the public would be vital to promoting better career recognition and prospects. Therefore, the need for training to emphasize research skills and applied competencies remains a major consideration.Respondents generally believed that there is a critical need to equip trainees with skills in the areas of biomedical sciences research, education, scientific services, and roles among others. This has also been previously reported . It was LimitationsThe main limitation of this study was that we could not extend the qualitative aspects to include in-depth interviews and all focus group discussions due to logistics constraints including limited availability of resources, time, and funding.In conclusion, the Nigeria Anatomy Program is very robust in philosophy and indicative content. It is, therefore, important to ensure a process that optimizes the training programs based on the curricula. It is necessary to equip graduates at all levels of training with competencies that are directly and clearly aligned with the roles that graduates of the program should play in workplaces. It is, therefore, recommended that the program delivery should emphasize competency in scientific investigation and science education. Specific cutting-edge skills and research methods should be included in alignment with overall program objectives and deliverables.