Search results for: White Man's Burden

Authors: Biniam Bahiru Tufa, Hana Delil Tesfaye, Seife Demisse Legesse, Manaye Tamire

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The healthcare industry is witnessing a digital transformation, with artificial intelligence (AI) offering potential solutions for challenges in health supply chain management (HSCM). However, the adoption of AI in this field remains limited. This research aimed to assess the knowledge, attitude, and practice of AI among students and employees in the health supply chain sector in Ethiopia. Using an explanatory case study research design with a concurrent mixed approach, quantitative and qualitative data were collected simultaneously. The study included 153 participants comprising students and employed health supply chain professionals working in various sectors. The majority had a pharmacy background, and one-third of the participants were male. Most respondents were under 35 years old, and around 68.6% had less than 10 years of experience. The findings revealed that 94.1% of participants had prior knowledge of AI, but only 35.3% were aware of its application in the supply chain. Moreover, the majority indicated that their training curriculum did not cover AI in health supply chain management. Participants generally held positive attitudes toward the necessity of AI for improving efficiency, effectiveness, and cost savings in the supply chain. However, many expressed concerns about its impact on job security and satisfaction, considering it as a burden Graduate students demonstrated higher knowledge of AI compared to employed staff, while graduate students also exhibited a more positive attitude toward AI. The study indicated low previous utilization and potential future utilization of AI in the health supply chain, suggesting untapped opportunities for improvement. Overall, while supply chain experts and graduate students lacked sufficient understanding of AI and its significance, they expressed favorable views regarding its implementation in the sector. The study recommends that the Ethiopian government and international organizations consider introducing AI in the undergraduate pharmacy curriculum and promote its integration into the health supply chain field.

Keywords: knowledge, attitude, practice, supply chain, articifial intellegence

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Authors: Lawong Damian Bernsah

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Neglected Tropical Diseases (NTDs) are most predominant among the poor and rural populations and are endemic in 149 countries. These diseases are the most prevalent and responsible for infecting 1.4 billion people worldwide. There are 17 neglected tropical diseases recognized by WHO that constitute the fourth largest disease health and economic burden of all communicable diseases. Five of these 17 diseases are considered for the cost analysis of this paper: lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, and soil transmitted helminth infections. WHO has proposed a roadmap for eradication and elimination by 2020 and treatments have been donated through the London Declaration by pharmaceutical manufacturers. The paper estimates the cost of NTD control programme and elimination for each NTD disease and total in Nigeria. This is necessary as it forms the bases upon which programme budget and expenditure could be based. Again, given the opportunity cost the resources for NTD face it is necessary to estimate the cost so as to provide bases for comparison. Cost of NTDs control and elimination programme is estimated using the population at risk for each NTD diseases and for the total. The population at risk is gotten from the national master plan for the 2015 - 2020, while the cost per person was gotten for similar studies conducted in similar settings and ranges from US$0.1 to US$0.5 for Mass Administration of Medicine (MAM) and between US$1 to US$1.5 for each NTD disease. The combined cost for all the NTDs was estimated to be US$634.88 million for the period 2015-2020 and US$1.9 billion for each NTD disease for the same period. For the purpose of sensitivity analysis and for robustness of the analysis the cost per person was varied and all were still high. Given that health expenditure for Nigeria (% of GDP) averages 3.5% for the period 1995-2014, it is very clear that efforts have to be made to improve allocation to the health sector in general which is hoped could trickle to NTDs control and elimination. Thus, the government and the donor partners would need to step-up budgetary allocation and also to be aware of the costs of NTD control and elimination programme since they have alternative uses. Key Words: Neglected Tropical Disease, Cost Analysis, NTD Programme Control and Elimination, Cost per Person

Keywords: Neglected Tropical Disease, Cost Analysis, Neglected Tropical Disease Programme Control and Elimination, Cost per Person

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Authors: Ayesha Ali, Emilia Lindquist, Arif Jalal, Hannah Yusuf, Kayan Cheung, Rowan Eastabrook

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It is currently estimated that over a third of deaths in children under five in Tanzania are caused by acute respiratory infections (ARIs). However, despite being one of the leading causes of morbidity and mortality across the developing world, its risk factors are poorly understood. Therefore, a systematic review of the literature published between 2015 and 2020 was conducted, focusing on risk factors for ARI in Tanzanian children under the age of five. 2015 Demographic and Health Survey (DHS) for Tanzania was analysed to supplement these findings with national data. 2224 papers were retrieved from two databases and were analysed by three independent reviewers. Thirteen papers were eligible for inclusion, covering a wide range of risk factors among which comorbidities (n=6), malnutrition (n=5), lack of parental education (n=4), poor socio-economic status (n=3), and delay in seeking healthcare (n=3) were the most cited risk factors. The risk factors with the highest reported risk ratios/odds ratios were lack of parental education (RR=11.5-14.5), followed by enrolment in school (RR=4.4), delay in seeking healthcare (RR=3.8) and cooking indoors (aOR =1.8-RR=5.5). The DHS data provided local context to these risk factors. For instance, the number of children experiencing symptoms of ARI in both urban and rural areas ranged between 4.5-5% in the two weeks prior to the survey. However, 79% of symptomatic children in Zanzibar received antibiotics for treatment compared to just 34% of those in the Southern Highlands. As demonstrated by both the systematic review and the DHS analysis, risk factors for ARI are predominantly socially determined, with Tanzania’s poorer rural children possessing the highest risk for ARI and more adverse health outcomes. Therefore, the burden of ARIs in Tanzanian children may be alleviated through the provision of appropriate treatment and parental education in rural areas.

Keywords: acute respiratory infection, child, health education, morbidity, mortality, pneumonia, Tanzania

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Authors: Manamba Epaphra

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This paper analyzes the causal effect between domestic private investment, public investment, foreign direct investment and economic growth in Tanzania during the 1970-2014 period. The modified neo-classical growth model that includes control variables such as trade liberalization, life expectancy and macroeconomic stability proxied by inflation is used to estimate the impact of investment on economic growth. Also, the economic growth models based on Phetsavong and Ichihashi (2012), and Le and Suruga (2005) are used to estimate the crowding out effect of public investment on private domestic investment on one hand and foreign direct investment on the other hand. A correlation test is applied to check the correlation among independent variables, and the results show that there is very low correlation suggesting that multicollinearity is not a serious problem. Moreover, the diagnostic tests including RESET regression errors specification test, Breusch-Godfrey serial correlation LM test, Jacque-Bera-normality test and white heteroskedasticity test reveal that the model has no signs of misspecification and that, the residuals are serially uncorrelated, normally distributed and homoskedastic. Generally, the empirical results show that the domestic private investment plays an important role in economic growth in Tanzania. FDI also tends to affect growth positively, while control variables such as high population growth and inflation appear to harm economic growth. Results also reveal that control variables such as trade openness and life expectancy improvement tend to increase real GDP growth. Moreover, a revealed negative, albeit weak, association between public and private investment suggests that the positive effect of domestic private investment on economic growth reduces when public investment-to-GDP ratio exceeds 8-10 percent. Thus, there is a great need for promoting domestic saving so as to encourage domestic investment for economic growth.

