Search results for: mix proportions

Authors: Chen Zhi-Wei, Hsieh Wei-Fang

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Taiwan annual rainfall is global average of 2.5 times, plus city excessive development, green constantly to reduced, instead of is big area of artificial base disc, makes Taiwan rainy season during occurred of storm cannot timely of emissions, led to flood constantly, and rain also cannot was retained again using, led to city hydrological balance suffered damage, and to Regulation city of by brings of negative effect, increased green covered rate became most effective of method, and city land limited, so roof green gradually became a alternative program. Green roofs have become one of the Central and local government policy initiatives for urban development, in foreign countries, such as the United States, and Japan, and Singapore etc. Development of roof greening as an important policy, has become a trend of the times. In recent years, many experts and scholars are also on the roof greening all aspects of research, mostly for green roof for the environmental impact of benefits, such as: carbon reduction, cooling, thermostat, but research on the benefits of green roofs under water cut but it is rare. Therefore, this research literature from green roof in to view and analyze what kind of medium suitable for roof greening and use of green base plate combination simulated green roof structure, via different proportions of the medium with water retention plate and drainage board, experiment with different planting base plate combination of water conservation performance. Research will want to test the effect of roof planting base mix, promotion of relevant departments and agencies in future implementation of green roofs, prompted the development of green roofs, which in the end Taiwan achieve sustainable development of the urban environment help.

Keywords: thin-layer roof greening and planting medium, water efficiency

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Authors: Rafla Attia, Claudio Zucca, Bao Quang Le, Sana Dridi, Thouraya Sahli, Taoufik Hermassi

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In Tunisia, landscape change and land degradation are critical issues for landscape conservation, management, and planning. Landscapes are undergoing crucial environmental problems made evident by soil degradation and desertification. Human improper uses of land resources (e.g., unsuitable land uses, unsustainable crop intensification, and poor rangeland management) and climate change are the main factors leading to the landscape transformation and desertification affecting high proportions of the Tunisian lands. Land use planning (LUP) to achieve Land Degradation Neutrality (LDN) must be supported by methodologies and technologies that help identify best solutions and practices and design context-specific sustainable land management (SLM) strategies. Such strategies must include restoration or rehabilitation efforts in areas with high land degradation, as well as prevention of degradation that could be caused by improper land use (LU) and land management (LM). The geoinformatics Land Use Planning for LDN (LUP4LDN) tool has been designed for this purpose. Its aim is to support national and sub-national planners in i) mapping geographic patterns of current land degradation; ii) anticipating further future land degradation expected in areas that are unsustainably managed; and iii) providing an interactive procedure for developing participatory LU-LM transitional scenarios over selected regions of interest and timeframes, visualizing the related expected levels of impacts on ecosystem services via maps and graphs. The tool has been co-developed and piloted with national stakeholders in Tunisia. The piloting implementation assessed how the LUP4LDN tool fits with existing LUP processes and the benefits achieved by using the tool to support land use planning for LDN.

Keywords: land use system, land cover, sustainable land management, land use planning for land degradation neutrality

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Authors: Arnold S. Freitas Neto, Rodrigo E. Coelho, Erick S. Mendonça

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The study aims to assess if high-purity iron powder in iron-aluminum alloys can be replaced by SAE 1020 steel chips with an atomicity proportion of 50% for each element. Chips of SAE 1020 are rejected in industrial processes. Thus, the use of SAE 1020 as a replaceable composite for iron increase the sustainability of ferrous alloys by recycling industrial waste. The alloys were processed by high energy milling, of which the main advantage is the minimal loss of raw material. The raw material for three of the six samples were high purity iron powder and recyclable aluminum cans. For the other three samples, the high purity iron powder has been replaced with chips of SAE 1020 steel. The process started with the separate milling of chips of aluminum and SAE 1020 steel to obtain the powder. Subsequently, the raw material was mixed in the pre-defined proportions, milled together for five hours and then underwent a closed-die hot compaction at the temperature of 500 °C. Thereafter, the compacted samples underwent heat treatments known as sintering and solubilization. All samples were sintered one hour, and 4 samples were solubilized for either 4 or 10 hours under well-controlled atmosphere conditions. Lastly, the composition and the mechanical properties of their hardness were analyzed. The samples were analyzed by optical microscopy, scanning electron microscopy and hardness testing. The results of the analysis showed a similar chemical composition and interesting hardness levels with low standard deviations. This verified that the use of SAE 1020 steel chips can be a low-cost alternative for high-purity iron powder and could possibly replace high-purity Iron in industrial applications.

Keywords: Fe-Al alloys, high energy milling, iron-aluminum alloys, metallography characterization, powder metallurgy, recycling ferrous alloy, SAE 1020 steel recycling

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Authors: Alyaa Farouk AbdelFattah Ibrahim, Agnes Monica, Dolores I. Cabansag

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The prevalence of diabetes mellitus is reaching epidemic proportions in many parts of the world causing an increasing public health concern. Cases of Type 2 diabetes are rapidly increasing in the Middle East region. Deprived of lifestyle deviations, a section of the Middle East’s inhabitants will be pretentious by 2035. As all sociocultural factors have created unhealthy lifestyles, which have become part of the social norms within Saudi society, thereby increased the prevalence of sedentary lifestyle and obesity in women living in Saudi Arabia. So, this study aimed to assess the impact of diabetes mellitus on quality of life of female nursing students in King Saud bin Abdulaziz University for Health Sciences, Riyadh. In a crossectional study design, 151 nursing students at King Saud bin Abdulaziz University for health sciences in Riyadh were included in the study. Biosociodemographic questionnaire and Short-Form 36 (SF-36) Health Related Quality of life Survey Arabic version were used for data collection, and all included students were screened for random blood glucose level. Results depicted that among 151 subjects included in the study 17 (11.3%) had diagnosed medical problems, and 29.4% of those participants with medical problems were diabetics. Univariate regression model for the relation between diabetes mellitus and overall percent score of SF-36 health survey domains showed no statistically significant difference between diabetic and non-diabetic subjects 0.990(0.931-1.053). In conclusion, although the diabetes prevalence was high among the study subjects it did not affect their quality of life may be due to age of the study population.

