Risk factors for lymphatic filariasis and mass drug administration non‑participation in Mandalay Region, Myanmar

Background Myanmar commenced a lymphatic filariasis (LF) elimination programme in 2000. Whilst the country has made considerable progress since then, a number of districts have demonstrated persistent transmission after many rounds of mass drug administration (MDA). The causes of unsuccessful MDA have been examined elsewhere; however, there remains little information on the factors that contribute in Myanmar. Methods We conducted an analysis of factors associated with persistent infection, LF-related hydrocoele and MDA participation in an area with ongoing transmission in 2015. A cross-sectional household survey was undertaken in 24 villages across four townships of Mandalay Region. Participants were screened for circulating filarial antigen (CFA) using immunochromatographic tests and, if positive, for microfilaria by night-time thick blood slide. Individuals 15 year and older were assessed for filariasis morbidity (lymphoedema and, if male, hydrocoele) by ultrasound-assisted clinical examination. A pre-coded questionnaire was used to assess risk factors for LF and for non-participation (never taking MDA). Significant variables identified in univariate analyses were included in separate step-wise multivariate logistic regressions for each outcome. Results After adjustment for covariates and survey design, being CFA positive was significantly associated with age [odds ratio (OR) 1.03, 95% CI 1.01–1.06), per year], male gender (OR 3.14, 1.27–7.76), elevation (OR 0.96, 0.94–0.99, per metre) and the density of people per household room (OR 1.59, 1.31–1.92). LF-related hydrocoele was associated with age (OR 1.06, 1.03–1.09, per year) and residing in Amarapura Township (OR 8.93, 1.37–58.32). Never taking MDA was associated with male gender [OR 6.89 (2.13–22.28)] and age, particularly in females, with a significant interaction term. Overall, compared to those aged 30–44 years, the proportion never taking MDA was higher in all age groups (OR highest in those  60 years, ranging from 3.37 to 12.82). Never taking MDA was also associated with residing in Amarapura township (OR 2.48, 1.15–5.31), moving to one’s current village from another (OR 2.62, 1.12–6.11) and ever having declined medication (OR 11.82, 4.25–32.91). Decreased likelihood of never taking MDA was associated with a higher proportion of household members being present during the last MDA round (OR 0.16, 0.03–0.74) and the number visits by the MDA programme (OR 0.69, 0.48–1.00). Conclusions These results contribute to the understanding of LF and MDA participation-related risk factors and will assist Myanmar to improve its elimination and morbidity management programmes

Retention and mortality outcomes from a community-supported public–private HIV treatment programme in Myanmar

Introduction: There is a growing interest in the potential contribution the private sector can make towards increasing access to antiretroviral therapy (ART) in low- and middle-income settings. This article describes a public–private partnership that was developed to expand HIV care capacity in Yangon, Myanmar. The partnership was between private sector general practitioners (GPs) and a community-based non-governmental organization (International HIV/AIDS Alliance). Methods: Retrospective analysis of 2119 patient records dating from March 2009 to April 2015 was conducted. Outcomes assessed were immunological response, loss to follow-up, all-cause mortality, and alive and retained in care. Follow-up time was calculated from the date of registration to the date of death, loss to follow-up, transfer out, or if still alive and known to be in care, until April 2015. Cox proportional hazards model was used to identify predictors of loss to follow-up and mortality. Kaplan–Meier survival analysis was used to estimate survival function of being alive and retained in care. Results: The median number of patients for each of the 16 GPs was 42 (interquartile range (IQR): 25–227), and the median follow-up period was 13 months. The median patient age was 35 years (IQR: 30–41); 56.6% were men, 62 and 11.8% were in WHO Stage III and Stage IV at registration, respectively; median CD4 count at registration was 177 cells/mm3; and 90.7% were on ART in April 2015. The median CD4 count at registration increased from 122 cells/mm3 in 2009 to 194 cells/mm3 in 2014. Among patients on ART, CD4 counts increased from a median of 187 cells/mm3 at registration to 436 cells/mm3 at 36 months. The median time to initiation of ART among eligible patients was 29 days, with 93.8% of eligible patients being initiated on ART within 90 days. Overall, 3.3% patients were lost to follow-up, 4.2% transferred out to other health facilities, and 8.3% died during the follow-up period. Crude mortality rate was 48.6/1000 person-years; 42% (n=74) of deaths occurred during the pre-ART period and 39.8% (n=70) occurred during the first six months of ART. Of those who died during the pre-ART period, 94.5% were eligible for ART. In multivariate regression, baseline CD4 count and ART status were independent predictors of mortality, whereas ART status, younger age and patient volumes per provider were predictors of loss to follow-up. Probability of being alive and retained in care at six months was 96.8% among those on ART, 38.5% among pre-ART but eligible patients, and 20.0% among ART-ineligible patients. Conclusions: Effectively supported private sector GPs successfully administered and monitored ART in Myanmar, suggesting that community-supported private sector partnerships can contribute to expansion of HIV treatment and care capacity. To further improve patient outcomes, early testing and initiation of ART, combined with close clinical monitoring and support during the initial periods of enrolling in treatment and care, are required

Numerical Solutions for the Composite Fractional Oscillation Equation by Using Fractional Difference Method

In this paper, Grünwald-Letnikov fractional derivatives, Riemann-Liouville fractional derivatives and Caputo fractional derivatives are introduced. The fractional difference method is applied for solving linear ordinary fractional differential equations of fractional order α . This method can be used for obtaining approximate solutions of fractional differential equations in different types. The composite fractional oscillation equation (1 α 2) is solved by using this method