Keywords: FDI, public investment, domestic private investment, crowding out effect, economic growth

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Authors: Murat Emre, Zeynep Tufekcioglu

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Objective: We describe a patient with late onset phenylketonuria which presented with rapidly progressive dementia and parkinsonism that were reversible after management. Background: Phenylketonuria is an autosomal recessive disorder due to mutations in the phenylalanine hydroxlase gene. It normally presents in childhood, in rare cases, however, it may have its onset in adulthood and may mimic other neurological disorders. Case description: A previously normal functioning, 59 year old man was admitted for blurred vision, cognitive impairment and gait difficulty which emerged over the past eight months. In neurological examination he had brisk reflexes, slow gait and left-dominant parkinsonism. Mini-mental state examination score was 25/30, neuropsychological testing revealed a dysexecutive syndrome with constructional apraxia and simultanagnosia. In cranial MRI there were bilateral diffuse hyper-intense lesions in parietal and occipital white matter with no significant atrophy. Electroencephalography showed diffuse slowing with predominance of teta waves. In cerebrospinal fluid examination protein level was slightly elevated (61mg/dL), oligoclonal bands were negative. Electromyography was normal. Routine laboratory examinations for rapidly progressive dementia and parkinsonism were also normal. Serum amino acid levels were determined to explore metabolic leukodystrophies and phenylalanine level was found to be highly elevated (1075 µmol/L) with normal tyrosine (61,20 µmol/L). His cognitive impairment and parkinsonian symptoms improved following three months of phenylalanine restricted diet. Conclusions: Late onset phenylketonuria is a rare, potentially reversible cause of rapidly progressive parkinsonism with dementia. It should be considered in the differential diagnosis of patients with suspicious features.

Keywords: dementia, neurology, Phenylketonuria, rapidly progressive parkinsonism

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Authors: Khachen Kongpakwattana, Charungthai Dejthevaporn, Orapitchaya Krairit, Piyameth Dilokthornsakul, Devi Mohan, Nathorn Chaiyakunapruk

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Background: Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HR-QoL) associated with AD in Low- and Middle-Income Countries (LMICs) is still lacking. We, therefore, aimed to collect real-world cost and HR-QoL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. Methods: We recruited AD patients aged ≥ 60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HR-QoL and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HR-QoL. Results: Among 148 community-dwelling patients, average annual total societal costs of AD care were 8,014 US$ [95% Confidence Interval (95% CI): 7,295 US$ - 8,844 US$] per patient. Total costs of patients with severe stage (9,860 US$; 95% CI: 8,785 US$ - 11,328 US$) were almost twice as high as those of mild stage (5,524 US$; 95% CI: 4,649 US$ - 6,593 US$). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HR-QoL (p-value < 0.001). Conclusions: Our real-world findings suggest the distinct major cost driver which results from expensive AD treatment, emphasizing the demand for country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement on patient’s HR-QoL.

Keywords: Alzheimer's disease, associations, costs, disease-severity indicators, health-related quality of life

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Authors: Augustine O. Ani, Ifeyinwa E. Ezemagu, Eunice A. Akuru

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A seven-week study was conducted to evaluate the response of grower turkeys to varying dietary levels of Moringa oleifera leaf meal (MOLM) in a humid tropical environment. A total of 90 twelve weeks old male and female grower turkeys were randomly divided into five groups of 18 birds each in a completely randomized design (CRD) and assigned to five caloric (2.57-2.60 Mcal/kg ME) and isonitrogenous (19.95% crude protein) diets containing five levels (0, 15, 20, 25 and 30%) of MOLM, respectively. Each treatment was replicated three times with 6 birds per replicate housed in a deep litter pen of fresh wood shavings measuring 1.50m x 1.50m. Feed and water were provided to the birds' ad libitum. Parameters measured were: final live weight (FLW) daily weight gain (DWG), daily feed intake (DFI), feed conversion ratio (FCR), protein efficiency ratio (PER), packed cell volume (PCV), haemoglobin concentration (Hb), red blood cell (RBC) count, white blood cell (WBC) count, mean cell volume (MCV), mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC), feed cost / kg weight gain and apparent nutrient retention. Results showed that grower turkeys fed 20% MOLM diet had significantly (p < 0.05) higher FLW and DWG values (4410.30 g and 34.49 g, respectively) and higher DM and NFE retention values (67.28 and 58.12%, respectively) than turkeys fed other MOLM diets. Feed cost per kg gain decreased significantly (p < 0.05) with increasing levels of MOLM in the diets. The PCV, Hb, WBC, MCV, MCH and MCHC values of grower turkeys fed 20% MOLM diet were significantly (p < 0.05) higher than those of grower turkeys fed other diets. It was concluded that a diet containing 20% MOLM is adequate for the normal growth of grower turkeys in the tropics.

Keywords: Diets, grower turkeys, Moringa oleifera leaf meal, response, tropical environment

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Authors: O. Hakim, K. Hart, P. McCabe, J. Berry, L. E. Rhodes, N. Spyrou, A. Alfuraih, S. Lanham-New

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It is known that skin pigmentation reduces the penetration of ultraviolet radiation (UVR) and thus photosynthesis of 25(OH)D. However, the ethnic differences in 25(OH)D production remain to be fully elucidated. This study aimed to investigate the differences in vitamin D production between Asian and Caucasian postmenopausal women, in response to a defined, controlled UVB exposure. Seventeen women; nine white Caucasian (skin phototype II and III), eight South Asian women (skin phototype IV and V) participated in the study, acting as their controls. Three blood samples were taken for measurement of 25(OH)D during the run-in period (nine days, no sunbed exposure) after which all subjects underwent an identical UVR exposure protocol irrespective of skin colour (nine days, three sunbed sessions: 6, 8 and 8 minutes respectively with approximately 80% of body surface exposed). Skin tone was measured four times during the study. Both groups showed a gradual increase in 25(OH)D with final levels significantly higher than baseline (p<0.01). 25(OH)D concentration mean from a baseline of 43.58±19.65 to 57.80±17.11 nmol/l among Caucasian and from 27.03±23.92 to 44.73±17.74 nmol/l among Asian women. The baseline status of vitamin D was classified as deficient among the Asian women and insufficient among the Caucasian women. The percentage increase in vitamin D3 among Caucasians was 39.86% (21.02) and 207.78% (286.02) in Asian subjects respectively. This greater response to UVR exposure reflects the lower baseline levels of the Asian subjects. The mixed linear model analysis identified a significant effect of duration of UVR exposure on the production of 25(OH)D. However, the model shows no significant effect of ethnicity and skin tone on the production of 25(OH)D. These novel findings indicate that people of Asian ethnicity have the full capability to produce a similar amount of vitamin D compared to the Caucasian group; initial vitamin D concentration influences the amount of UVB needed to reach equal serum concentrations.