Keywords: diabetes mellitus, diabetes prevalence, quality of life, university students' health

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Authors: A. K. Jain, M. C. Paliwal

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The production of cement leads to the emission of large amounts of carbon-dioxide gas into the atmosphere which is a major contributor for the greenhouse effect and the global warming; hence it is mandatory either to quest for another material or partly replace it with some other material. According to the practical demonstrations and reports, Egg Shell Powder (ESP) can be used as a binding material for different field applications as it contains some of the properties of lime. It can partially replace the cement and further; it can be used in different proportion for enhancing the performance of cement. It can be used as a first-class alternative, for material reuse and waste recycling practices. Eggshell is calcium rich and analogous to limestone in chemical composition. Therefore, use of eggshell waste for partial replacement of cement in concrete is feasible. Different studies reveal that plasticity index of the soil can be improved by adding eggshell wastes in all the clay soil and it has wider application in construction projects including earth canals and earthen dams. The scarcity of aggregates is also increasing nowadays. Utilization of industrial waste or secondary materials is increasing in different construction applications. Coconut shell was successfully used in the construction industry for partial or full replacement for coarse aggregates. The use of coconut shell gives advantage of using waste material to partially replace the coarse aggregate. Studies carried on coconut shell indicate that it can partially replace the aggregate. It has good strength and modulus properties along with the advantage of high lignin content. It absorbs relatively low moisture due to its low cellulose content. In the paper, study carried out on eggshell powder and coconut shell will be discussed. Optimum proportions of these materials to be used for partial replacement of cement and aggregate will also be discussed.

Keywords: greenhouse, egg shell powder, binding material, aggregates, coconut shell, coarse aggregates

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Authors: Eli Maria Pazzianotto-Forti, Patrícia Brigatto, Letícia Baltieri, Carolina Moraes Da Costa, Maura Rigoldi Simoes Da Rocha, Irineu Rasera Jr

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The application of positive pressure in airway can contribute to the restoration of lung volumes, capacities and prevent respiratory complications. The aim was to investigate the use of Bilevel Positive Airway Pressure (BIPAP) in morbidly obese in two moments in postoperative bariatric surgery: In the post-anesthetic recovery (PAR) and on the 1st postoperative day (1stPO). Twenty morbidly obese, aged between 25 and 55 years, underwent pulmonary function test and chest X-ray preoperatively and on the day of discharge (2nd day after surgery). They were randomly allocated in groups. GPAR: received BIPAP treatment in PAR, for an hour and G1stPO: received BIPAP for one hour, on the 1stPO. There were significant reductions in slow vital capacity (SVC) (p=0.0007), inspiratory reserve volume (IRV) (p=0.0016) and forced vital capacity (FVC) (p=0.0013) in the postoperative in GPAR and the expiratory reserve volume (ERV) remained (p=0.4446). In the G1stPO, there were significant reductions for: SVC p=<0.0001, ERV p=0.0191, IRV p= 0.0026 and FVC p=<0.0001. Comparing between groups, the SVC (p=0.0027) and FVC (p=0.0028) showed significant difference between the treatments. However, the GPAR showed fewer declines of these capacities. To the ERV (p= 0.1646) and IRV (p=0.3973) there was no significant difference between groups. The atelectasis prevalence was 10% for the GPAR and 30% for G1stPO, with significant difference between the proportions (p = 0.0027). The lowest reduction in SVC and FVC happens when positive pressure is applied in PAR. Thus, the use of BIPAP in the PAR can promote a restoration of ERV and contribute to the reduction of atelectasis. FAPESP 2013/06334-8.

Keywords: atelectasis, bariatric surgery, physiotherapy, pulmonary function, positive pressure

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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Authors: Jesus D. Cortes Gil, Fernanda Ewerling, Leonardo Ferreira, Aluisio J. D. Barros

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Background: The sustainable development goals call for inclusive, equitable, and quality learning opportunities for all. This is especially important for children, to ensure they all develop to their full potential. We studied the prevalence and inequalities of suspected delay in child development in 63 low- and middle-income countries. Methods and Findings: We used the early child development module from national health surveys, which covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track. We calculated the age-adjusted prevalence of suspected delay at the country level and stratifying by wealth, urban/rural residence, sex of the child, and maternal education. We also calculated measures of absolute and relative inequality. We studied 330.613 children from 63 countries. The prevalence of suspected delay for the ECDI ranged from 3% in Barbados to 67% in Chad. For all countries together, 25% of the children were suspected of developmental delay. At regional level, the prevalence of delay ranged from 10% in Europe and Central Asia to 42% in West and Central Africa. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large inequalities, and most markedly for the literacy-numeracy domain. Conclusions: To date, our study presents the most comprehensive analysis of child development using an instrument especially developed for national health surveys. With a quarter of the children globally suspected of developmental delay, we face an immense challenge. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving these children behind.

Keywords: child development, inequalities, global health, equity

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Authors: N. Hachemi, I. Benmehdi, O. Hasnaoui

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The air like water is an essential element for living beings. Each day, a man breathes about 20m3 of air. It originally consists of a set of gas whose presence and concentrations correspond to the needs of life. This study focuses on air pollution by smoke and dust emitted from the chimney of the cement works of Beni Saf, pathological and their impact on the environment. Dust of the cement plant are harmless to permissible levels for living organisms, but the two combined phenomena namely the release of dust and aridity of the climate, which severely marked area of Beni Saf; have contributed adverse effects in on human health and the degradation of vegetation cover and species especially weakened by environmental stress. The most visible impact is certainly the deposition of dust on the surrounding areas of the cement factory, and seriously affecting the aesthetics of the landscape. Health problems are more important inside and outside the factory. Among the diseases notable caused by the cement works are: deafness, heart disease, asthma and mental. The dust of the cement works is mainly composed of fine particles of limestone, clay, free lime, silicates and also loaded of the gases such as carbon dioxide gas CO2. The accumulation of this gas in the atmosphere is directly involved in the phenomenon of increasing of greenhouse effect. Some gases, for example, are directly toxic. They can change the climate, changing precipitation types and become a greater source of stress by drought, etc. The environment also suffers from air pollution indirectly; it is more precisely the acid rain. They are produced by the combustion of non-metals in air. Acid rain has consequences for contaminating the soil, weakening the flora, fauna and acidifies lakes. Finally, the pollution problems are multiple and specific dust. It can worsen and change, it has reached epidemic proportions quantitatively and qualitatively disturbing and unpredictable.

