Search results for: fecal prevalence

Authors: Petra Balla, Gabor Manhertz, Akos Antal

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Nowadays spinal deformities are very frequent problems among teenagers. Scheuermann disease is a one dimensional deformity of the spine, but it has prevalence over 11% of the children. A traditional technology, the moiré method was used by us for screening and diagnosing this type of spinal deformity. A LabVIEW program has been developed to evaluate the moiré pictures of patients with Scheuermann disease. Two different solutions were tested in this computer program, the extreme and the inflexion point calculation methods. Effects using these methods were compared and according to the results both solutions seemed to be appropriate. Statistical results showed better efficiency in case of the extreme search method where the average difference was only 6,09⁰.

Keywords: spinal deformity, picture evaluation, Moiré method, Scheuermann disease, curve detection, Moiré topography

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Authors: Roman Khanferyan, Levon Gevorkyan, Ivan Radysh

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Skin barrier dysfunction induces multiple inflammatory skin diseases. Epidemiological studies clearly support the link between most dermatological pathologies, immune disorders and metabolic disorders. Among them most common are psoriasis (PS) and Atopic dermatitis (AD). Psoriasis is a chronic immune-mediated inflammatory skin disease that affects 1.5 to 3.0% of the world's population. Comorbid metabolic disorders play an important role in the progression of PS and AD, as well. It is well known that PS, AD and overweight/obesity are associated with common pathophysiological mechanisms of mild chronic inflammation. The goal of the study was to study the immune disturbances in patients with PS, AD and comorbid metabolic disorders. To study the prevalence of comorbidity of PS and AD (data from 1406 patient’s histories of diseases) were analyzed. The severity of the disease is assessed using the PASI index (Psoriasis Area and Severity Index). 59 patients with psoriasis of different localizations of lesions and severity, as well as with different body mass index (BMI), were examined. The determination of the concentration of pro-inflammatory cytokines (IL-6, IL-8, IFNγ, IL-17, L-18 and TNFa) and chemokines (RANTES, IP-10, MCP-1 and Eotaxin) in sera and supernatants of 48h-cultivated peripheral blood mononuclear cell (PBMC) of psoriasis patients and healthy volunteers (36 adults) have been carried out by multiplex assay (Luminex Corporation, USA). It has been demonstrated that 42% of PS patients had comorbidity with different types of atopies. The most common was bronchial asthma and allergic rhinitis. At the same time, the prevalence of AD in PS patients was determined in 8.7% of patients. It has been shown that serum levels of all studied cytokines (IL-6, IL-8, IFNγ, IL-17, L-18 and TNF) in most of the studied patients were higher in PS patients than in those with AD and healthy controls (p<0.05). An in vitro synthesis of the IL-6 and IFNγ by PBMC demonstrated similar results to those determined in blood sera. There was a high correlation between BMI, immune mediators and the concentrations of adipokines and chemokines (p<0.05). The concentrations of Leptin and Resistin in obese psoriatic patients were greater by 28.6% and 17%, respectively, compared to non-obese psoriatic patients. In obese patients with psoriasis the serum levels of adiponectin were decreased up to 1.3-fold. The mean serum RANTES, IP-10, MCP-1, EOTAXIN levels in obese psoriatic patients were decreased by up to 13.1%, 21.9%, 40.4% and 28.2%, respectively. Similar results have been demonstrated in AD patients with comorbid overweight and obesity. Thus, the study demonstrated the important role of cytokines and chemokines dysregulation in inflammatory skin diseases, especially in patients with comorbid obesity and overweight. Metabolic disorders promote the severity of PS and AD, highly increase immune dysregulation, and synthesis of adipokines, which correlates with the production of proinflammatory immune mediators in comorbid obesity and overweight.

Keywords: psoriasis, atopic dermatitis, pro-inflammatory cytokines, chemokines, comorbid obesity

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Authors: Katerina H. Takova, Ivan N. Minkov, Gergana G. Zahmanova

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Molecular farming is the production of recombinant proteins in plants with the aim to use the protein as a purified product, crude extract or directly in the planta. Plants gain more attention as expression systems compared to other ones due to the cost effective production of pharmaceutically important proteins, appropriate post-translational modifications, assembly of complex proteins, absence of human pathogens to name a few. In addition, transient expression in plant leaves enables production of recombinant proteins within few weeks. Hepatitis E virus (HEV) is a causative agent of acute hepatitis. HEV causes epidemics in developing countries and is primarily transmitted through the fecal-oral route. Presently, all efforts for development of Hepatitis E vaccine are focused on the Open Read Frame 2 (ORF2) capsid protein as it contains epitopes that can induce neutralizing antibodies. For our purpose, we used the CMPV-based vector-pEAQ-HT for transient expression of HEV ORF2 in Nicotiana benthamina. Different molecular analysis (Western blot and ELISA) showed that HEV ORF2 capsid protein was expressed in plant tissue in high-yield up to 1g/kg of fresh leaf tissue. Electron microscopy showed that the capsid protein spontaneously assembled in low abundance virus-like particles (VLPs), which are highly immunogenic structures and suitable for vaccine development. The expressed protein was recognized by both human and swine HEV positive sera and can be used as a diagnostic reagent for the detection of HEV infection. Production of HEV capsid protein in plants is a promising technology for further HEV vaccine investigations. Here, we reported for a rapid high-yield transient expression of a recombinant protein in plants suitable for vaccine production as well as a diagnostic reagent. Acknowledgments -The authors’ research on HEV is supported with grants from the Project PlantaSYST under the Widening Program, H2020 as well as under the UK Biotechnological and Biological Sciences Research Council (BBSRC) Institute Strategic Programme Grant ‘Understanding and Exploiting Plant and Microbial Secondary Metabolism’ (BB/J004596/1). The authors want to thank Prof. George Lomonossoff (JIC, Norwich, UK) for his contribution.