Keywords: ethnicity, Caucasian, South Asian, vitamin D, ultraviolet radiation, UVR

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Authors: Robyn White, Juan Bornman, Ensa Johnson

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People with disabilities are at a high risk of becoming victims of crime. Individuals with little or no functional speech (LNFS) face an even higher risk. One way of reducing the risk of remaining a victim of crime is to face the alleged perpetrator in court as a witness – therefore it is important for a person with LNFS who has been a victim of crime to have the required vocabulary to testify in court. The aim of this study was to identify and describe the core and fringe legal vocabulary required by illiterate victims of crime, who have little or no functional speech, to testify in court as witnesses. A mixed-method, the exploratory sequential design consisting of two distinct phases was used to address the aim of the research. The first phase was of a qualitative nature and included two different data sources, namely in-depth semi-structured interviews and focus group discussions. The overall aim of this phase was to identify and describe core and fringe legal vocabulary and to develop a measurement instrument based on these results. Results from Phase 1 were used in Phase 2, the quantitative phase, during which the measurement instrument (a custom-designed questionnaire) was socially validated. The results produced six distinct vocabulary categories that represent the legal core vocabulary and 99 words that represent the legal fringe vocabulary. The findings suggested that communication boards should be individualised to the individual and the specific crime. It is believed that the vocabulary lists developed in this study act as a valid and reliable springboard from which communication boards can be developed. Recommendations were therefore made to develop an Alternative and Augmentative Communication Resource Tool Kit to assist the legal justice system.

Keywords: augmentative and alternative communication, person with little or no functional speech, sexual crimes, testifying in court, victim of crime, witness competency

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Authors: Ballari Bagchi

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The dynamism ingrained in the process of urban-rural integration is manifested in the emergence of rurban settlements, referring to areas that combine the characteristics of agricultural activities found in rural zones with those of suburban living areas and industrialised zones. The concept of rurbanisation refers to the idea of introducing urban conveniences and opportunities, to rural areas in an attempt to stem rural urban migration. In the backdrop of the worldwide problem of disharmonised urban-rural dependence and the associated problems in urban and rural areas, the present study seeks to explore the potentialities of few settlements having a blend of rural and urban characteristics in the urban field of Koch Bihar. The prime concern of the present paper is three-fold: (i) to identify the rurban centres, (ii) to analyse the spatial integration of these identified centres with the rural areas situated in the urban periphery, and (iii) to suggest the necessities to be introduced in these settlements. The methodology applied here includes rurban index, gravity model, and functional classification of rurban centres, correlation and regression analysis and cartographic representation of data collected through primary and secondary sources. The investigation has identified a number of settlements potentially viable to be termed as rurban centres which may render services to the other less equipped rural areas in all aspects of life and thereby would lessen the burden on Koch Bihar urban centre. The levels of infrastructure of these settlements should be such that it might even attract the urban population in a reverse direction. The villages belonging to the lower rung of these service settlements would require metalled road connection with these intermediate settlements in addition to their connection with the core town. That is to say, a proper policy needs to be adopted in this regard to furnish these settlements with required infrastructures for serving their own population as well as the population of other villages. As a consequence of that, the idea of a well-coordinated settlement hierarchy may emerge in future.

Keywords: Hinterland, rurban, settlement hierarchy, urban-rural integration

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Authors: Nagui A. Abdel-Khalek, Khaled A. Selim, Ahmed Hamdy

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Kaolin is naturally occurring ore predominantly containing kaolinite mineral in addition to some gangue minerals. Typical impurities present in kaolin ore are quartz, iron oxides, titanoferrous minerals, mica, feldspar, organic matter, etc. The main coloring impurity, particularly in the ultrafine size range, is titanoferrous minerals. Kaolin is used in many industrial applications such as sanitary ware, table ware, ceramic, paint, and paper industries, each of which should be of certain specifications. For most industrial applications, kaolin should be processed to obtain refined clay so as to match with standard specifications. For example, kaolin used in paper and paint industries need to be of high brightness and low yellowness. Egyptian kaolin is not subjected to any beneficiation process and the Egyptian companies apply selective mining followed by, in some localities, crushing and size reduction only. Such low quality kaolin can be used in refractory and pottery production but not in white ware and paper industries. This paper aims to study the amenability of beneficiation of an Egyptian kaolin ore of El-Teih locality, Sinai, to be suitable for different industrial applications. Attrition scrubbing and classification followed by magnetic separation are applied to remove the associated impurities. Attrition scrubbing and classification are used to separate the coarse silica and feldspars. Wet high intensity magnetic separation was applied to remove colored contaminants such as iron oxide and titanium oxide. Different variables affecting of magnetic separation process such as solid percent, magnetic field, matrix loading capacity, and retention time are studied. The results indicated that substantial decrease in iron oxide (from 1.69% to 0.61% ) and TiO2 (from 3.1% to 0.83%) contents as well as improving iso-brightness (from 63.76% to 75.21% and whiteness (from 79.85% to 86.72%) of the product can be achieved.

Keywords: Kaolin, titanoferrous minerals, beneficiation, magnetic separation, attrition scrubbing, classification

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Authors: Spyridon Komaitis, Christos Koutsarnakis, Evangelos Drosos, Aristotelis Kalyvas

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This study opts to investigate the intrinsic architecture, morphology, and spatial relationship of the subcortical pathways implicated in the connectivity of the motor/premotor cortex and SMA/pre-SMA complex. Twenty normal, adult, formalin-fixed cerebral hemispheres were explored through the fiber micro-dissection technique. Lateral to medial and medial to lateral dissections focused on the area of interest were performed in a tandem manner and under the surgical microscope. We traced the subcortical architecture, spatial relationships, and axonal connectivity of four major pathways: a) the dorsal component of the SLF (SLF-I) was found to reside in the medial aspect of the hemisphere and seen to connect the precuneus with the SMA and pre-SMA complex, b) the frontal longitudinal system (FLS) was consistently encountered as the natural anterior continuation of the SLF-II and SLF-III and connected the premotor and prefrontal cortices c) the fronto-caudate tract (FCT), a fan-shaped tract, was documented to participate in connectivity of the prefrontal and premotor cortices to the head and body of the caudate nucleus and d) the cortico-tegmental tract(CTT) was invariably recorded to subserve the connectivity of the tegmental area with the fronto-parietal cortex. No hemispheric asymmetries were recorded for any of the implicated pathways. Sub-segmentation systems were also proposed for each of the aforementioned tracts. The structural connectivity and functional specialization of motor and premotor areas in the human brain remain vague to this day as most of the available evidence derives either from animal or tractographic studies. By using the fiber-microdissection technique as our main method of investigation, we provide sound structural evidence on the delicate anatomy of the related white matter pathways.