Keywords: atmospheric pollution, cement, dust, environment

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Authors: Selvam M., Vadthya Poornachandar, Surender Singh

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These Reclaimed Asphalt Pavement (RAP) aggregates are generally dumped in the open area after the demolition of Asphalt Pavements. The utilization of RAP aggregates in cement concrete pavements may provide several socio-economic-environmental benefits and could embrace the circular economy. The cross recycling of RAP aggregates in the concrete pavement could reduce the consumption of virgin aggregates and saves the fertile land. However, the structural, as well as functional properties of RAP-concrete could be significantly lower than the conventional Pavement Quality Control (PQC) pavements. This warrants judicious selection of RAP fraction (coarse and fine aggregates) along with the accurate proportion of the same for PQC highways. Also, the selection of the RAP fraction and its proportion shall not be solely based on the mechanical properties of RAP-concrete specimens but also governed by the structural and functional behavior of the pavement system. In this study, an effort has been made to predict the optimum RAP fraction and its corresponding proportion for cement concrete pavements by considering the low-volume and high-volume roads. Initially, the effect of inclusions of RAP on the fresh and mechanical properties of concrete pavement mixes is mapped through an extensive literature survey. Almost all the studies available to date are considered for this study. Generally, Indian Roads Congress (IRC) methods are the most widely used design method in India for the analysis of concrete pavements, and the same has been considered for this study. Subsequently, fatigue damage analysis is performed to evaluate the required safe thickness of pavement slab for different fractions of RAP (coarse RAP). Consequently, the performance of RAP-concrete is predicted by employing the AASHTO-1993 model for the following distresses conditions: faulting, cracking, and smoothness. The performance prediction and total cost analysis of RAP aggregates depict that the optimum proportions of coarse RAP aggregates in the PQC mix are 35% and 50% for high volume and low volume roads, respectively.

Keywords: concrete pavement, RAP aggregate, performance prediction, pavement design

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Authors: Andreas Ateke Njoh, Shalom Tchokfe Ndoula, Amani Adidja, Germain Nguessan Menan, Annie Mengue, Eric Mboke, Hassan Ben Bachir, Sangwe Clovis Nchinjoh, Yauba Saidu, Laurent Cleenewerck De Kiev

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Vaccines serve a great deal in protecting the population globally. Vaccine products are subject to rigorous quality control and approval before use to ensure safety. Even if all actors take the required precautions, some people could still have adverse events following immunization (AEFI) caused by the vaccine composition or an error in its administration. AEFI underreporting is pronounced in low-income settings like Cameroon. The Country introduced electronic platforms to strengthen surveillance. With the introduction of many novel vaccines, like COVID-19 and the novel Oral Polio Vaccine (nOPV) 2, there was a need to monitor AEFI in the Country. A cross-sectional study was conducted from July to December 2022. Data on AEFI per region of Cameroon were reviewed for the past five years. Data were analyzed with MS Excel, and the results were presented in proportions. AEFI reporting was uncommon in Cameroon. With the introduction of novel vaccines in 2021, the health authorities engaged in new tools and training to capture cases. AEFI detected almost doubled using the open data kit (ODK) compared to previous platforms, especially following the introduction of the nOPV2 and COVID-19 vaccines. The AEFI rate was 1.9 and 160 per administered 100 000 doses of nOPV2 and COVID-19 vaccines, respectively. This mobile tool captured individual information for people with AEFI from all regions. The platform helped to identify common AEFI following the use of these new vaccines. The ODK mobile technology was vital in improving AEFI reporting and providing data to monitor using new vaccines in Cameroon.

Keywords: adverse events following immunization, cameroon, COVID-19 vaccines, nOPV, ODK

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Authors: Camilo Andres Agudelo-Velez, Lina María Martinez-Sanchez, Natalia Perilla-Hernandez, Maria De Los Angeles Rodriguez-Gazquez, Felipe Hernandez-Restrepo, Dayana Andrea Quintero-Moreno, Camilo Ruiz-Mejia, Isabel Cristina Ortiz-Trujillo, Monica Maria Zuluaga-Quintero

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Chronic obstructive pulmonary disease is common condition, characterized by a persistent blockage of airflow, partially reversible and progressive, that represents 5% of total deaths around the world, and it is expected to become the third leading cause of death by 2030. Objective: To establish the clinical and epidemiological profile of patients with chronic obstructive pulmonary disease in a medical institution from the city of Medellin, Colombia. Methods: A cross-sectional study was performed, with a sample of 50 patients with a diagnosis of chronic obstructive pulmonary disease in a private institution in Medellin, during 2015. The software SPSS vr. 20 was used for the statistical analysis. For the quantitative variables, averages, standard deviations, and maximun and minimun values were calculated, while for ordinal and nominal qualitative variables, proportions were estimated. Results: The average age was 73.5±9.3 years, 52% of the patients were women, 50% of them had retired, 46% ere married and 80% lived in the city of Medellín. The mean time of diagnosis was 7.8±1.3 years and 100% of the patients were treated at the internal medicine service. The most common clinical features were: 36% were classified as class D for the disease, 34% had a FEV1 <30%, 88% had a history of smoking and 52% had oxygen therapy at home. Conclusion: It was found that class D was the most common, and the majority of the patients had a history of smoking, indicating the need to strengthen promotion and prevention strategies in this regard.