Keywords: hepatitis E virus, plant molecular farming, transient expression, vaccines

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Authors: Aashutosh Garg, Ankur Rajpal, A. A. Kazmi

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The efficiency of an on-site wastewater treatment system named Johkasou was evaluated based on its pollutant removal efficiency over 10 months. This system was installed at IIT Roorkee and had a capacity of treating 7 m3/d of sewage water, sufficient for a group of 30-50 people. This system was fed with actual wastewater through an equalization tank to eliminate the fluctuations throughout the day. Methanol and ammonium chloride was added into this equalization tank to increase the Chemical Oxygen Demand (COD) and ammonia content of the influent. The outlet from Johkasou is sent to a tertiary unit consisting of a Pressure Sand Filter and an Activated Carbon Filter for further treatment. Samples were collected on alternate days from Monday to Friday and the following parameters were evaluated: Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), and Total Nitrogen (TN). The Average removal efficiency for Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), and Total Nitrogen (TN) was observed as 89.6, 97.7, 96, and 80% respectively. The cost of treating the wastewater comes out to be Rs 23/m3 which includes electricity, cleaning and maintenance, chemical, and desludging costs. Tests for the coliforms were also performed and it was observed that the removal efficiency for total and fecal coliforms was 100%. The sludge generation rate is approximately 20% of the BOD removal and it needed to be removed twice a year. It also showed a very good response against the hydraulic shock load. We performed vacation stress analysis on the system to evaluate the performance of the system when there is no influent for 8 consecutive days. From the result of stress analysis, we concluded that system needs a recovery time of about 48 hours to stabilize. After about 2 days, the system returns again to original conditions and all the parameters in the effluent become within the limits of National Green Tribunal (NGT) standards. We also performed another stress analysis to save the electricity in which we turned the main aeration blower off for 2 to 12 hrs a day and the results showed that we can turn the blower off for about 4-6 hrs a day and this will help in reducing the electricity costs by about 25%. It was concluded that the Johkasou system can remove a sufficient amount of all the physiochemical parameters tested to satisfy the prescribed limit set as per Indian Standard.

Keywords: on-site treatment, domestic wastewater, Johkasou, nutrient removal, pathogens removal

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Authors: Arosha Rashmi De Silva, Ananda Chandrasekara

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This study seeks to comprehensively examine the influence of fast-food consumption and physical activity levels on the body weight of young employees within the private sector of Sri Lanka. The escalating popularity of fast food has raised concerns about its nutritional content and associated health ramifications. To investigate this phenomenon, a cohort of 100 individuals aged between 25 and 45, employed in Sri Lanka's private sector, participated in this research. These participants provided socio-demographic data through a standardized questionnaire, enabling the characterization of their backgrounds. Additionally, participants disclosed their frequency of fast-food consumption and engagement in physical activities, utilizing validated assessment tools. The collected data was meticulously compiled into an Excel spreadsheet and subjected to rigorous statistical analysis. Descriptive statistics, such as percentages and proportions, were employed to delineate the body weight status of the participants. Employing chi-square tests, our study identified significant associations between fast-food consumption, levels of physical activity, and body weight categories. Furthermore, through binary logistic regression analysis, potential risk factors contributing to overweight and obesity within the young employee cohort were elucidated. Our findings revealed a disconcerting trend, with 6% of participants classified as underweight, 32% within the normal weight range, and a substantial 62% categorized as overweight or obese. These outcomes underscore the alarming prevalence of overweight and obesity among young private-sector employees, particularly within the bustling urban landscape of Colombo, Sri Lanka. The data strongly imply a robust correlation between fast-food consumption, sedentary behaviors, and higher body weight categories, reflective of the evolving lifestyle patterns associated with the nation's economic growth. This study emphasizes the urgent need for effective interventions to counter the detrimental effects of fast-food consumption. The implementation of awareness campaigns elucidating the adverse health consequences of fast food, coupled with comprehensive nutritional education, can empower individuals to make informed dietary choices. Workplace interventions, including the provision of healthier meal alternatives and the facilitation of physical activity opportunities, are essential in fostering a healthier workforce and mitigating the escalating burden of overweight and obesity in Sri Lanka

Keywords: fast food consumption, obese, overweight, physical activity level

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Authors: Shilpi, Indu Gaur, Neha Bhadauria, Susmita Goswami, Prabir K. Paul

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Cultivation and consumption of organically grown fruits and vegetables have increased by several folds. However, the presence of Human Enteric Pathogens on the surface of organically grown vegetables causing Gastro-intestinal diseases, are most likely due to contaminated water and fecal matter of farm animals. Human Enteric Pathogens are adapted to colonize the human gut, and also colonize plant surface. Microbes on plant surface communicate with each other to establish quorum sensing. The cross talk study is important because the enteric pathogens on phylloplane have been reported to mask the beneficial resident bacteria of plant. In the present study, HEPs and bacterial colonizers were identified using 16s rRNA sequencing. Microbial colonization patterns after interaction between Human Enteric Pathogens and natural bacterial residents on tomato phylloplane was studied. Tomato plants raised under aseptic conditions were inoculated with a mixture of Serratia fonticola and Klebsiella pneumoniae. The molecules involved in cross-talk between Human Enteric Pathogens and regular bacterial colonizers were isolated and identified using molecular techniques and HPLC. The colonization pattern was studied by leaf imprint method after 48 hours of incubation. The associated protein-protein interaction in the host cytoplasm was studied by use of crosslinkers. From treated leaves the crosstalk molecules and interaction proteins were separated on 1D SDS-PAGE and analyzed by MALDI-TOF-TOF analysis. The study is critical in understanding the molecular aspects of HEP’s adaption to phylloplane. The study revealed human enteric pathogens aggressively interact among themselves and resident bacteria. HEPs induced establishment of a signaling cascade through protein-protein interaction in the host cytoplasm. The study revealed that the adaptation of Human Enteric Pathogens on phylloplane of Solanum lycopersicum involves the establishment of complex molecular interaction between the microbe and the host including microbe-microbe interaction leading to an establishment of quorum sensing. The outcome will help in minimizing the HEP load on fresh farm produce, thereby curtailing incidences of food-borne diseases.