Keywords: neuroanatomy, premotor, motor, connectivity

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Authors: Ahmed Abdrabou, Medhat Abdalla

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The studied stele dates back to Third Intermediate Period (1075-664) B.C in an ancient Egypt. It is made of wood and covered with painted gesso layers. This study aims to use a combination of multi spectral imaging {visible, infrared (IR), Visible-induced infrared luminescence (VIL), Visible-induced ultraviolet luminescence (UVL) and ultraviolet reflected (UVR)}, along with portable x-ray fluorescence in order to map and identify the pigments as well as to provide a deeper understanding of the painting techniques. Moreover; the authors were significantly interested in the identification of wood species. Multispectral imaging acquired in 3 spectral bands, ultraviolet (360-400 nm), visible (400-780 nm) and infrared (780-1100 nm) using (UV Ultraviolet-induced luminescence (UVL), UV Reflected (UVR), Visible (VIS), Visible-induced infrared luminescence (VIL) and Infrared photography. False color images are made by digitally editing the VIS with IR or UV images using Adobe Photoshop. Optical Microscopy (OM), potable X-ray fluorescence spectroscopy (p-XRF) and Fourier Transform Infrared Spectroscopy (FTIR) were used in this study. Mapping and imaging techniques provided useful information about the spatial distribution of pigments, in particular visible-induced luminescence (VIL) which allowed the spatial distribution of Egyptian blue pigment to be mapped and every region containing Egyptian blue, even down to single crystals in some instances, is clearly visible as a bright white area; however complete characterization of the pigments requires the use of p. XRF spectroscopy. Based on the elemental analysis found by P.XRF, we conclude that the artists used mixtures of the basic mineral pigments to achieve a wider palette of hues. Identification of wood species Microscopic identification indicated that the wood used was Sycamore Fig (Ficus sycomorus L.) which is recorded as being native to Egypt and was used to make wooden artifacts since at least the Fifth Dynasty.

Keywords: polychrome wooden stele, multispectral imaging, IR luminescence, Wood identification, Sycamore Fig, p-XRF

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Authors: Uzma Imtiaz

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Ecological feminism adheres to the basic philosophy that patriarchy is the wellspring of natural and gender domination. It explores the relationship between women and nature in a patriarchal society. Eco-feminism argues that women and nature have an intrinsic association and exploitation of women is the exploitation of nature itself. It further views the world as a holistic institution that offers equal opportunities for men and women. Eco-feminism rejects male domination in a patriarchal society where men and women do not get equal rights to survival. Furthermore, it investigates modern capitalist practices that exert unjust male dominance over nature and women. Cultural eco-feminist theorists argue that industrialization and modern science are male-centered and exhibit male chauvinistic views in attempts to control females’ ability to reproduce. This research intends to analyze an eco-feminist novel by Laila Halaby from the eco-feminism theoretical framework of Maria Mies and Vandana Shiva. The feminist dystopian novel throws light on the double-faced processes of capitalism and housewifization that destroy the autonomy of women over their bodies and life. Moreover, this study aims to highlight the unjust capitalistic processes and policies that turn other countries and women into colonies to exploit them by white men in the name of progress and civilization. The novel brings the patriarchal ways of dominance over women into question. This research paper concludes that women and men should get equal opportunities to survive in society, and women should have given rights over their bodies to decide their future. The research is qualitative in nature, so the method of close reading is selected to analyze the hypodermic effect of patriarchy in society. This study is valuable in highlighting the exploitative ways of men to subjugate women and nature and helps to give awareness to women against gender exploitation in society.

Keywords: housewifization, exploitation, capitalist patriarchy, female victimization

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Authors: Rudra Prasad Khanal

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Introduction: Non-communicable disease, such as cancer, has spread all over the world for some last decades. However, every nation has experienced a burden from the development of technology. In the context of Nepal, 10 to 15 thousand new cancer incidences are being registered in different hospitals for treatment. Since the date of starting nuclear medicine at Bir Hospital in 1998, cancer patients have been getting treatment regularly. According to the data of the population-based cancer registry, approximately 60% of the population having a middle-class income is being affected by cancer in Nepal. Methods and Materials: The study is aimed to find out the particular place where the population density of new cancer incidence is highest in Nepal and to inform the concerned regulatory body that is working on cancer screening and early detection for the proper treatment from the beginning. In order to identify the areas with the highest population density of new cancer incidence, all the data of cancer patients were collected from five different renowned hospitals and also from the population-based cancer registry center and then analyzed the data. The history of cancer patients was studied from 2003 to 2020, but here the data are analyzed from 2015 to 2020 only to find the latest trend in cancer incidence. Results: In the five major hospitals in Nepal, the total new cancer incidence was 61783 from 2015 to 2020. Out of those, 34617 were female, and 27176 were male. This research shows that female cancer patients were more every year. In the male, lung cancer patients more than cancer of other organs, but in females, the number of breast cancer patients was greatest. The age-adjusted mortality rate for males in Kathmandu valley was 36.3, and for females was 27.0 per 100,000 population. The cancer incidence and mortality rate were slightly lesser in other districts of Nepal. This rate increased with the increase in the age of people. Over 60 years, cancer incidence and mortality rates have been found to increase rapidly. Conclusion: This research supports conducting the program of cancer screening and early detection at Kathmandu valley with high priority and then Morang, Rukum, SSDM, etc., to control cancer.