Keywords: pulmonary disease, chronic obstructive, pulmonary medicine, oxygen inhalation therapy

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Authors: Florge Francis A. Sy

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Physicians develop emotional and psychological distress after facing a patient’s death. This can result in stress or burnout. Coping mechanisms in dealing with these deaths may be maladaptive. Determining grief, emotional impact, and coping strategies in physicians is necessary to identify those needing intervention. This can be done by employing validated assessment tools such as the Texas Revised Inventory of Grief (TRIG) scale, Impact of Events Scale (IES), and BriefCOPE tool, respectively. This prospective, observational study was done in a private hospital in Cebu City. Fifty-five internal medicine residents were included and tasked to answer a survey based on their most memorable patient death encounter. The TRIG, IES, and BriefCOPE scores were determined. Participants were divided into severe grief and non-severe grief based on TRIG scores, low-impact, moderate-impact, and high-impact based on IES, and low-use, moderate-use, and high-use based on the BriefCOPE. The differences in the groups’ characteristics were statistically determined, and a p-value of < 0.05 was significant. The participants’ average age was 28.45 years. Most were female and single. Most belonged to the non-severe group based on TRIG, a moderate-impact group based on the IES, and high-use group based on the BriefCOPE. However, 21.8% reported severe grief, 27.3% reported high-impact, and 10.9% had low use of coping strategies. The proportion of residents who encountered CPR prior to the patient’s death was greater in the severe group. Proportions of both high-impact and non-high impact groups were comparable. The proportion of female residents was higher in the high-use group. There were a number of residents who reported severe grief, high emotional impact, and low coping strategies. This highlights the need for interventions such as debriefing after CPR or formal training in residency programs in dealing with emotional burden to counteract maladaptive coping behaviors and prevent negative outcomes.

Keywords: residents, grief, emotional impact, coping, patient death

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Authors: Mahzabin Afroz, Indubhushan Patnaikuni, Srikanth Venkatesan

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It is well-known that fly ash can be used in high volume as a partial replacement of cement to get beneficial effects on concrete. High volume fly ash (HVFA) concrete is currently emerging as a popular option to strengthen by fiber. Although studies have supported the use of fibers with fly ash, a unified model along with the incorporation into finite element software package to estimate the maximum flexural loads need to be developed. In this study, nonlinear finite element analysis of steel fiber reinforced high strength HVFA concrete beam under static loadings was conducted to investigate their failure modes in terms of ultimate load. First of all, the experimental investigation of mechanical properties of high strength HVFA concrete was done and validates with developed numerical model with the appropriate modeling of element size and mesh by ANSYS 16.2. To model the fiber within the concrete, three-dimensional random fiber distribution was simulated by spherical coordinate system. Three types of high strength HVFA concrete beams were analyzed reinforced with 0.5, 1 and 1.5% volume fractions of steel fibers with specific mechanical and physical properties. The result reveals that the use of nonlinear finite element analysis technique and three-dimensional random fiber orientation exhibited fairly good agreement with the experimental results of flexural strength, load deflection and crack propagation mechanism. By utilizing this improved model, it is possible to determine the flexural behavior of different types and proportions of steel fiber reinforced HVFA concrete beam under static load. So, this paper has the originality to predict the flexural properties of steel fiber reinforced high strength HVFA concrete by numerical simulations.

Keywords: finite element analysis, high volume fly ash, steel fibers, spherical coordinate system

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Authors: Hubert Feiglstorfer

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Due to its location in a transition zone from the Pannonian to the pre-Alpine region, the east of Austria shows a small-scale diversity in the regional development of certain vernacular building techniques. In this article the relationship between natural building material resources, topography and climate will be examined. Besides environmental preconditions, social and economic historical factors have developed different construction techniques within certain regions in the Weinviertel and Burgenland, the two eastern federal states of Austria. But even within these regions, varying building techniques were found, due to the locally different use of raw materials like wood, stone, clay, lime, or organic fibres. Within these small-scale regions, building traditions were adapted over the course of time due to changes in the use of the building material, for example from wood to brick or from wood to earth. The processing of the raw materials varies from region to region, for example as rammed earth, cob, log, or brick construction. Environmental preconditions cross national borders. For that reason, developments in the neighbouring countries, the Czech Republic, Slovakia, Hungary and Slovenia are included in this analysis. As an outcome of this research a map was drawn which shows the interrelation between locally available building materials, topography, climate and local building techniques? As a result of this study, which covers the last 300 years, one can see how the local population used natural resources very sensitively adapted to local environmental preconditions. In the case of clay, for example, changes of proportions of lime and particular minerals cause structural changes that differ from region to region. Based on material analyses in the field of clay mineralogy, on ethnographic research, literature and archive research, explanations for certain local structural developments will be given for the first time over the region of East Austria.

Keywords: European crafts, material culture, architectural history, earthen architecture, earth building history

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Authors: Melkamu A., Woldu B., Sitotaw C., Seyoum M., Aynalem M.

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Background: Liver disease is any condition that affects the liver cells and their function. It is directly linked to coagulation disorders since most coagulation factors are produced by the liver. Therefore, this study aimed to assess the magnitude and associated factors of coagulation abnormalities among liver disease patients. Methods: A cross-sectional study was conducted from August to October 2022 among 307 consecutively selected study participants at the University of Gondar Comprehensive Specialized Hospital. Sociodemographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 2.7 mL of venous blood was collected and analyzed by the Genrui CA51 coagulation analyzer. Data was entered into Epi-data and exported to STATA version 14 software for analysis. The finding was described in terms of frequencies and proportions. Factors associated with coagulation abnormalities were analyzed by bivariable and multivariable logistic regression. Result: In this study, a total of 307 study participants were included. Of them, the magnitude of prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) were 68.08% and 63.51%, respectively. The presence of anemia (AOR = 2.97, 95% CI: 1.26, 7.03), a lack of a vegetable feeding habit (AOR = 2.98, 95% CI: 1.42, 6.24), no history of blood transfusion (AOR = 3.72, 95% CI: 1.78, 7.78), and lack of physical exercise (AOR = 3.23, 95% CI: 1.60, 6.52) were significantly associated with prolonged PT. While the presence of anaemia (AOR = 3.02; 95% CI: 1.34, 6.76), lack of vegetable feeding habit (AOR = 2.64; 95% CI: 1.34, 5.20), no history of blood transfusion (AOR = 2.28; 95% CI: 1.09, 4.79), and a lack of physical exercise (AOR = 2.35; 95% CI: 1.16, 4.78) were significantly associated with abnormal APTT. Conclusion: Patients with liver disease had substantial coagulation problems. Being anemic, having a transfusion history, lack of physical activity, and lack of vegetables showed significant association with coagulopathy. Therefore, early detection and management of coagulation abnormalities in liver disease patients are critical.

