No abstract

The Middle East Respiratory Syndrome (MERS-CoV) is a potentially fatal respiratory viral infection that has had outbreaks in the Middle East and Asia region starting in 2012. As recent as 2015, MERS had outbreaks in South Korea, resulting in 36 deaths among 186 infected patients. The purpose of this thesis is to gain an in-depth understanding of how this viral infection behaves in outbreaks and how it is spread around the globe. To gain insight, real time analysis was performed under a case study methodology based on pooled data from the Ministry of Health & Welfare of South Korea. We calculated a striated mortality rate based on gender, age, and the presence of pre-existing health conditions ranging from heart, lung, and kidney diseases. We found that MERS outbreak follows the pattern of a point source outbreak, largely spurred by the patient-referral system under the universal healthcare system in South Korea. The purpose of this case is to discuss the benefits and challenges of such patient referral system, and to offer a possible solution in improving transparency between healthcare providers and the government under a universal healthcare system to prevent future outbreaks.

The current study has been undertaken to examine the beneficial effect in the power output of a microbial fuel cell (MFC) by adding cellulolytic bacteria Ruminococcus albus (R. albus) into the anodic chamber. Mediator-less H-type MFCs were set up where the anode chamber contained anaerobic digester microorganisms as inocula on finely ground pine tree (Avicel) at 2% (w/v) and the cathode chamber of 10mM phosphate buffered saline conductive solution, both separated by a cation exchange membrane. The functioning of the MFCs for generation of electrical power and the amounts of gaseous byproducts was monitored over a 9-day period. The addition of cellulolytic bacteria caused an increase of average power density from 7.9 m W/m 2 to19.5 m W/m 2 , about 245% increase over a 9-day period. For both groups of MFCs; with R. albus and the control, the head space gases collected were methane and CO 2 . While the methane: CO 2 ratios were found unchanged at 1.7:1 throughout the 9 days of operation, the total gas production increased from 248 mL to 319 mL due to the presence of R. albus addition. This study confirms that whereas the biocatalytic activity of anode microbial population determines the energy production, the addition of external cellulolytic bacteria into anode microbial population can improve and extend the biomass utilization.

To determine commonly used methods of contraception at Monkey Bay Community hospital, to compare different methods of contraception used by people of various age groups, parity, Human Immunodeficiency Virus (HIV) and Marital status, a clinical audit of family planning methods used by clients at Monkey Community hospital from January 2018 to June 2019 was done. Data was collected from the registers. A total number of 1734 clients reported at family planning clinic of Monkey-Bay Community Hospital between January 2018 and June 2019. All the clients were females. Most of these clients were in the age range of 15 -34 years (83.33%). There were 1,486 (87%) HIV negative clients, 208 (12%) HIV positive clients and 24 (1%) had unknown HIV status. Most clients had a parity of 1 -2 (905, 52.71%) followed by 3 -4 (540, 31.45%) and 5 or plus (272, 15.84%). There were more married people (1641, 97.23%) than unmarried ones (46, 2.73%). There was only one person who was divorced (1, 0.05%). Education status was not recorded. The five commonly used contraceptive methods were: Intramuscular (IM) injectable Depo-IM (1366, 79.51%), Jadelle (122, 7.10%), Subcutaneous (SC) injectable Depo-SC (65, 3.78%), Combined Oral Contraceptives (COC) (60, 3.49%) and Implanon (40, 2.33%). None of the clients was used female condoms as a method of contraception. The contraceptive use was common between the age group of 15 -24 (707, 44.92%) and 25 -34 (709, 45%). Depo-IM was most used in age group 25 -34 (44.5%) while Jadelle was mostly used by 15 -24 years old (48%). 1181 clients (79.5%) of HIV negative clients used Depo-IM as the contraceptive method while 164 clients (78.

The current study has been undertaken by studying the data from the hospital registers at the Kasugu District Hospital, Malawi. The malaria cases of 2014 were chosen for the study. They typically represent disease distribution based on the ages and genders of the patients. The data suggest that the cure rates among patients under age 5 and above do not have any significant difference, contrary to the commonly anticipated outcome that the older children should have better developed immune systems and should have higher cure rates. A notable point is there are huge dichotomies between genders in terms of the reported registered cases, the cure and mortality rates. The gender differentiation in the reporting and management of malaria is understood under the contemporary socio-cultural beliefs and economic realities of the Malawian society. This analysis has been carried out from a qualitative perspective, but with an attempt to identify a pattern from a year's length of statistical data.

Since the discovery of blood circulation and transfusion, there has been an insatiable demand for voluntary blood donations throughout the world. However, gathering blood donors has never been easy because eligible donors constitute only a fraction of the general population and are often reluctant to donate. This is especially challenging in underprivileged countries of sub-Saharan Africa such as Malawi whose nationally run blood transfusion service struggles to maintain hospital blood banks. As a result, hospitals turn to their local communities for directed donations. A retrospective analysis from January 2014 to June 2016 of directed blood donor data from two hospitals in the Kasungu District of Malawi was conducted. The analysis of 2134 donations was carried out with respect to sex, age, hemoglobin concentration, blood group, and presence of transfusion-transmissible infections. On average, donors were 30 years of age and predominately male. Blood group O+ constituted more than half of all directed blood donations. Ultimately, about one third of donations were unable to be utilized for transfusion.

Malawi has one of the highest rates of HIV prevalence in the world, and accounts for 4% of the total number of people living in sub-Saharan Africa with HIV. Approximately one million people in Malawi were living with HIV in 2016, with 24,000 HIV-related deaths. The Option B+ program, first implemented in Malawi, aimed to initiate ART for all pregnant women, regardless of their CD4 cell count or disease stage. This study serves to analyze and assess the effectiveness of Option B+ retention, in relation to the facilitation of how various social and cultural barriers were handled. A literature review of 29 publications was conducted. Careful evaluation of various studies indicates that although there is a myriad of reasons explaining low levels of retention, the women who were at the highest risk for low retention were young pregnant women who were treated on the same day of HIV-diagnosis. Solutions focused around women and their partners or communities showed promising evidence of success in increasing adherence, as these strategies likely provided women reliable social and emotional support to address major barriers to retention such as a lack of support from male partners, ineffective education from healthcare workers, or stigma towards their HIV disclosure statue.

Sub-Saharan Africa is faced with weak health systems and disproportionately inadequate number of health workers. Some studies have shown high vulnerability of these workers to occupational health infections from their patients. The COVID-19 pandemic which is spreading to the region and has affected the health work force in the west is likely to do the same in Sub-Saharan Africa. Non-availability or inadequate supply of good personal protective equipment (PPE) may become a disincentive to caring for the diagnosed cases and slow uptake for clinical research in the region. Slow manufacturing plans, poor supply chain and poor adherence by health workers could all contribute to the scarcity and effectiveness of PPE to the region if not well managed. Ensuring PPE are adequately available may be a big challenge for many of the poor countries in sub-Saharan Africa, but it is huddle that needs to be avoided for better uptake of clinical care and research.