Keywords: cancer incidence, research scholar, Tribhuvan University, Bhaktapur Cancer Hospital, Nepal

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Authors: Maulita Sari Hani, Abraham B. Sianipar, Jamaluddin Jompa, Natsir Nessa, Alan T. White

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Manta ray is an icon for tourism in Raja Ampat. The tourist volume has been increased for the past ten years which up to approximately 23,000 tourists in 2017. Since 2013, Conservation International Indonesia deployed satellite and acoustic tags on manta ray in Dampier strait to track the species and identify the aggregation areas. These findings encourage the government and the local community to boost conservation through the management of marine protected areas for tourism purposes. Community in Dampier strait including the village of Arborek, Kurkapa, Kapisawar, and Sawingray involved in variety of small scale tourism business including homestay, dive shop, tour operator, and crafts. Working groups of related local businesses were established to support the local community and to ensure the sustainability of the economic viability and environmental sustainability. In order to analyze the economic benefits of manta ray tourism, this study was conducted to identify the number of local business in Dampier Strait and the economic impacts in terms of local finance security, social, humanity, individual, and physical assets. The results of this study identify 30 homestays, 2 dive shops, 10 tour operators, 30 women involved in crafts, and about 50 villagers worked for dive resorts. In addition to community assets, we confirmed the welfare of community has been improved in terms of food security, households, education for children, savings, and health insurance.

Keywords: marine wildlife tourism, elasmobranch, conservation, ecotourism, co-management, economic viability, environmental sustainability

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Authors: Marta Kozuń, Krystian Toczewski, Sylwester Gerus, Justyna Wolicka, Kamila Boberek, Jarosław Filipiak, Dariusz Patkowski

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Long gap esophageal atresia is a congenital defect and is a challenge for pediatric surgeons all over the world. There are different surgical techniques in use to treat atresia. One of them is esophageal elongation but the optimal suture placement technique to achieve maximum elongation with low-risk complications is still unknown. The aim of the study was to characterize the process of esophageal elongation from the biomechanical point of view. Esophagi of white Pekin Duck was used as a model based on the size of this animal which is similar to a newborn (2.5-4kg). The specimens were divided into two groups: the control group (CG) and the group with sutures (SG). The esophagi of the control group were mounted in the grips of the MTS Tytron 250 testing machine and tensile test until rupture was performed. The loading speed during the test was 10mm/min. Then the SG group was tested. Each esophagus was cut into two equal parts and that were fused together using surgical sutures. The distance between both esophagus parts was 20mm. Ten both ends were mounted on the same testing machine and the tensile test with the same parameters was conducted. For all specimens, force and elongation were recorded. The biomechanical properties, i.e., the maximal force and maximal elongation, were determined on the basis of force-elongation curves. The maximal elongation was determined at the point of maximal force. The force achieved with the suture group was 10.1N±1.9N and 50.3N±11.6N for the control group. The highest elongation was also obtained for the control group: 18mm±3mm vs. 13.5mm ±2.4mm for the suture group. The presented study expands the knowledge of elongation of esophagi. It is worth emphasizing that the duck esophagus differs from the esophagus of a newborn, i.e., its wall lacks striated muscle cells. This is why the parts of animal esophagi used in the research are may characterized by different biomechanical properties in comparison with newborn tissue.

Keywords: long gap atresia treatment, esophageal elongation, biomechanical properties, soft tissue

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Authors: Shiran Bord, Assaf Oshri, Matthew W. Carlson, Sihong Liu

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Background: Alcohol-impaired driving (AID) and binge drinking are major health concerns among college students. Although the link between binge drinking and AID is well established, knowledge regarding binge drinking patterns, the factors influencing binge drinking, and the associations between consumption patterns and alcohol-related risk behaviors is lacking. Aims: To examine heterogeneous trajectories of binge drinking during college and tests factors that might predict class membership as well as class membership outcomes. Methods: Data were obtained from a sample of 1,265 college students (Mage = 18.5, SD = .66) as part of the Longitudinal Study of Violence Against Women (N = 1,265; 59.3% female; 69.2% white). Analyses were completed in three stages. First, a growth curve analysis was conducted to identify trajectories of binge drinking over time. Second, growth curve mixture modeling analyses were pursued to assess unobserved growth trajectories of binge drinking without predictors. Lastly, parental drinking variables were added to the model as predictors of class membership, and AID and being a passenger of a drunk driver were added to the model as outcomes. Results: Three binge drinking trajectories were identified: high-convex, medium concave and low-increasing. Parental drinking was associated with being in high-convex and medium-concave classes. Compared to the low-increasing class, the high convex and medium concave classes reported more AID and being a passenger of a drunk driver more frequently. Conclusions: Parental drinking may affect children’s later engagement in AID. Efforts should focus on parents' education regarding the consequences of parental modeling of alcohol consumption.

Keywords: alcohol impaired driving, alcohol consumption, binge drinking, college students, parental modeling

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Authors: Maiko Kiyohara, Toshiki Ito

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In this study, we used a psychotherapy process for patient with dissociative disorder and the graphic Rorschach (Digital version) (GRD). A dissociative disorder is a type of dissociation characterized by multiple alternating personalities (also called alternate identity or another identity). "dissociation" is a state in which consciousness, memory, thinking, emotion, perception, behavior, body image, and so on are divided and experienced. Dissociation symptoms, such as lack of memory, are seen, and the repetition of blanks in daily events causes serious problems in life. Although the pathological mechanism of dissociation has not yet been fully elucidated, it is said that it is caused by childhood abuse or shocking trauma. In case of Japan, no reliable data has been reported on the number of patients and prevalence of dissociative disorders, no drug is compatible with dissociation symptoms, and no clear treatment has been established. GRD is a method that the author revised in 2017 to a Graphic Rorschach, which is a special technique for subjects to draw language responses when enforce Rorschach. GRD reduces the burden on both the subject and the examiner, reduces the complexity of organizing data, improves the simplicity of organizing data, and improves the accuracy of interpretation by introducing a tablet computer during the drawing reaction. We are conducting research for the purpose. The patient in this case is a woman in her 50s, and has multiple personalities since childhood. At present, there are about 10 personalities whose main personality is just grasped. The patients is raising her junior high school sons as single parent, but personal changes often occur at home, which makes the home environment inferior and economically oppressive, and has severely hindered daily life. In psychotherapy, while a personality different from the main personality has appeared, I have also conducted psychotherapy with her son. In this case, the psychotherapy process and the GRD were performed to understand the personality characteristics, and the possibility of therapeutic significance to personality integration is reported.