Keywords: coagulation, liver disease, PT, Aptt

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Authors: Hadeel Seraj, Mohammed Khoshhal, Mustafa Alhamoud, Hassan Alhashim, Anas Alsaif, Amro Abukhashabah

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Central serous chorioretinopathy (CSCR) is an idiopathic retinal disease characterized by localized serous detachment of the neurosensory retina at the macula. To date, there is no high-quality evidence of recent updates on treating acute CSCR, focusing on photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF). Hence, this review aims to systematically review the latest treatment strategies for acute CSCR. Methodology: The following electronic databases were used for a comprehensive and systematic literature review: MEDLINE, EMBASE, and Cochrane. In addition, we analyzed studies comparing PDT with placebo, anti-VEGF with placebo, or PDT with anti-VEGF in treating acute CSC eyes with no previous intervention. Results: Seven studies were included, with a total of 292 eyes. The overall positive results were significantly higher among patients who received PDT compared to control groups (OR = 7.96, 95% CI, 3.02 to 20.95, p < 0.001). The proportions of positive results were 81.0% and 97.1% among patients who received anti-VEGF and PDT, respectively, with no statistically significant differences between the groups. In addition, there were no significant differences between anti-VEGF and control groups. In contrast, PDT was significantly associated with lower recurrence odds than the control groups (OR = 0.12, 95% CI, 0.04 to 0.39, p = 0.042). Conclusion: According to our findings, PDT showed higher positive results than Anti-VEGF in acute CSCR. In addition, PDT was significantly associated with a lower recurrence rate than the control group. However, the analysis needs to be confirmed and updated by large-scale, well-designed RCTs.

Keywords: central serous chorioretinopathy, Acute CSCR, photodynamic therapy, anti-vascular endothelial growth factor

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Authors: Shirko Ahmadi, Ahmad Fallahi, Marco C. Uchida, Gustavo L. Gutierrez

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The aims of the present study are to assess and compare the health habits and quality of life (QoL) of Iranian amateur athletes in different sports. A total of 120 male amateur athletes between 17 and 31 years, engaged in 16 kinds of sports which include team (n=44), individual (n=40) and combat sports (n=36) from sports clubs in the west cities of Iran; and also those not involved in any competition in the past. Additionally, this is a cross-sectional, descriptive observational study, which the subjects completed the WHOQOL-brief questionnaire to evaluate QoL. The questionnaire is composed of 26 questions in four domains (physical health, psychological, social and environmental domains), that was applied in the Persian language. Information on the frequency and duration of training sessions were also collected. The Shapiro-Wilk test was used to verify normal distribution, followed by the chi-squared test for proportions and simple analysis of variance for comparisons between groups of sports. Pearson’s correlation was used to assess the relationships between the variables analyzed. According to the findings, those from individual sports obtained highest points in the all domains of QoL; physical domains (87.1 ± 8.1 point), psychological domains (87.6 ± 9.6 point), social domains (89.7 ± 9.2 point), environmental domains (75.5± 10.7 point) and overall QoL score (84.9 ± 9.4 point). Generally, social domains were the highest QoL index (84.3 ± 7.2 points), and environmental domains were the lowest QoL index (68.1 ± 10.8 points), in all of the sports. No correlations were found between QoL domains and time engaged in the sport (r = 0.01; p = 0.93), number of weekly training sessions (r = 0.09; p = 0.37) and session duration (r = -0.06; p= 0.58). Comparison of QoL results with those of the general population revealed higher levels in the physical and psychological components of amateur athletes. In the present study, engaging in sports was associated with higher QoL levels in amateur athletes, particularly in the physical and psychological domains. Moreover, correlations were found between the overall score and domains of QoL.

Keywords: amateur, domains, Iranian, quality of life

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Authors: M. C. Muya, L. J. Erasmus

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Twenty four new born male Holstein calves were divided into two treatments groups and used to evaluate the effects of M. elsdenii NCIMB 41125. The first groups were dosed with 50 ml containing 108 CFU/mL of M. elsdenii NCIMB 41125 (Me) and the control calves were not dosed. Within each of the two treatments groups, calves were divided into three treatment groups (Not dosed: 7 d, 14 d and 21 d vs dosed Me 7 d, Me14 and Me21 d (treatments), each groups contained 4 calves within which two calves were euthanized at 24 h and two calves at 72 h. Calves entered the trial until euthanize at whether 24 or 72 H after dosing time. After receiving colostrum for 3 consecutive days after birth, calves were fed whole milk and had free access to a commercial calf starter pellet and fresh water. Fecal grab samples were taken from each calf in duplicate +24 h or +72 h relative to dosing. Immediately after euthanizing, the digestive tract was harvested, and duplicate rumen and colon digesta samples collected for VFA’s determination and DNA extraction for bacteria count using 16s RNA PCR probe technique. Independent two t-test was performed to compare mean volatile fatty acids. Mixed-effects linear regressions were performed to establish relationships between: 1) M. elsdenii and Me, and between VFA’s and Me using SAS (2009). M. elsdenii NCIMB 41125 was detected in the faeces, colon and rumen of dosed calves at both +24H and +72H and ranged from 1.6 x 106 to 4.9 x 109 cfu/ml, indicating its potential to colonize in the digestive tract of calves. There was a strong positive relationship (R²=0.96; P < 0.0001) between M. elsdenii NCIMB 41125 and M. elsdenii population (cfu/ml) in the rumen, suggesting that the increase in M. elsdenii was due to increased M. elsdenii NCIMB 41125. An increase in butyrate was observed from +24 h to +72 h when calves were dosed on both d 7 and 14. Results showed that Me presented a positive relationship with butyrate (P < 0.001, R² = 0.43) and a concomitant negative relationship with acetate (P = 0.017, R² = -0.33). These results suggest that dosing pre-weaned dairy calves with M. elsdenii NCIMB 41125 has the potential to alter ruminal VFA production through increasing proportions of butyrate at the expense of propionate.