Keywords: crosslinkers, human enteric pathogens (HEPs), phylloplane, quorum sensing

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Authors: Usha S. Adiga, Sachidanada Adiga

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Introduction: Diabetes Mellitus (DM) is one of the most common non-communicable diseases which imposes a large economic burden on the global health-care system. Cost of illness studies in India have assessed the health care cost of DM, but have certain limitations due to lack of standardization of the methods used, improper documentation of data, lack of follow up, etc. The objective of the study was to estimate the cost of illness of uncomplicated versus complicated type 2 diabetes mellitus in Coastal Karnataka, India. The study also aimed to find out the trend of cost of illness of the disease over a decade. Methodology: A prevalence based bottom-up approach study was carried out in two tertiary care hospitals located in Coastal Karnataka after ethical approval. Direct Medical costs like annual laboratory costs, pharmacy cost, consultation charges, hospital bed charges, surgical /intervention costs of 238 diabetics and 340 diabetic patients respectively from two hospitals were obtained from the medical record sections. Patients were divided into six groups, uncomplicated diabetes, diabetic retinopathy(DR), nephropathy(DN), neuropathy(DNeu), diabetic foot(DF), and ischemic heart disease (IHD). Different costs incurred in 2008 and 2017 in these groups were compared, to study the trend of cost of illness. Kruskal Wallis test followed by Dunn’s test were used to compare median costs between the groups and Spearman's correlation test was used for correlation studies. Results: Uncomplicated patients had significantly lower costs (p <0.0001) compared to other groups. Patients with IHD had highest Medical expenses (p < 0.0001), followed by DN and DF (p < 0.0001 ). Annual medical costs incurred were 1.8, 2.76, 2.77, 1.76, and 4.34 times higher in retinopathy, nephropathy, diabetic foot, neuropathy and IHD patients as compared to the cost incurred in managing uncomplicated diabetics. Other costs also showed a similar pattern of rising. A positive correlation was observed between the costs incurred and duration of diabetes, a negative correlation between the glycemic status and cost incurred. The cost incurred in the management of DM in 2017 was found to be elevated 1.4 - 2.7 times when compared to that in 2008. Conclusion: It is evident from the study that the economic burden due to diabetes mellitus is substantial. It poses a significant financial burden on the healthcare system, individual and society as a whole. There is a need for the strategies to achieve optimal glycemic control and operationalize regular and early screening methods for complications so as to reduce the burden of the disease.

Keywords: COI, diabetes mellitus, a bottom up approach, economics

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Authors: G. A. Gevorgyan, A. S. Mamyan, L. G. Stepanyan, L. R. Hambaryan

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Bacterio- and phytoplankton growth rates in 'Yerevanyan lich' reservoir and the Hrazdan river in Yerevan city, Armenia were investigated in April and June-August, 2015. Phytoplankton sampling and analysis were performed by the standard methods accepted in hydrobiological studies. The quantitative analysis of aerobic, coliform and E. coli bacteria is done by the 'RIDA COUNT' medium sheets (coated with ready-to-use culture medium). The investigations showed that the insufficient management of household discharges in Yerevan city caused the organic and fecal pollution of the Hrazdan river in this area which in turn resulted in an increase in bacterial count and increased sanitary and pathogenic risks to the environment and human health. During the investigation in April, the representatives of diatom algae prevailed quantitatively in the coastal area of 'Yerevanyan lich' reservoir, nevertheless, a significant change in the phytoplankton community in June occurred: due to green algae bloom in the reservoir, the quantitative parameters of phytoplankton increased significantly. This was probably conditioned by a seasonal increase in the water temperature in the conditions of the sufficient concentration of nutrients. However, a succession in phytoplankton groups during July-August occurred, and a dominant group (according to quantitative parameters) in the phytoplankton community was changed as follows: green algae-diatom algae-blue-green algae. Rapid increase in the quantitative parameters of diatom and blue-green algae in the reservoir may have been conditioned by increased organic matter level resulted from green algae bloom. Algal bloom in 'Yerevanyan lich' reservoir caused changes in phytoplankton community and an increase in bacterioplankton count not only in the reservoir but also in the Hrazdan river sites located in the downstream from the reservoir. Thus, the insufficient management of urban discharges and aquatic ecosystems in Yerevan city led to unfavorable changes in water quality and microbial and phytoplankton communities in “Yerevanyan lich” reservoir and the Hrazdan river which in turn caused increased sanitary and pathogenic risks to the environment and human health.

Keywords: algal bloom, bacterioplankton, phytoplankton, Hrazdan river, Yerevanyan lich reservoir

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Authors: Isaiah Phillip Smith

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It is reported that alcohol consumption accounts for 3 million annual deaths globally, thus, it is a significant public health challenge internationally. The excessive consumption of alcohol is argued in literature to be related to problematic behaviors like crime, accident, fighting, violence, and unprotected sex, among others. Alcohol consumption among university students in South Africa particularly is considered endemic – with a prevalence rate of 25.27%, 32.34%, and 23.34% across universities, colleges, and high schools. Adopting the tenets of social learning and ecological theories, the culture of drinking amongst male university students is critically explored. This study found that age, gender, early exposure to alcohol, and peer pressure are significant factors contributing to alcohol consumption amongst university students. While participants acknowledged that moderate and responsible consumption of alcohol is necessary, they agree that it does not translate to responsible drinking behaviours.

Keywords: alcohol, drinking, university, students

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Authors: Noureddine Adjlane, Nizar Haddad

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Deformed Wing Virus (DWV) is considered as the most prevalent virus that dangerous the honeybee health worldwide today. In this study we aimed to evaluate the impact of the virus on honeybees (Apis mellifera intermissa) mortality in Algeria and we conducted the study on samples collected from the central area in the country. We used PCR for the diagnoses of the (DWV) in the diagnosis. The results had shown a high infestation in the sampled colonies and it represented 42% of the total sample. In this study, we found a clear role of both Varroa destructor mite and DWV on hive mortality in the experimented apiary. Further studies need to be conducted in order to give soled recommendations to the beekeepers, decision makers and stockholders of the Algerian beekeeping sector.

Keywords: honey bee, DWV, Varroa destructor, mortality, prevalence, infestation

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Authors: Khalid Mohammed Idrees

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Endodontic treatment aims to reverse the disease process and thereby eliminate the associated signs of symptoms. When the treatment itself appears to initiate the onset of pain and /or swelling (endodontic flare-up), the result can be distressing to both the patient and the operator. Patient might even consider postoperative symptoms as a bench mark against which the clinician’s skills are measured. Obviously the treatment with the lowest prevalence of postoperative pain is usually the treatment of choice as long as effectiveness and cost are not compromised. Knowledge of the cause and mechanism behind intra appointment flare-up is of utmost importance for the clinician to properly prevent or manage this undesirable condition. This review lecture will discuss the causative factors of flare-up with special attention to the microorganism role, various modalities of preventive measures would be discussed. Those measures are based on scientific evidence combined with the long clinical experience of the lecturer.