Keywords: GRD, dissociative disorder, a case study of psychotherapy process, dissociation

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Authors: Denise Muro

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Conflict in Syria, producing over 11 million displaced persons, has incited global attention to displacement. Although neighboring countries have borne the largest part of the displacement burden, due to the influx of refugees into Europe, the so-called ‘refugee crisis’ is taking place on two fronts: Syria’s neighboring countries, with millions of refugees, and Europe, a destination goal for so many that European states face unprecedented challenges. With increasing attention to displacement, forcibly displaced persons are consistently portrayed as either un-agentic victims, or as dangerous free agents. Recognizing that these dominant portrayals involve discourses of power and inequality, this research investigates the extent to which this victim-agent dichotomy affects refugees and organizations that work closely with them during initial integration processes in Berlin, Germany. The research measures initial integration based on German policy measures regarding integration juxtaposed with the way refugees and those who work with them understand integration. Additionally, the study examines day-to-day interactions of refugees in Germany as a way to gauge social integration in a bottom-up approach. This study involved a discourse analysis of portrayals of refugees and participant observation and interviews with refugees and those who work closely with them, which took place during fieldwork in Berlin in the summer of 2016. Germany is unique regarding their migration history and lack of successful integration, in part due to the persistent refrain, ‘Wir sind kein einwanderungsland’ (‘We are not an immigration country’). Still, their accepted asylum seeker population has grown exponentially in the past few years. Findings suggest that the victim-agent dichotomy is present and impactful in the process of refugees entering and integrating into Germany. Integration is hindered due to refugees either being patronized or criminalized to such an extent that, despite being constantly told that they must integrate, they cannot become part of German society.

Keywords: discourse analysis, Germany, integration, refugee crisis

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Authors: Ralene Sim, Stefan Mueller, N. Gopalakrishna Iyer, Ngian Chye Tan, Khee Chee Soo, R. Shetty Mahalakshmi, Hiang Khoon Tan

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Background: Regional failure in nasopharyngeal carcinoma (NPC) is managed by salvage treatment in the form of neck dissection. Radical neck dissection (RND) is preferred over modified radical neck dissection (MRND) since it is traditionally believed to offer better long-term disease control. However, with the advent of more advanced imaging modalities like high-resolution Magnetic Resonance Imaging, Computed Tomography, and Positron Emission Tomography-CT scans, earlier detection is achieved. Additionally, concurrent chemotherapy also contributes to reduced tumour burden. Hence, there may be a lesser need for an RND and a greater role for MRND. With this retrospective study, the primary aim is to ascertain whether MRND, as opposed to RND, has similar outcomes and hence, whether there would be more grounds to offer a less aggressive procedure to achieve lower patient morbidity. Methods: This is a retrospective study of 66 NPC patients treated at Singapore General Hospital between 1994 to 2016 for histologically proven regional recurrence, of which 41 patients underwent RND and 25 who underwent MRND, based on surgeon preference. The type of ND performed, primary treatment mode, adjuvant treatment, and pattern of recurrence were reviewed. Overall survival (OS) was calculated using Kaplan-Meier estimate and compared. Results: Overall, the disease parameters such as nodal involvement and extranodal extension were comparable between the two groups. Comparing MRND and RND, the median (IQR) OS is 1.76 (0.58 to 3.49) and 2.41 (0.78 to 4.11) respectively. However, the p-value found is 0.5301 and hence not statistically significant. Conclusion: RND is more aggressive and has been associated with greater morbidity. Hence, with similar outcomes, MRND could be an alternative salvage procedure for regional failure in selected NPC patients, allowing similar salvage rates with lesser mortality and morbidity.

Keywords: nasopharyngeal carcinoma, neck dissection, modified neck dissection, radical neck dissection

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Authors: Ayo Osisanya, Promise Ebuka Okonkwo

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Reduced hearing sensitivity among the elderly has been attributed to some risk factors and influence of age-related degenerative conditions such as diabetes, cardiovascular disease, Alzheimer’s disease, bipolar disorder, and hypertension. Hearing loss; especially the age-related type (presbycusis), has been reported as one of the global burden affecting the general well-being and quality of life of the elderly with hypertension. Thus, hearing loss has been observed to be associated with hypertension and functional decline in elderly, as this condition makes them experience poor communication, fatigue, reduced social functions, mood-swing, and withdrawal syndrome. Emerging research outcomes indicate a strong relationship between hypertension and reduced auditory performance among the elderly. Therefore, this study determined the prevalence, types, and patterns of hearing loss associated with hypertension, with a bid to suggesting comprehensive management strategies and a model of creating awareness towards promoting good healthy living among the elderly in Nigeria. One hundred and seventy-two elderly, aged 65–85 with hypertension were purposively selected from patients undergoing treatment for hypertension in some tertiary hospitals in southwest Nigeria for the study. Participants were suggested to Pure-Tone Audiometry (PTA) through the use of Maico 53 Diagnostic Audiometer to determine the degree, types ad patterns of hearing loss among the elderly with hypertension. Results showed that 148 (86.05%) elderly with hypertension presented with different degrees, types, and patterns of hearing loss. Out of this number, 123 (83.11%) presented with bilateral hearing loss, while 25 (16.89%) had unilateral hearing loss. Degree of hearing loss, 74 moderate hearing loss, 118 moderately severe and 50 severe hearing loss. 36% of the hearing loss appeared as flat audiometric configuration, 24% were slopping, 19% were rising, while 21% were tough-shaped audiometric configurations. The findings showed high prevalence of hearing loss among the elderly with hypertension in Southwest, Nigeria. Based on the findings, management of elderly with hypertension should include regular audiological rehabilitation and total adherence to hearing conservation principles, otological management, regulation of blood pressure and adequate counselling / follow-up services.

Keywords: auditory performance, elderly, hearing loss, hypertension

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Authors: Kebede Mengistu, Kassahun Alemu, Bikes Destaw

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Introduction: Malnutrition continues to be a major public health problem in developing countries. It is the most important risk factor for the burden of diseases. It causes about 300, 000 deaths per year and responsible for more than half of all deaths in children. In Ethiopia, child malnutrition rate is one of the most serious public health problem and the highest in the world. High malnutrition rates in the country pose a significant obstacle to achieving better child health outcomes. Objective: To assess prevalence of malnutrition and associated factors among children aged 6-59 months at Hidabu Abote district, North shewa, Oromia. Methods: A community based cross sectional study was conducted on 820 children aged 6-59 months from September 8-23, 2012 at Hidabu Abote district. Multistage sampling method was used to select households. Children were selected from each kebeles by simple random sampling. Anthropometric measurements and structured questioners were used. Data was processed using EPi-info soft ware and exported to SPSS for analysis. Then after, sex, age, months, height, and weight transferred with HHs number to ENA for SMART 2007software to convert nutritional data into Z-scores of the indices; H/A, W/H and W/A. Bivariate and multivariate logistic regressions were used to identify associated factors of malnutrition. Results: The analysis this study revealed that, 47.6%, 30.9% and 16.7% of children were stunted, underweight and wasted, respectively. The main associated factors of stunting were found to be child age, family monthly income, children were received butter as pre-lacteal feeding and family planning. Underweight was associated with number of children HHs and children were received butter as per-lacteal feeding but un treatment of water in HHs only associated with wasting. Conclusion and recommendation: From the findings of this study, it is concluded that malnutrition is still an important problem among children aged 6-59 months. Therefore, especial attention should be given on intervention of malnutrition.