Keywords: calves, megasphaera elsdenii, rumen fermentation, bacteria

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Authors: Margaret Elaine J. Villamayor, Lobert A. Padua, Neil S. Bacaltos, Virgilio P. Bañez

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Significance: This study aimed to determine the prevalence of Hepatobiliary Tuberculosis (HBTB) with biliary obstruction and to compare the outcomes of ERCP versus PTBD in these patients. Methodology: This is a cross-sectional study involving patients from PGH who underwent biliary drainage from HBTB from January 2009 to June 2014. HBTB was defined as having evidence of TB (culture, smear, PCR, histology) or clinical diagnosis with the triad of jaundice, fever, and calcifications on imaging with other causes of jaundice excluded. The primary outcome was successful drainage and secondary outcomes were mean hospital stay and complications. Simple logistic regression was used to identify factors associated with success of drainage, z-test for two proportions to compare outcomes of ERCP versus PTBD and t-test to compare mean hospital stay post-procedure. Results: There were 441 patients who underwent ERCP and PTBD, 19 fulfilled the inclusion criteria. 11 underwent ERCP while 8 had PTBD. There were more successful cases in PTBD versus ERCP but this was not statistically significant (p-value 0.3615). Factors such as age, gender, location and nature of obstruction, vices, coexisting pulmonary or other extrapulmonary TB and presence of portal hypertension did not affect success rates in these patients. The PTBD group had longer mean hospital stay but this was not significant (p-value 0.1880). There were no complications reported in both groups. Conclusion: HBTB comprises 4.3% of the patients undergoing biliary drainage in PGH. Both ERCP and PTBD are equally safe and effective in the management of biliary obstruction from HBTB.

Keywords: cross-sectional, hepatobiliary tuberculosis, obstructive jaundice, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage

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Authors: Vibha Venkataramu, B. V. Venkatarama Reddy

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Natural river sand is the most preferred choice as fine aggregate in masonry mortars. Uncontrolled mining of sand from riverbeds for several decades has had detrimental effects on the environment. Several countries across the world have put strict restrictions on sand mining from riverbeds. However, in countries like India, the huge infrastructural boom has made the local construction industry to look for alternative materials to sand. This study aims at understanding the suitability of granulated blast furnace slag (GBS) as fine aggregates in masonry mortars. Apart from characterising the material properties of GBS, such as particle size distribution, pH, chemical composition, etc., of GBS, tests were performed on the mortars with GBS as fine aggregate. Additionally, the properties of five brick tall, stack bonded masonry prisms with various types of GBS mortars were studied. The mortars with mix proportions 1: 0: 6 (cement: lime: fine aggregate), 1: 1: 6, and 1: 0: 3 were considered for the study. Fresh and hardened properties of mortar, such as flow and compressive strength, were studied. To understand the behaviour of GBS mortars on masonry, tests such as compressive strength and flexure bond strength were performed on masonry prisms made with a different type of GBS mortars. Furthermore, the elastic properties of masonry with GBS mortars were also studied under compression. For comparison purposes, the properties of corresponding control mortars with natural sand as fine aggregate and masonry prisms with sand mortars were also studied under similar testing conditions. From the study, it was observed the addition of GBS negatively influenced the flow of mortars and positively influenced the compressive strength. The GBS mortars showed 20 to 25 % higher compressive strength at 28 days of age, compared to corresponding control mortars. Furthermore, masonry made with GBS mortars showed nearly 10 % higher compressive strengths compared to control specimens. But, the impact of GBS on the flexural strength of masonry was marginal.

Keywords: building materials, fine aggregate, granulated blast furnace slag in mortars, masonry properties

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Authors: Raymond Puijk, Rachid Rassir, Inger N. Sierevelt, Anneke Spekenbrink-Sporen, Bart G. C. W. Pijls, Rob G. H. H. Nelissen, Peter A. Nolte

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Background: Among uncemented total knee arthroplasty (TKA), a wide variety of metal surface structures (MSS) and coatings exist to enhance implants' biological properties (i.e., bone ingrowth). This study explores the variety of MSS-coating combinations and compares their mid-long-term survivorships with cemented TKAs, by using data from the Dutch Arthroplasty Register. Methods: A total of 235,500 cemented and 11,132 uncemented primary TKAs with a median follow-up of 5.1 years were included. MSS-coating combinations were (1) Porous-uncoated (n=8986), (2) Beaded-hydroxyapatite (HA)(n=1093), (3) Matte-uncoated (n=846), (4) Matte-Titanium-nitride (TiN) (n=207). Five- and 10-year revision-free survival for all-cause revisions, and aseptic loosening of the tibial component, were calculated and compared by using Kaplan-Meier, Log-rank tests, and multivariable Cox proportional hazard regression analyses. Results: Ten-year survival rates with all-cause revisions as an endpoint, were 94.2% for cement, and 94.7%, 96.3%, 92.1%, and 79.0% for porous-uncoated, beaded-HA, matte-uncoated, and Matte-TiN, respectively (p<0.01). Rates for aseptic loosening were 98.8% for cemented, and 98.7%, 99.8%, 97.2%, and 94.9% for the uncemented, respectively (p<0.01).The beaded-HA implants were half the risk for an all-cause revision compared to cemented implants (p<0.01). Matte-uncoated and matte-TiN implants were at more risk of an all-cause revision than cemented implants (p=0.01, p<0.01). Proportions of revisions for aseptic loosening were comparable among most groups. Conclusion: Based on Dutch registry data, four main MSS-coating combinations among uncemented TKAs were found. survivorships for all-cause revisions and aseptic release differed widely between groups. Beaded-HA and porous-uncoated implants had the best survival rates among the uncemented TKAs and were non-inferior to the cemented TKAs.

Keywords: total knee arthroplasty, cement, uncemented, cementless;, metal surface structure, coating

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Authors: Precious Roselyn Obuobi

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Background: In Ghana, water-borne diseases remain a public health concern due to its impact. While marine pollution has been linked to outbreak of diseases especially in communities along the coast, associated risks such as oil spillage, marine debris, erosion, improper waste disposal and management practices persist. Objective: The study seeks to investigate sanitation practices that contribute to marine pollution in Prampram and the prevalence of selected water-borne diseases (diarrhea and typhoid fever). Method: This study used a descriptive cross-sectional design, employing the mix-method (qualitative and quantitative) approach. Twenty-two (22) participants were selected and semistructured questionnaire were administered to them. Additionally, interviews were conducted to collect more information. Further, an observation check-list was used to aid the data collection process. Secondary data comprising information on water-borne diseases in the district was acquired from the district health directorate to determine the prevalence of selected water-borne diseases in the community. Data Analysis: The qualitative data was analyzed using NVIVO® software by adapting the six steps thematic analysis by Braun and Clarke whiles STATA® version 16 was used to analyze the secondary data collected from the district health directorate. A descriptive statistic employed using mean, standard deviation, frequencies and proportions were used to summarize the results. Results: The results showed that open defecation and indiscriminate waste disposal were the main practices contributing to marine pollution in Prampram and its effect on public health. Conclusion: These findings have implications on public health and the environment, thus effort needs to be stepped up in educating the community on best sanitation practices.