Keywords: endodontic flare-up, causative factors, inflammatory mediators, preventive measures

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Authors: Celestine Odigwe, Epoke Lincoln, Rhoda-Dara Ephraim

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Background; Immunization against the childhood killer diseases is the cardinal strategy for the prevention of these diseases all over the world in under five children, these diseases include; Tuberculosis, Measles, Polio, Tetanus, Diphthria, Pertusis, Yellow Fever, Hepatitis B, Haemophilus Influenza type B. 6.9 million children die before their fifth birthday , 80% of the worlds death in children under 5 years occur in 25 countries most in Africa and Asia and 2 million children can be saved each year with routine immunization Therefore failure to achieve total immunization coverage puts several children at risk. Aim; The aim of the study was to ascertain the prevalence, Investigate the various reasons and causes why several under five children in a suburb of calabar municipal county fail to get the required immunizations as at and when due and possibly the consequences, so that efforts can be re-directed towards the solution of the problems so identified. Methods; the study was a community based cross sectional study. The respondents were the mothers/guardians of the sampled children who were all aged 0-59 months. To be eligible for recruitment into the study, the parent or guardian was required to give an informed consent, reside within the Calabar South County with his/her children aged 0-59 months. We calculated our sample size using the Leslie-Kish formula and we used a two-staged sampling method, first to ballot for the wards to be involved and then to select four of the most populated ones in the wards chosen. Data collection was by interviewer administered structured questionnaire (Appendix I), Data collected was entered and analyzed using Statistical Package for the Social Sciences (SPSS) Version 20. Percentages were calculated and represented using charts and tables Results; The number of children sampled was 159. We found that 150 were fully immunized and 9 were not, the prevalence of missed opportunity was 32% from the study. The reasons for missed opportunities were varied, ranging from false contraindications, logistical problems resulting in very poor access roads to health facilities and poor organization of health centers together with negative health worker attitudes. Some of the consequences of these missed opportunities were increased susceptibility to vaccine preventable diseases, resurgence of the above diseases and increased morbidity and mortality of children aged less than 5 years. Conclusion; We found that ignorance on the part of both parents/guardians and health care staff together with infrastructural inadequacies in the county such as- roads, poor electric power supply for storage of vaccines were hugely responsible for most missed opportunities for immunization. The details of these and suggestions for improvement and the way forward are discussed.

Keywords: missed opportunity, immunization, under five, Calabar south

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Authors: Obasanjo Afolabi Bolarinwa

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This study assesses the levels of knowledge of sexually transmitted infections among unmarried youths in Nigeria; examines the pattern of high risk sex among unmarried youths in Nigeria; investigate the socio-demographic factors (age, place of residence, religion, level of education, wealth index and employment status) affecting the practice of high-risk sexual behaviour and ascertain the relationships between knowledge of sexually transmitted infections and practice of high risk sex. The goal of the study is to identify the factors associated with the practice of high risk sex among youth. These were with a view to identifying critical actions needed to reduce high risk sexual behaviour among youths. The study employed secondary data. The data for the study were extracted from the 2013 Nigeria Demographic and Health Survey (NDHS). The 2013 NDHS collected information from 38,948 Women ages 15-49 years and 17,359 men ages 15-49. A total of 7,744 female and 6,027 male respondents were utilized in the study. In order to adjust for the effect of oversampling of the population, the weighting factor provided by Measure DHS was applied. The data were analysed using frequency distribution and logistic regression. The results show that both male (92.2%) and female (93.6%) have accurate knowledge of sexually transmitted infections. The study also revealed that prevalence of high risk sexual behavior is high among Nigerian youths; this is evident as 77.7% (female) and 78.4% (male) are engaging in high risk sexual behavior. The bivariate analysis shows that age of respondent (χ2=294.2; p < 0.05), religion (χ2=136.64; p < 0.05), wealth index (χ2=17.38; p < 0.05), level of education (χ2=34.73; p < 0.05) and employment status (χ2=94.54; p < 0.05) were individual factors significantly associated with high risk sexual behaviour among male while age of respondent (χ2=327.07; p < 0.05), place of residence (χ2=6.71; p < 0.05), religion (χ2=81.04; p < 0.05), wealth index (χ2=7.41; p < 0.05), level of education (χ2=18.12; p < 0.05) and employment status (χ2=51.02; p < 0.05) were individual factors significantly associated with high risk sexual behaviour among female. Furthermore, the study shows that there is a relationship between knowledge of sexually transmitted infections and high risk sex among male (χ2=38.32; p < 0.05) and female (χ2=18.37; p < 0.05). At multivariate level, the study revealed that individual characteristics such as age, religion, place of residence, wealth index, levels of education and employment status were statistically significantly related with high risk sexual behaviour among male and female (p < 0.05). Lastly, the study shows that knowledge of sexually transmitted infection was significantly related to high risk sexual behaviour among youths (p < 0.05). The study concludes that there is a high level of knowledge of sexually transmitted infections among unmarried youths in Nigeria. The practice of high risk sex is high among unmarried youths but higher among male youths. The prevalence of high risk sexual activity is higher for males when they are at disadvantage and higher for females when they are at advantage. Socio-demographic factors like age of respondents, religion, wealth index, place of residence, employment status and highest level of education are factors influencing high risk sexual behaviour among youths.

Keywords: high risk sex, wealth index, sexual behaviour, knowledge

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Authors: Catelyn Coyle, Helena Kwakwa