Keywords: children, Hidabu Abote district, malnutrition, public health

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Authors: Emna Ketata, Wafa Farhat

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Introduction: Hyponatremia is defined by a blood sodium level of ≤ 136 mmol/L; it is associated with a high risk of morbidity and mortality in the emergency room. This was explained by transit disorders, including diarrhea and inappropriate antidiuretic hormone secretion (Syndrome of inappropriate antidiuretic hormone secretion). Pneumonia can cause dyspnea, stress-causing SIADH and digestive symptoms (diarrhea and vomiting). Aim: The purpose of this study was to determine the link between pneumonia and hyponatremia as a predictor of patient’s prognosis and intra-hospital mortality. Methodology: This is a prospective observational study over a period of 3 years in the emergency department. Inclusion :patients (age > 14 years), with clinical signs in favor of pneumonia. Natremia was measured. Natremia was classified as mild to moderate with a blood sodium level between 121 and 135 mmol/L and as severe with a blood sodium level ≤ 120 mmol/L. Results: This study showed an average serum sodium value of 135 mmol/L (range 114–159 mmol/L) in these patients. Hyponatremia was observed in 123 patients (43.6%), 115 patients (97,8%) had mild to moderate hyponatremia and 2,8% had severe hyponatremia. The mean age was 65±17 years with a sex ratio of 1.05. The main reason for consultation in patients with hyponatremia was cough in 58 patients (47.2%), and digestive symptoms were present in 25 patients (20.3. An altered state of consciousness was observed in 11 patients (3%). Patients with hyponatremia had greater heart rate (p=0.02),white blood cell count (p=0.009) , plasmatic lactate (p=0.002) and higher rate of pneumonia recurrence (p=0.001) .In addition, 80% of them have a positive CURB65 score (>=2). hyponatremia had higher rates of use of oxygen therapy compared to patients with normo-natremia (54% vs. 45%). The analytical study showed that hyponatremia is significantly associated with intra-hospital mortality with( p=0.01), severe hyponatremia p=0.04. Conclusion: Hyponatremia is a predictor of mortality and worse prognosis. Recognition of the pathophysiological mechanisms of hyponatremia in pneumonia will probably allow better management of it.

Keywords: oxygenotherapy, mortality, recurrence, positif curb65

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Authors: Beatrice Adeoye

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Background: One of the health challenges developing countries face is air pollution from indoor and outdoor activities. Smoke as a result of cooking, burning wastes and power generators litter the air space on a continual basis due to poverty and governance challenges. The short and long term implications of these actions are enormous and studies have attributed smoke as one of the leading preventable risk factors contributing to global burden of respiratory infections. Design/Methods: The issue at hand therefore includes an exploration of the existing policy frameworks regarding smoke, adherence to international conventions and practices, and more importantly the activities of the government in addressing these issues. Aside this, an understanding of the implications of smoke on peoples’ health and well-being also become crucial. Consequently, this article seeks to interrogate the effect of smoke on the health and well-being of Nigerians and the activities of the policy makers in addressing these challenges. Results (Main Argument): This study reviewed both primary and secondary data on poverty, smoke emission and attendant health risks coupled with existing policies on smoke and air pollution in the country. For instance, over 69% of Nigerians are poor, ranking third in the world; 2.9 billion people live in homes using wood, coal or dung as their primary cooking fuel; equally, 50.6% of Nigerians has no access to regular electricity supply. Further, sustainable policy regarding smoke emission is lacking in the country. This work further submitted that continued low standard of living as a result of governance challenges coupled with a lack of sustainable policy have aggravated the health risks related to smoke in the country. Conclusions: The implication on the health of the children, mothers and vulnerable groups for the future of the country is enormous and may continue if not addressed. Urgent attention therefore needs to be focused on this area considering what this portends for the nation now and in the future.

Keywords: air pollution, indoor, outdoor, respiratory infections

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Authors: A. A. Saki, Y. Karimi, H. J. Najafabadi, P. Zamani, Z. Mostafaie

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The restaurant residuals reasons such as competition between human and animal consumption of cereals, increasing environmental pollution and the high cost of production of livestock products is important. Therefore, in this restaurant residuals have a high nutritional value (protein and high energy) that it is possible can replace some of the poultry diets are especially Japanese quail. Today, the challenges of processing and consumption of these lesions occurring in modern industry would be confronting. Increasing costs, pressures, and problems associated with waste excretion, the need for re-evaluation and utilization of waste to livestock and poultry feed fortifies. This study aimed to investigate the effects of different levels of restaurant residuals on performance of 300 layer Japanese quails. This experiment included 5 treatments, 4 replicates, and 15 quails in each from 10 to 18 weeks age in a completely randomized design (CRD). The treatments consist of basal diet including corn and soybean meal (without residual restaurants), and treatments 2, 3, 4 and 5, includes a basal diet containing 5, 10, 15 and 20% of restaurant residuals, respectively. There were no significant effect of restaurant residuals levels on body weight (BW), feed conversion ratio (FCR), percentage of egg production (EP), egg mass (EM) between treatments (P > 0/05). However, feed intake (FI) of 5% restaurant residual was significantly higher than 20% treatment (P < 0/05). Egg weight (EW) was also higher by receiving 20% restaurant residuals compared with 10% in this respect (P < 0/05). Yolk weight (YW) of treatments containing 10 and 20% of the residual restaurant were significantly higher than control (P < 0/05). Eggs white weight (EWW) of 20 and 5% restaurants residual treatments were significantly increased compared by 10% (P < 0/05). Furthermore, EW, egg weight to shell surface area and egg surface area in 20% treatment were significantly higher than control and 10% treatment (P < 0/05). The overall results of this study have shown that restaurant residuals for laying quail diets in levels of 10 and 15 percent could be replaced with a part of the quail ration without any adverse effect.