Keywords: environment, sanitation, marine pollution, water-borne diseases

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Authors: Alemayehu Agizew Woldeamanuel, Mekonnen Maschal Tarekegn, Raj Mohan Balakrishina

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Composting is one of the conventional techniques adopted for organic waste management, but the practice is very limited in emerging cities despite the most of the waste generated is organic. This paper aims to examine the viability of composting for organic waste management in the emerging city of Addis Ababa, Ethiopia, by addressing the composting practice, quality of compost, and application of compost in urban agriculture. The study collects data using compost laboratory testing and urban farm households’ survey and uses descriptive analysis on the state of compost production and application, physicochemical analysis of the compost samples, and regression analysis on the urban farmer’s willingness to pay for compost. The findings of the study indicated that there is composting practice at a small scale, most of the producers use unsorted feedstock materials, aerobic composting is dominantly used, and the maturation period ranged from four to ten weeks. The carbon content of the compost ranges from 30.8 to 277.1 due to the type of feedstock applied, and this surpasses the ideal proportions for C:N ratio. The total nitrogen, pH, organic matter, and moisture content are relatively optimal. The levels of heavy metals measured for Mn, Cu, Pb, Cd and Cr⁶⁺ in the compost samples are also insignificant. In the urban agriculture sector, chemical fertilizer is the dominant type of soil input in crop productions but vegetable producers use a combination of both fertilizer and other organic inputs, including compost. The willingness to pay for compost depends on income, household size, gender, type of soil inputs, monitoring soil fertility, the main product of the farm, farming method and farm ownership. Finally, this study recommends the need for collaboration among stakeholders’ along the value chain of waste, awareness creation on the benefits of composting and addressing challenges faced by both compost producers and users.

Keywords: composting, emerging city, organic waste management, urban agriculture

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Authors: Muhammad Waheed Mushtaq, Shahid bashir, Atta Ur Rehman

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In the past decade, the growing demand for capital and the increased utilization of supercapacitors reflect advancements in energy-producing systems and energy storage devices. Metal oxides and ferrites have emerged as promising candidates for supercapacitors and batteries. In our current study, we synthesized Lithium manganese nanoferrite, denoted as LixMnxFe₂O₄, using the hydrothermal technique. Subsequently, we treated it with sodium dodecyl benzene sulphonate (SDBS) surfactant to create nanocomposites of Lithium manganese nano ferrite (LMFe) with poly pyrrole (LixMnxFe₂O₄-PPY). We employed Powder X-ray diffraction (XRD) to confirm the crystalline nature and spinel phase structure of LMFe nanoparticles, which exhibited a single-phase crystal structure, indicating sample purity. To assess the surface topography, morphology, and grain size of both synthesized LixMnxFe₂O₄ and LixMnxFe₂O₄-PPY, we used atomic force microscopy and scanning electron microscopy (SEM). The average particle size of pure ferrite was found to be 54 nm, while that of its nanocomposite was 71 nm. Energy dispersive X-ray (EDX) analysis confirmed the presence of all required elements, including Li, Mn, Fe, and O, in the appropriate proportions. Saturation magnetization (32.69 emu), remanence (Mr), and coercive force (Hc) were measured using a Vibrating Sample Magnetometer (VSM). To assess the electrochemical performance of the material, we conducted Cyclic Voltammetry (CV) measurements for both pure LMFe and LMFe-PPY. The CV results for LMFe-PPY demonstrated that specific capacitance decreased with increasing scan rate while the area of the current-voltage loop increased. These findings are promising for the development of supercapacitors and lithium-ion batteries (LIBs).

Keywords: lithium manganese ferrite, poly pyrrole, nanocomposites, cyclic voltammetry, cathode

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Authors: Redhouane Ghernaout, Amira Fredj, Boualem Remini

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Suspended sediment transport is a serious problem worldwide, but it is much more worrying in certain regions of the world, as is the case in the Maghreb and more particularly in Algeria. It continues to take disturbing proportions in Northern Algeria due to the variability of rains in time and in space and constant deterioration of vegetation. Its prediction is essential in order to identify its intensity and define the necessary actions for its reduction. The purpose of this study is to analyze the concentration data of suspended sediment measured at Wadi El-Abtal Hydrometric Station. It also aims to find and highlight regressive power relationships, which can explain the suspended solid flow by the measured liquid flow. The study strives to find models of artificial neural networks linking the flow, month and precipitation parameters with solid flow. The obtained results show that the power function of the solid transport rating curve and the models of artificial neural networks are appropriate methods for analysing and estimating suspended sediment transport in Wadi Mina at Wadi El-Abtal Hydrometric Station. They made it possible to identify in a fairly conclusive manner the model of neural networks with four input parameters: the liquid flow Q, the month and the daily precipitation measured at the representative stations (Frenda 013002 and Ain El-Hadid 013004 ) of the watershed. The model thus obtained makes it possible to estimate the daily solid flows (interpolate and extrapolate) even beyond the period of observation of solid flows (1985/86 to 1999/00), given the availability of the average daily liquid flows and daily precipitation since 1953/1954.