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Objective: As novel and better tolerated therapies become available, effective HCV testing and care models become increasingly necessary to not only identify individuals with active infection but also link them to HCV providers for medical evaluation and treatment. Our aim is to describe an effective HCV testing and linkage to care model piloted in a network of five community health centers located in Philadelphia, PA. Methods: In October 2012, National Nursing Centers Consortium piloted a routine opt-out HCV testing model in a network of community health centers, one of which treats HCV, HIV, and co-infected patients. Key aspects of the model were medical assistant initiated testing, the use of laboratory-based reflex test technology, and electronic medical record modifications to prompt, track, report and facilitate payment of test costs. Universal testing on all adult patients was implemented at health centers serving patients at high-risk for HCV. The other sites integrated high-risk based testing, where patients meeting one or more of the CDC testing recommendation risk factors or had a history of homelessness were eligible for HCV testing. Mid-course adjustments included the integration of dual HIV testing, development of a linkage to care coordinator position to facilitate the transition of HIV and/or HCV-positive patients from primary to specialist care, and the transition to universal HCV testing across all testing sites. Results: From October 2012 to June 2015, the health centers performed 7,730 HCV tests and identified 886 (11.5%) patients with a positive HCV-antibody test. Of those with positive HCV-antibody tests, 838 (94.6%) had an HCV-RNA confirmatory test and 590 (70.4%) progressed to current HCV infection (overall prevalence=7.6%); 524 (88.8%) received their RNA-positive test result; 429 (72.7%) were referred to an HCV care specialist and 271 (45.9%) were seen by the HCV care specialist. The best linkage to care results were seen at the test and treat the site, where of the 333 patients were current HCV infection, 175 (52.6%) were seen by an HCV care specialist. Of the patients with active HCV infection, 349 (59.2%) were unaware of their HCV-positive status at the time of diagnosis. Since the integration of dual HCV/HIV testing in September 2013, 9,506 HIV tests were performed, 85 (0.9%) patients had positive HIV tests, 81 (95.3%) received their confirmed HIV test result and 77 (90.6%) were linked to HIV care. Dual HCV/HIV testing increased the number of HCV tests performed by 362 between the 9 months preceding dual testing and first 9 months after dual testing integration, representing a 23.7% increment. Conclusion: Our HCV testing model shows that integrated routine testing and linkage to care is feasible and improved detection and linkage to care in a primary care setting. We found that prevalence of current HCV infection was higher than that seen in locally in Philadelphia and nationwide. Intensive linkage services can increase the number of patients who successfully navigate the HCV treatment cascade. The linkage to care coordinator position is an important position that acts as a trusted intermediary for patients being linked to care.

Keywords: HCV, routine testing, linkage to care, community health centers

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Authors: Onesmus Nyaude

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The aim of the study was to investigate participants’ views on how corruption can be combated to enhance learner academic achievement. The study was undertaken on three select public secondary institutions in Zimbabwe. This study also focuses on exploring the various views of educators; parents and the learners on the role played by corruption in perpetuating the seemingly existing learner academic achievement disparities in various educational institutions. The study further interrogates and examines the nexus between the prevalence of corruption in schools and the subsequent influence on the academic achievement of learners. Corruption is considered a form of social injustice; hence in Zimbabwe, the general consensus is that it is perceived rife to the extent that it is overtaking the traditional factors that contributed to the poor academic achievement of learners. Coupled to this, have been the issue of gross abuse of power and some malpractices emanating from concealment of essential and official transactions in the conduct of business. Through proposing robust anti-corruption mechanisms, teaching and learning resources poured in schools would be put into good use. This would prevent the unlawful diversion and misappropriation of the resources in question which has always been the culture. This study is of paramount significance to curriculum planners, teachers, parents, and learners. The study was informed by the interpretive paradigm; thus qualitative research approaches were used. Both probability and non-probability sampling techniques were adopted in ‘site and participants’ selection. A representative sample of (150) participants was used. The study found that the majority of the participants perceived corruption as a social problem and a human right threat affecting the quality of teaching and learning processes in the education sector. It was established that corruption prevalence within institutions is as a result of the perpetual weakening of ethical values and other variables linked to upholding of ‘Ubuntu’ among general citizenry. It was further established that greediness and weak systems are major causes of rampant corruption within institutions of higher learning and are manifesting through abuse of power, bribery, misappropriation and embezzlement of material and financial resources. Therefore, there is great need to collectively address the problem of corruption in educational institutions and society at large. The study additionally concludes that successful combating of corruption will promote successful moral development of students as well as safeguarding their human rights entitlements. The study recommends the adoption of principles of good corporate governance within educational institutions in order to successfully curb corruption. The study further recommends the intensification of interventionist strategies and strengthening of systems in educational institutions as well as regular audits to overcome the problem associated with rampant corruption cases.

Keywords: academic achievement, combating, corruption, good corporate governance, qualitative study

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Authors: Claire Sciberras

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Introduction: Autism Spectrum Disorder (ASD) has become recognized as being the most common childhood neurological condition. Indeed, numerous studies demonstrate an increase in the prevalence rate of children diagnosed with ASD. Concurrent with these findings, the European Agency for Special Needs and Inclusive Education reported a similar escalating tendency in prevalence also in Malta. Such an increase within the educational context in Malta has led the European Agency to call for increased support within educational settings in Malta. However, although research has addressed the positive impact of mainstream education on learners with ASD, empirical studies vis-à-vis the internal and external strengths and weaknesses present within the support provided in mainstream settings in Malta is distinctly limited. In light of the aforementioned argument, Malta would benefit from research which focuses on analysing the strengths, weaknesses, opportunities, and threats (SWOTs) which are present within the support provision of learners with ASD in mainstream primary schools. Such SWOT analysis is crucial as lack of appropriate opportunities might jeopardize the educational and social experiences of persons with ASD throughout their schooling. Methodology: A mixed methodological approach would be well suited to examine the provision of support of learners with ASD as the combination of qualitative and quantitative approaches allows researchers to collect a comprehensive range of data and validate their results. Hence, it is intended that questionnaires will be distributed to all the stakeholders involved so as to acquire a broader perspective to be collected from a wider group who provide support to students with ASD across schools in Malta. Moreover, the use of a qualitative approach in the form of interviews with a sample group will be implemented. Such an approach will be considered as it would potentially allow the researcher to gather an in-depth perspective vis-à-vis to the nature of the services which are currently provided to learners with ASD. The intentions of the study: Through the analysis of the data collected vis-à-vis to the SWOTs within the provision of support of learners with ASD it is intended that; i) a description in regards to the educational provision for learners with ASD within mainstream primary schools in Malta in light of the experiences and perceptions of the stakeholders involved will be acquired; ii) an analysis of the SWOTs which exist within the services for learners with ASD in primary state schools in Malta is carried out and iii) based on the SWOT analysis, recommendations that can lead to improvements in practice in the field of ASD in Malta and beyond will be provided. Conclusion: Due to the heterogeneity of individuals with ASD which spans across several deficits related to the social communication and interaction domain and also across areas linked to restricted, repetitive behavioural patterns, educational settings need to alter their standards according to the needs of their students. Thus, the standards established by schools throughout prior phases do not remain applicable forever, and therefore these need to be reviewed periodically in accordance with the diversities and the necessities of their learners.