Keywords: by-product, laying quail, performance, restaurant residuals

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Authors: Wajeeha Zahid, Shafquat Rozi, Farhan Raza, Masood Kadir

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Background: Dental caries affects the overall health and well-being of children. Findings from various international studies regarding the association of dental caries with asthma are inconsistent. With the increasing burden of caries and childhood asthma, it becomes imperative for an underdeveloped country like Pakistan where resources are limited to identify whether there is a relationship between the two. This study aims to identify an association between dental caries and asthma. Methods: A cross-sectional study was conducted on 544 children aged 12-15 years recruited from five private schools in Karachi. Information on asthma was collected through the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The questionnaire addressed questions regarding child’s demographics, physician diagnoses of asthma, type of medication administered, family history of asthma and allergies, dietary habits and oral hygiene behavior. Dental caries was assessed using DMFT Index (Decayed, Missing, Filled teeth) index The data was analyzed using Cox proportional Hazard algorithm and crude and adjusted prevalence ratios with 95% CI were reported. Results: This study comprises of 306 (56.3%) boys and 238 (43.8%) girls. The mean age of children was 13.2 ± (0.05) years. The total number of children with carious teeth (DMFT > 0) were 166/544 (30.5%), and the decayed component contributed largely (22.8%) to the DMFT score. The prevalence of physician’s diagnosed asthma was 13%. This study identified almost 7% asthmatic children using the internationally validated International Study of Asthma and Allergies in Childhood (ISAAC) tool and 8 children with childhood asthma were identified by parent interviews. Overall prevalence of asthma was 109/544 (20%). The prevalence of caries in asthmatic children was 28.4% as compared to 31% among non-asthmatic children. The adjusted prevalence ratio of dental caries in asthmatic children was 0.8 (95% CI 0.59-1.29). After adjusting for carious food intake, age, oral hygiene index and dentist visit, the association between asthma and dental caries turned out to be non-significant. Conclusion: There was no association between asthma and dental caries among children who participated in this study.

Keywords: asthma, caries, children, school-based

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Authors: Thuraya Ahmed Al Shidhani, Yahya Al Farsi, Alya Al Husni, Samir Al Adawi

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Background: Knee osteoarthritis (knee OA) represents a major public health burden worldwide, particularly among older adults. However, little has been documented from Arabian Gulf countries, which have left an information gap. Objective: This study describes the socio-demographic, clinical risk factors, and use of herbal medicine among men and women seeking consultation for knee OA at two secondary healthcare facilities in Muscat, Oman. Methods: A cross-sectional study was conducted among 213 Omani adults with knee OA attending a referral polyclinic in Muscat, Oman, over 12 months from January to December. Socio-demographic data were collected from the participants who are seeking consultation for knee OA. Results: Among the 213 study participants, 171 were females and 42 males. The females were comparatively older than the males, had lower education and lower-income, and more overweight. The majority of the participants were normal weight or underweight. About one-third of participants reported OA in other joints as well. Most participants recalled that they had knee OA for less than a year. About 12% reported a history of trauma. The majority (63%) concurrently had other chronic illnesses, and 33% reported having at least one complication. About 22% were using herbal medicines. About 77% are using herbal local applications in form of powder and creams. Conclusion: This study, to our knowledge, is the first to explore socio-demographic characteristics, clinical risk factors and use of herbal medicine among sufferers of knee OA in Oman. Knee OA tended to occur among our participants at younger ages than reported elsewhere, while obesity appeared orthogonal to the severity of knee OA. Women were more affected than men. About one quarter of Omani patients are using herbal medicine. More studies are needed to understand the causal factors and development of knee OA in Oman. Targeted health education and rehabilitation programs are needed, particularly among Omani women, to improve their physical quality of life.

Keywords: knee joint, osteoarthritis, herbal medicine, Oman

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Authors: Cigdem Gul, Murat Tosunoglu, Nurcihan Hacioglu

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The contamination or desiccation of fresh waters also has a negative effect on freshwater turtles like other fresh water-dependent species. In order to conserve those species, which are confronted with such negative conditions, it is necessary to know beforehand the biology and the physiology of species. In this study, a comprehensive health assessment was conducted on a total of 20 clinically normal individuals free living Western Caspian Turtle (Mauremys rivulata) captured from two different freshwater localities in the Biga stream (Çanakkale-Turkey). When comparing our findings with the Turkish legislation (Water pollution control regulation), the 1. Locality of the Biga stream in terms of total coliform classified as "high quality water" (Coliform: 866.66 MPN/100 mL), while the 2. Locality was a “contaminated water" (Coliform: 53266.66 MPN/100 mL). Blood samples for hematological and biochemical analyses were obtained from the dorsal coccygeal vein. A total of 1-2 mL of blood was collected from each of the specimens via needle. After the required procedures had been performed, the turtles were put back in the same localities. Hematological and biochemical analyses based on high quality water and contaminated water, respectively, are as follows: Red blood cell count (512600-582666.66 per cubic millimeter of blood), white blood cell count (5920-5980 per cubic millimeter of blood), hematocrit value (24-24.66 %), hemoglobin concentration (6.52-6.35 g/dl), mean corpuscular volume (466.20-468.98 fl), mean corpuscular hemoglobin (125.77-113.84 pg), mean corpuscular hemoglobin concentration (28.25-26.49 %), glucose (94.43-87.43 mg/dl), creatinine (0.23-0.3241 mg/dl), uric acid (12.59-10.48 mg/L), albumin (1.46-1.25 g/dl), calcium (8.67-9.59 mg/dl), triglyceride (95.55-75.21 mg/dl), and total protein (4.85-3.45 g/dl). When an examination was made depending on the water quality of freshwater, variations were detected in hematology and biochemistry values, but not found significant difference.

Keywords: biochemistry, freshwater quality, hematological parameters, Mauremys rivulata.

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Authors: Murorunkwere Marie Claire

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Introduction: In Sub-Saharan Africa and specifically in Rwandan rural areas, mother-to-Child human immunodeficiency virus transmission remains a big challenge. This is mainly due to lack of awareness and ignorance among pregnant rural women, leading to neglect regular taking of prophylactic antiretroviral treatment and to persistently beliefs in traditional healers and home deliveries. This paper explores the factors associated with stagnant reduction in human immunodeficiency virus vertical transmission among pregnant rural women and provides solutions to tackle it. Methodology: The first phase of this research will be a qualitative survey was conducted to assess the knowledge, attitudes and practices towards vertical human immunodeficiency virus transmission among pregnant women in one rural district in Rwanda. The data generated from phase one of this research will be used to address the main factors revealed through community mobilization and motivation on attending required antenatal consultations and hospital deliveries, proper and regular antiretroviral treatment taking, and discouraging beliefs in traditional healers and home deliveries. Refresher training seminars will also be organized for healthcare providers qualified on conducting deliveries about current measures to maximize the reduction of chances that can lead to mother -child contamination (to avoid early rupture of membranes and to prevent any source of contamination). Results: This paper is expected to contribute in a significant reduction of the vertical human immunodeficiency virus transmission burden among pregnant rural women. Conclusion: Strong campaigns on prevention of mother- to-child human immunodeficiency virus transmission and community mobilization of pregnant rural women, and house to house education and continuous reminders as well as training seminars to health care personnel on updated measures is, key in addressing vertical human immunodeficiency virus transmission.

Keywords: attitudes transformation, community mobilisation, pregnant rural women, vertical HIV transmission

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