Embodied carbon emissions of buildings: Taking a step towards net zero buildings

As global concerns about climate change and environmental sustainability escalate, the construction industry is shifting significantly towards eco-resilient and sustainable building practices. This paper comprehensively explores integrating Building Information Modelling (BIM) with eco-resilient principles to create a framework for designing and constructing sustainable buildings. This research introduced a practical approach for evaluating the embodied carbon from building construction, drawing insights from a residential building in Yangon City, Myanmar. The method developed in this study aims to assess the carbon footprints associated with distinct stages of the construction process, including raw material production and material transportation. Additionally, the proposed method compares the material embodied carbon, transportation embodied carbon, and total cost in the residential building, considering two cases of traditional and low-carbon materials. The results indicate that material embodied carbon contributes merely 84% to the overall, while material transportation makes up the remaining 16% for both cases. Utilising low-carbon materials yields remarkable reductions, with a 40% decrease in material embodied carbon and a 39% decrease in transportation carbon footprint compared to conventional materials. However, adopting low-carbon materials incurs a modest increase of approximately 6.7% in total cost. This study underscores the imperative of integrating low-carbon materials into the design of future passive buildings, advancing the pursuit of a net-zero strategy. This research underlines the potential for BIM-driven eco-resilient practices in mitigating carbon emissions and the need for continued innovation and collaboration in sustainable building design and construction

Audio Classification in Speech and Music by using Neural Network: Multilayer Perceptron

Audio classification can be used in many different applications. Rapid increase in the amount of audio data demands for an efficient method to automatically segment or classify audio stream based on its content. This paper focuses the attention on audio classification in music and speech. This audio classification system consists of three processing stages: feature extraction, training and classification. Spectral flux, short time energy and cepstrum coefficient are used to classify input audio into two types: speech and music. In this paper, single type of audio classification system is based on Multilayer Perceptron (MLP) neural network. Back propagation algorithm is used to perform training process. Simulation results are also included in this paper. It can classify audio files combining speech and music

Computerized Tutorial Testing System

This paper is a software project that is tends to test the student's learning capability. The system consists of three question types such as true/false, fill in the blanks and multiple choices. This system helps first year through adult students' independently master basic skills in their courses. When the student submits the answers, they can see their score and right answers. This system provides to support for any paper of any subject by changing the questions of the respective papers

A contemporary understanding of organizational climate in healthcare setting: A concept analysis

AIM: The overarching objective of this report is to provide an updated definition of the concept of organizational climate and to strengthen its operational application. BACKGROUND: Organizational climate is one of the major contributing factors to the exodus of the nursing workforce from the profession. Extensive research has addressed the impact of organizational climate on the nursing workforce; yet variations in the interpretation of the concept calls for an updated definition. DESIGN: Walker and Avant\u27s strategy was implemented. DATA SOURCE: Data were compiled from Medline and CINAHL, Google search engine, and book chapters. REVIEW METHOD: A comprehensive and detailed review of the literature was performed. Nineteen historic publications (1939-2012) and 39 healthcare-related publications (2013-2018) were included in the final review. RESULTS: The climate of an organization reflects a set of core values and behaviors that can be used to implement evidence-based leadership and management within the context of the 21st century. We have revised the definition of organizational climate to capture this context. CONCLUSION: The perception of a supportive and constructive climate in an organization propels the workforce, independent of ethnic or personal background, to a higher level of productivity and encourages loyalty and workforce stability

The prevalence of lymphatic filariasis infection and disease following six rounds of mass drug administration in Mandalay Region, Myanmar.

Lymphatic filariasis is widely endemic in Myanmar. Despite the establishment of an elimination program in 2000, knowledge of the remaining burden of disease relies predominantly on programmatic information. To assist the program, we conducted an independent cross-sectional household cluster survey to determine the prevalence of filariasis infection, morbidity and mass-drug administration coverage in four townships of the Mandalay Region: Amarapura, Patheingyi, Tada-U and Wundwin. The survey included 1014 individuals from 430 randomly selected households in 24 villages. Household members one year and older were assessed for antigenaemia using immunochromatographic test cards and if positive, microfilaraemia by night-time thick blood smear. Participants 15 years and older were assessed for filariasis morbidity by ultrasound-assisted clinical examination. The overall prevalence of infection was 2.63% by antigenaemia (95% confidence interval (CI) 1.71-4.04%) and 1.03% by microfilaraemia (95%CI 0.59-1.47%). The prevalence of hydrocoele in adult males was 2.78% (95%CI 1.23-6.15%) and of lymphoedema in both genders was 0% (95%CI 0-0.45%). These results indicate the persistence of filarial infection and transmission despite six rounds of annual mass drug administration and highlight the need for further rounds as well as the implementation of morbidity management programs in the country

Schematic representation of <i>bab</i> genotyping by PCR.

<p><b>A</b>- Genomic location of locus marker genes and <i>bab</i> genes in 26695. <b>B</b>- Locus A, Locus B and Locus C represents the three genomic loci where the <i>bab</i> genes are located. The annealing positions of locus specific forward primers are represented as forward arrows. Annealing positions of <i>bab</i> specific reverse primers are represented as backward arrows (26695 and Bhutan strain, BT-18 in which <i>bab</i>-genotype is similar to J99). <b>C</b>- The agarose-gel electrophoresis results showing the positive-bands for <i>bab</i> genes (<i>babA</i>, <i>babB</i> or <i>babC</i>) in respective locus in 26695 and BT-18 (similar to J99). The negative result for band in locus C shows the locus is empty (no <i>bab</i> gene at locus C in J99 or BT-18).</p