Keywords: autism spectrum disorders, mainstream educational settings, provision of support, SWOT analysis

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Authors: Teresa McGrath, Ryan Johnson, Rebecca Stamm, Cassidy Clarity, Wei Yung Lui

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Building and construction is the second largest plastic user behind packaging, accounting for 16% of plastic production. Building and construction is also by far the largest user of one of the most impactful plastics, polyvinyl chloride (aka vinyl or PVC), accounting for 69% of PVC production. Building materials also have an outsized contribution to plastic pollution, including microplastic pollution. Yet building materials are often overlooked in plastic waste and pollution reduction efforts. Habitable will present a plastics and petrochemical analysis of over 250 common building material types and demonstrate how changes to building material selection towards safer, renewable, and lower carbon materials can reduce global consumption of plastics and associated pollution.

Keywords: building materials, fenceline communities, microplastics, safer alternatives, embodied carbon, life cycle analysis, petrochemicals, green chemistry

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Authors: J. Fernandez, R. Fernandez de Canete, J. Perea-Paizal, J. C. Ramos-Diaz

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The high prevalence of cardiovascular diseases has provoked a raising interest in the development of mathematical models in order to evaluate the cardiovascular function both under physiological and pathological conditions. In this paper, a physical model of the cardiovascular system with intrinsic regulation is presented and implemented by using the object-oriented Modelica simulation software tools.  For this task, a multi-compartmental system previously validated with physiological data has been built, based on the interconnection of cardiovascular elements such as resistances, capacitances and pumping among others, by following an electrohydraulic analogy. The results obtained under both physiological and pathological scenarios provide an easy interpretative key to analyze the hemodynamic behavior of the patient. The described approach represents a valuable tool in the teaching of physiology for graduate medical and nursing students among others.

Keywords: cardiovascular system, MODELICA simulation software, physical modelling, teaching tool

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Authors: Chandanee Wasana Kalansooriya

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Dietary behaviour is a crucial factor affecting diabetes control. With increasing rates of diabetes prevalence in Asian countries, examining their dietary patterns, which are largely based on rice, is timely required. It has been identified that higher consumption of some rice varieties is associated with increased risk of type 2 diabetes. Although diabetes patients are advised to consume healthier rice varieties, which contains low glycemic, several conditions, one of which food insecurity, make them difficult to preserve those healthy dietary guidelines. Hence this study tries to investigate how food security affects on making right decisions of rice consumption within diabetes affected households using a sample from Sri Lanka, a country which rice considered as the staple food and records the highest diabetes prevalence rate in South Asia. The study uses data from the Household Income and Expenditure Survey 2016, a nationally representative sample conducted by the Department of Census and Statistics, Sri Lanka. The survey used a two-stage stratified sampling method to cover different sectors and districts of the country and collected micro-data on demographics, health, income and expenditures of different categories. The study uses data from 2547 households which consist of one or more diabetes patients, based on the self-recorded health status. The Household Dietary Diversity Score (HDDS), which constructed based on twelve food groups, is used to measure the level of food security. Rice is categorized into three groups according to their Glycemic Index (GI), high GI, medium GI and low GI, and the likelihood and impact made by food security on each rice consumption categories are estimated using a Two-part Model. The shares of each rice categories out of total rice consumption is considered as the dependent variable to exclude the endogeneity issue between rice consumption and the HDDS. The results indicate that the consumption of medium GI rice is likely to increase with the increasing household food security, but low GI varieties are not. Households in rural and estate sectors are less likely and Tamil ethnic group is more likely to consume low GI rice varieties. Further, an increase in food security significantly decreases the consumption share of low GI rice, while it increases the share of medium GI varieties. The consumption share of low GI rice is largely affected by the ethnic variability. The effects of food security on the likelihood of consuming high GI rice varieties and changing its shares are statistically insignificant. Accordingly, the study concludes that a higher level of food security does not ensure diabetes patients are consuming healthy rice varieties or reducing consumption of unhealthy varieties. Hence policy attention must be directed towards educating people for making healthy dietary choices. Further, the study provides a room for further studies as it reveals considerable ethnic and sectorial differences in making healthy dietary decisions.

Keywords: diabetes, food security, glycemic index, rice consumption

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Authors: Annie Singh, Ishaan Singh

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Background: Transgenders are people who have a gender identity different from their sex assigned at birth. Their gender behaviour doesn’t match their body anatomy. The community faces discrimination due to their gender identity all across the world. The term transgender is an umbrella term for many people non-conformal to their biological identity; note that the term transgender is different from gender dysphoria, which is a DSM-5 disorder defined as problems faced by an individual due to their non-conforming gender identity. Transgender people have been a part of Indian culture for ages yet have continued to face exclusion and discrimination in society. This has led to the low socio-economic status of the community. Various studies done across the world have established the role of discrimination, harassment and exclusion in the development of psychological disorders. The study is aimed to assess the frequency of stress and anxiety in the transgender population and understand the various factors affecting the same. Methodology: A cross-sectional survey of self consenting transgender individuals above the age of 18 residing in Delhi was done to assess their socioeconomic status and experiential ecology. Recruitment of participants was done with the help of NGOs. The survey was constructed GAD-7 and PSS-10, two well-known scales were used to assess the stress and anxiety levels. Medians, means and ranges are used for reporting continuous data wherever required, while frequencies and percentages are used for categorical data. For associations and comparison between groups in categorical data, the Chi-square test was used, while the Kruskal-Wallis H test was employed for associations involving multiple ordinal groups. SPSS v28.0 was used to perform the statistical analysis for this study. Results: The survey showed that the frequency of stress and anxiety is high in the transgender population. A demographic survey indicates a low socio-economic background. 44% of participants reported facing discrimination on a daily basis; the frequency of discrimination is higher in transwomen than in transmen. Stress and anxiety levels are similar among both transmen and transwomen. Only 34.5% of participants said they had receptive family or friends. The majority of participants (72.7%) reported a positive or neutral experience with healthcare workers. The prevalence of discrimination is significantly lower in the higher educated groups. Analysis of data shows a positive impact of acceptance and reception on mental health, while discrimination is correlated with higher levels of stress and anxiety. Conclusion: The prevalence of widespread transphobia and discrimination faced by the transgender community has culminated in high levels of stress and anxiety in the transgender population and shows variance according to multiple socio-demographic factors. Educating people about the LGBT community formation of support groups, policies and laws are required to establish trust and promote integration.