Keywords: suspended sediment, concentration, regression, liquid flow, solid flow, artificial neural network, modeling, mina, algeria

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Authors: Sara Santos, Cristina Saraiva, Sónia Saraiva

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The objective of this study was to evaluate the welfare of reared broilers using scoring systems at the slaughterhouse. The welfare of broilers from 70 different flocks was assessed in three different slaughterhouses, regarding 373043 animals, although not in equal proportions in each slaughterhouse due to the difference in the amount of flocks slaughtered per day because of different company size. Twenty-one flocks were evaluated in slaughterhouse A (30%), thirty in slaughterhouse B (42,9%) and nineteen in slaughterhouse C (27,1%). The parameters evaluated were feather cleanness, foot pad dermatitis, hock burn, breast burn and causes of carcass condemnation. Feather cleanness was scored into three classes: 0=clean; 1=moderately dirty and 2=dirty feathers. Foot pad dermatitis, hock burn and breast ulcer were graded in three classes: 0=no lesions, 1=moderate lesions and 2=severe lesions. Causes of carcass condemnation were divided into emaciation, ascites, colour alteration and febrile state, arthritis, aerosaculitis, dermatitis, peritonitis, myositis, cellulitis, extensive trauma and technopathies as mechanical trauma, insufficient bleeding and deficient plucking. Broilers evaluated had a body weight ranging between 0,909kg and 2,588kg (median 1,522kg) and age between 25 days and 45 days (median 33 days). Rejection rate of flocks ranged between 0,1% and 10,48% (median 1,4029%) and footpad dermatitis total score between 2 and 197, resulting in 20 flocks presenting moderate lesions and 15 flocks with severe lesions. Moderate hock burn was associated with severe foot pad dermatitis and with breast burn. The associations between these lesions suggest that the development of contact dermatitis is caused by a common cause, the prolonged contact with litter of poor quality. In conclusion, contact dermatitis lesions, mostly foot pad dermatitis, feather hygiene conditions and rejection rate were the main restrictions of good welfare and considered important indicators for the follow-up on the farm conditions.

Keywords: broiler, dermatitis, welfare, slaughterhouse

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Authors: Mohamed Karodia

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Accountancy as a subject is one of the sciences that for many years has been perceived as a difficult subject to study and teach. Yet, it continuously attracts scholars graduating from school and entering Higher Education Institutions as a subject of choice and career. The teaching and learning of this subject have not been easy and has evolved and progressed over the past few decades however students still find it difficult to study and this has resulted in poor student achievement. In search of solutions, this study has considered the effect and efficacy that study skills have on the performance of Accountancy students and in particular students studying Second Year Diploma in Accountancy at the University of Johannesburg. These students appear to have a lack of appropriate study skills and as a result of these impacts on their performance in the courses, they are studying. This study also focuses on strategies to enhance Second Year Diploma Accountancy students’ academic performance. A literature review was conducted to investigate what scholarly literature suggests about study skills, in general, and in particular for Accountancy to be successful. In order to determine what study skills Second Year Accountancy students are applying when they learn and why they are failing the Accountancy examinations and formal class tests, the study adopted the quantitative research method. A questionnaire addressing various aspects of study skills, studying accountancy and studying, in general, was provided to 800 students studying Second Year Diploma in Accountancy at the University of Johannesburg’s Soweto Campus. The quantitative data collected were analyzed using descriptive statistics in the form of proportions, frequencies, means, and standard deviations, t-tests to compare differences between two groups as well as correlations between variables. Based on the findings of this study, it is recommended that students are provided with courses in time management, procrastination, reading, note taking and writing, test preparation techniques as well as study attitude. Lecturers spend more time teaching students how to study in general as well as accountancy specifically preferably at the first-year level before proceeding to the second year. It is also recommended that the University implements a study skills course to assist the students with studying.

Keywords: accountancy, skills, strategies, study

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Authors: D. Díaz Fernández, I. Csízi, K. Pető, G. Nagy

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An outstanding part of the animal products are based on the grasslands, due to the fact that the grassland ecosystems can be found all over the globe. In places where economical and successful crop production cannot be managed, the grassland based animal husbandry can be an efficient way of food production. In addition, these ecosystems have an important role in carbon sequestration, and with their rich flora – and fauna connected to it – in conservation of biodiversity. The protection of nature, and the sustainable agriculture is getting more and more attention in the European Union, but, looking at the consumers’ needs, the production of healthy food cannot be neglected either. Because of these facts, the effects of two specific composts - which are officially authorized in organic farming, in Agri-environment Schemes and Natura 2000 programs – on grass yields and sward compositions were investigated in a field trial. The investigation took place in Hungary, on a natural grassland based on solonetz soil. Three rates of compost (10 t/ha, 20 t/ha, 30 t/ha) were tested on 3 m X 10 m experimental plots. Every treatment had four replications and both type of compost had four-four control plots too, this way 32 experimental plots were included in the investigations. The yield of the pasture was harvested two-times (in May and in September) and before cutting the plots, measurements on botanical compositions were made. Samples for laboratory analysis were also taken. Dry matter yield of pasture showed positive responses to the rates of composts. The increase in dry matter yield was partly due to some positive changes in sward composition. It means that the proportions of grass species with higher yield potential increased in ground cover of the sward without depressing out valuable native species of diverse natural grasslands. The research results indicate that the use of organic compost can be an efficient way to increase grass yields in a sustainable way.

Keywords: compost application, dry matter yield, native grassland, sward composition

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Authors: Sisay Tiroro Salato

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Background: Ethiopia has been implementing the maternal death surveillance and response system to provide real-time actionable information, including causes of death and contributing factors. Analysis of maternal mortality surveillance data was conducted to identify the causes and underlying factors in Addis Ababa, Ethiopia. Methods: We carried out a retrospective surveillance data analysis of 324 maternal deaths reported in Addis Ababa, Ethiopia, from 2017 to 2021. The data were extracted from the national maternal death surveillance and response database, including information from case investigation, verbal autopsy, and facility extraction forms. The data were analyzed by computing frequency and presented in numbers, proportions, and ratios. Results: Of 324 maternal deaths, 92% died in the health facilities, 6.2% in transit, and 1.5% at home. The mean age at death was 28 years, ranging from 17 to 45. The maternal mortality ratio per 100,000 live births was 77for the five years, ranging from 126 in 2017 to 21 in 2021. The direct and indirect causes of death were responsible for 87% and 13%, respectively. The direct causes included obstetric haemorrhage, hypertensive disorders in pregnancy, puerperal sepsis, embolism, obstructed labour, and abortion. The third delay (delay in receiving care after reaching health facilities) accounted for 57% of deaths, while the first delay (delay in deciding to seek health care) and the second delay (delay in reaching health facilities) and accounted for 34% and 24%, respectively. Late arrival to the referral facility, delayed management after admission, andnon-recognition of danger signs were underlying factors. Conclusion: Over 86% of maternal deaths were attributed by avoidable direct causes. The majority of women do try to reach health services when an emergency occurs, but the third delays present a major problem. Improving the quality of care at the healthcare facility level will help to reduce maternal death.

Keywords: maternal death, surveillance, delays, factors

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