Keywords: transgender, gender, stress, anxiety, mental health, discrimination, exclusion

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Authors: Muhammad Hamza Tariq

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The regrouping of the Islamists and the politics of religious education was the most common debate in the last decades of Turkish history. Religious schools were criticized to be influenced by partisan politics. Within this turmoil, the faculty of Ilahiyat which was established by the Republic to cherish Islamic modernism and to raise modern clergy also underwent a considerable change. This research studies the revisions in the curriculum of the faculty over the last few decades. A series of interviews were also conducted to observe the prevalent trends, especially modernist among the professors at the Ilahiyat faculties. Lastly, a survey was done among the freshman and final year students based on the similar questions to observe the changes of opinions with regards to their views on Islam, modernity, political Islam, interpretation, etc. A shift in the curriculum was noted though it cannot be overgeneralized whereas a degree of prevalence of modernist thoughts was also recorded among the teachers and the students.

Keywords: ilahiyat, divinity, religion, Islamization

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Authors: Melissa K. Hord, Stephen P. Whiteside

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With lifetime prevalence rates ranging from 6% to 15%, anxiety disorders are among the most common childhood mental health diagnoses. Anxiety disorders diagnosed in childhood generally show an unremitting course, lead to additional psychopathology and interfere with social, emotional, and academic development. Effective evidence-based treatments include cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI’s). However, if anxious children receive any treatment, it is usually through primary care, typically consists of medication, and very rarely includes evidence-based psychotherapy. Despite the high prevalence of anxiety disorders, there have only been two independent research labs that have investigated long-term results for CBT treatment for all childhood anxiety disorders and two for specific anxiety disorders. Generally, the studies indicate that the majority of youth maintain gains up to 7.4 years after treatment. These studies have not been replicated. In addition, little is known about the additional mental health care received by these patients in the intervening years after anxiety treatment, which seems likely to influence maintenance of gains for anxiety symptoms as well as the development of additional psychopathology during the subsequent years. The original sample consisted of 335 children ages 7 to 17 years (mean 13.09, 53% female) diagnosed with an anxiety disorder in 2010. Medical record review included provider billing records for mental health appointments during the five years after anxiety treatment. The subsample for this study was classified into three groups: 64 children who received CBT in an anxiety disorders clinic, 56 who received treatment from a psychiatrist, and 10 who were seen in a primary care setting. Chi-square analyses resulted in significant differences in mental health care utilization across the five years after treatment. Youth receiving treatment in primary care averaged less than one appointment each year and the appointments continued at the same rate across time. Children treated by a psychiatrist averaged approximately 3 appointments in the first two years and 2 in the subsequent three years. Importantly, youth treated in the anxiety clinic demonstrated a gradual decrease in mental health appointments across time. The nuanced differences will be presented in greater detail. The results of the current study have important implications for developing dissemination materials to help guide parents when they are selecting treatment for their children. By including all mental health appointments, this study recognizes that anxiety is often comorbid with additional diagnoses and that receiving evidence-based treatment may have long-term benefits that are associated with improvements in broader mental health. One important caveat might be that the acuity of mental health influenced the level of care sought by patients included in this study; however, taking this possibility into account, it seems those seeking care in a primary care setting continued to require similar care at the end of the study, indicating little improvement in symptoms was experienced.

Keywords: anxiety, children, mental health, outcomes

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Authors: Azad A. Meerkhan, Alaa Hani Razak, Bayan M. S. Younis

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The efficiency of enzyme-linked immunosorbent assay (ELISA) in sheep infected with Fasciola hepatica was studied. 232 jaundiced sheep among 5208 sheep slaughter in the Duhok abattoir (regardless of the age and gender) between the period of May. 2012 to Oct. 2012 were examined by direct examination (Searching of adult flukes in the bile duct) and by Enzyme-linked immunosorbent assay (ELISA) to detect the prevalence of fascioliasis in the studied population which showed a high observed infection ratio in Sep. 2012 (12.2%) with the high (ELISA) result of infection in May. 2012 (25.36%). Significant differences were found between the two ways in all of the months with the highest difference in May. 2012 and the net deference between the both ways was 6.91%.

Keywords: fascioliasis, Fasciola hepatica, layers, liver fluk, ELISA, direct examination

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Authors: Mehdi Moradi Sarmeidani, Peyman Keyhani, Hasan Momtaz

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Chlamydophila psittaci is a avian pathogen that may cause respiratory disorders in humans. Conjunctival and cloacal swabs from 54 captive psittacine birds presented at veterinary clinics were collected to determine the prevalence of C. psittaci in domestic birds in Isfahan. Samples were collected during 2014 from a total of 10 different species of parrots, with African gray(33), Cockatiel lutino(3), Cockatiel gray(2), Cockatiel cinnamon(1), Pearl cockatiel(6), Timneh African grey(1), Ringneck parakeet(2), Melopsittacus undulatus(1), Alexander parakeet(2), Green Parakeet(3) being the most representative species sampled. C. psittaci was detected in 27 (50%) birds using molecular detection (PCR) method. The detection of this bacterium in captive psittacine birds shows that there is a potential risk for human whom has a direct contact and there is a possibility of infecting other birds.

Keywords: chlamydophila psittaci, psittacine birds, PCR, Isfahan

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Authors: Ogunlesi Olufunso, John Ogunsola, Omolade Oladele, Benjamin Emikpe

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Context: Coccidiosis is a parasitic disease that affects poultry production, leading to economic losses. Garlic is known for medicinal properties and has been used as a natural remedy for various diseases. This study aims to investigate the prophylactic effect of garlic inclusion in the feed of commercial broilers with coccidiosis. Research Aim: The aim of this study is to determine the possible effect of garlic meal inclusion in poultry feed on the body weight gain of commercial broilers and to investigate it's therapeutic effect on broilers with coccidiosis. Methodology: The study conducted a case-control study for eight weeks with One hundred Arbor acre commercial broilers separated into five (5) groups from day-old, where 6,000 Eimeria oocysts were orally inoculated into each broiler in the different groups. Feed intake, body weight gain, feed conversion ratio, oocyt shedding rate, histopathology and erythrocyte indices were assessed. Findings: The inclusion of garlic meal in the broilers' diet resulted in an improved feed conversion ratio, decreased oocyst counts, reduced diarrhoeic fecal spots, decreased susceptibility to coccidial infection, and increased packed cell volume (PCV). Theoretical Importance: This study contributes to the understanding of the prophylactic effect of garlic supplementation, including its antiparasitic properties on commercial broilers with coccidiosis. It highlights the potential use of non-conventional feed additives or ayurvedic herb and spices in the treatment of poultry diseases. Data Collection and Analysis Procedures: The study collected data on feed intake, body weight gain, oocyst shedding rate, histopathological observations, and erythrocyte indices. Data were analyzed using Analysis of Variance and Duncan's Multiple range Test. Questions Addressed: The study addressed the possible effect of garlic meal inclusion in poultry feed on the body weight gain of broilers and its therapeutic effect on broilers with coccidiosis. Conclusion: The study concludes that garlic inclusion in the feed of broilers has a prophylactic effect, including antiparasitic properties, resulting in improved feed conversion ratio, reduced oocyst counts and increased PCV.

Keywords: broilers, eimeria spp, garlic, Ibadan

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Authors: N. N. Pilau, M. S. Abubakar, A. Danmaigoro, P. C. Mshelia, Y. Sani

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A severely debilitated 4months old Caucasian male dog presented dehydration, emaciation, vomiting, icteric ocular and oral mucous membranes, generalized lymphadenopathy, hematuria, anorexia and prolonged recumbency. Clinical workup was done in established protocols for diagnosis based on history, clinical signs and selected laboratory tests. Treatment course were administered over 48hours during which the patient died of overwhelming hepatopathy, nephropathy and pneumonia. Postmortem findings supported by ante mortem laboratory test results tentatively diagnosed leptospirosis, a disease endemic and presenting potentially fatal epidemics and zoonoses in some countries amongst the developing regions of the world. This disease is reviewed and a call for attention on the public health significance of the disease is hereby presented through this case report.

Keywords: canine, endemic, leptospirosis, prevalence

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Authors: Shailender Kumar

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Current health policy pronouncements in India advocate for insurance-based financing mechanism to achieve universal health coverage (UHC), while undermine the role of comprehensive healthcare provision system. UHC is achieved when all people receive the health services they need without suffering financial hardship. This study, using 68th & 71st NSS rounds data, examines their relative and combined strength in achieving the above objective. Health-insurance has been unsuccessful in reducing prevalence and catastrophic effects of out-of-pocket payment and even dismantle the effectiveness of traditional way of health financing system. Healthcare provision is the best way forward to enhance health and well-being of households in condition if India removes existing inadequacies and inequalities in service provision across districts/states and ensure free/low cost medicines/diagnostics to the citizens.

Keywords: health policy, demand-side financing, supply-side financing, incidence of health payment

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Authors: Ng Liang Shen, Ngahzaifa Abdul Ghani

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This research aimed at developing an early warning system for pre-diabetic and diabetics by analyzing simple and easily determinable signs and symptoms of diabetes among the people living in Malaysia using Particle Swarm Optimized Artificial. With the skyrocketing prevalence of Type 2 diabetes in Malaysia, the system can be used to encourage affected people to seek further medical attention to prevent the onset of diabetes or start managing it early enough to avoid the associated complications. The study sought to find out the best predictive variables of Type 2 Diabetes Mellitus, developed a system to diagnose diabetes from the variables using Artificial Neural Networks and tested the system on accuracy to find out the patent generated from diabetes diagnosis result in machine learning algorithms even at primary or advanced stages.

Keywords: diabetes diagnosis, Artificial Neural Networks, artificial intelligence, soft computing, medical diagnosis

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Authors: Karen Armstrong

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This paper explores the impact of two aspects of online communication: the absence of touch and the sound of silence. In order to place the discussion in context, the paper begins with a brief description of communication itself and the many ways in which we communicate with each other both verbally and non-verbally. Next, the discussion moves to consider the general characteristics of online communication and the ways in which it is similar as well as very different from face to face communication. This examination considers the ways we communicate primarily in email, but also through texting, instagram stickers, and twitter—the primary modes of online communication aside from face to face videos, which are less common. With few exceptions of course, most such interactions take place without sound or physical contact. First to be examined is the absence of touch, followed by the presence of silence. The paper explores these issues, concluding with the ways in which both absence of touch and the prevalence of silence are important determinants shaping communication in our online universe.

Keywords: absence of touch, communication, face-to-face, haptics, online, silence

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Authors: J. Waita, S. Wamuhu, J. Makoyo, M. Rachel, T. Ngangari, W. Christine, M. Zipporah

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Contraceptive use is one of the key global strategies to alleviate maternal mortality. Global efforts through advocating for contraceptive uptake and service provision has led improved contraceptive prevalence. In Kenya maternal mortality rate has remained a challenged despites efforts by government and non-governmental organizations. Objective: To describe the uptake of contraceptives among women in Tunza Clinics, Kenya. Design and Methods: Ps Kenya through health care marketing fund is implementing a family planning program among its 350 Tunza fractional franchise facilities. Through private partnership, private owned facilities in low socio-economic areas are recruited and trained on contraceptive technology update. The providers are supported through facilitative supervision through a mobile based application Health Network Quality Improvement System (HNQIS) and interpersonal communication through 150 community based volunteers. The data analyzed in this paper was collected between January to July 2017 to show the uptake of modern Contraceptives among women in the Tunza franchise, method mix, age and distribution among the age bracket. Further analysis compares two different service delivery strategies; outreach and walk ins. Supportive supervision HNQIS scores was analyzed. Results: During the time period, a total of 132121 family planning clients were attended in 350 facilities. The average age of clients was 29.6 years. The average number of clients attended in the facilities per month was 18874. 73.7 %( n=132121) of the clients attended in the Tunza facilities were aged above 25 years while 22.1% 20-24 years and 4.2% 15-19 years. On contraceptive method mix, intra uterine device insertions clients contributed to 7.5%, implant insertions 15.3%, pills 11.2%, injections 62.7% while condoms and emergency pills had 2.7% and 0.6% respectively. Analysis of service delivery strategy indicated more than 79% of the clients were walk ins while 21% were attended to during outreaches. Uptake of long term contraceptive methods during outreaches was 73% of the clients while short term modern methods were 27%. Health Network Quality Improvement system assessment scores indicated 51% of the facilities scored over 90%, 25% scoring 80-89% while 21% scored below 80%. Conclusion: Preference for short term methods by women is possibly associated to cost as they are cheaper and easy to administer. When the cost of intra uterine device Implants is meant affordable during outreaches, the uptake is observed to increase. Making intra uterine device and implants affordable to women is a key strategy in increasing contraceptive prevalence hence averting maternal mortality.

Keywords: contraceptives, contraceptive uptake, low socio economic, supportive supervision

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