Post on 25-Feb-2023
HIV/AIDS DIAGNOSTIC SYSTEM
BY
CHIICHII, ORSEER HOSEA
UE/18714/10
08033515694
A PROJECT WORK SUBMITTED TO THE
DEPARTMENT OF MATHEMATICS/STATISTICS/COMPUTER
SCIENCE,
UNIVERSITY OF AGRICULTURE, MAKURDI
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE AWARD OF A BACHELOR OF SCIENCE (B.Sc.)
DEGREE IN STATISTICS/COMPUTER SCIENCE
i
Declaration
I, CHIICHII ORSEER with registration number UE/18714/10
of the department of Mathematics/Statistics/Computer
Science, Federal university of Agriculture, Makurdi in Benue
State of Nigeria hereby declare that the dissertation
entitled HIV/AIDS Diagnostic System (HADS) is my research
work and has not formed the basis for award of degree in any
other university or higher institution of learning.
NAME OF STUDENT: CHIICHII ORSEER HOSEA
REGISTRATION NUMBER: UE/18714/10
SIGNATURE OF STUDENT: ………………………………….
DATE: ………………………………….
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Certification
This is to certify that the dissertation work entitled
HIV/AIDS Diagnostic System (HADS) is a bonafide research
work carried out by CHIICHII, ORSEER HOSEA with registration
number UE/18714/10 in the department of
mathematics/statistics/computer science, federal university
of agriculture, Makurdi, Benue state as part of the
requirements for the award of Bachelor of Science degree in
statistics/computer science
Title of Project: HIV/AIDS Diagnostic System
Mr. M.A AGANA ………………………
…….…………….. Project Supervisor
Signature Date
Dr. T ABOIYAR ….………………………
…….…………….. Head of Department
Signature Date
v
Prof M.A Tiamiyu …………………………
…………..……….. External Examiner
Signature Date
Dedication
I sincerely dedicate this work to God almighty who has
not only created and kept me alive till this day, but has
also given me the wisdom throughout my educational pursuit.
I also dedicate this research work to my guardian angels
Late M.W.O J.N Chiichii and Late Mrs N. Chiichii for
overseeing me right from my birth and not forsaking me even
in their absence as their inspiration keeps me going.
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Acknowledgement
With a joyful heart and gratitude to God I lack words
and space to appreciate all the contributors to the success
of not just this research work but my academic carrier,
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however I wish to mention but a few. My humble appreciation
goes to my family who even in the stormy weather of our
life’s have relentlessly provided for me in every way they
could until this day, I wish to say a big thank you to them
and hope God in his infinite mercy guide them all through. I
appreciate the efforts of all my close friends who have
pushed me and stayed beside me in my trial times, I also wish
to identify in person the likes of Mr Ekoja Peter and Miss
Akpa Nancy Suleyol.
To my Supervisors, Mr Agana M.A and Mr Onoja G.U, I lack
the right words to use for your competency, your joint effort
in monitoring my research work have been of great help to me
as I now derive joy performing research work despite my
previous hatred for research. To all the staff of the
department of mathematics/statistics/computer science federal
university of agriculture Makurdi, Benue state, I say keep
the flag flying, and to all those who I could not mention but
have however contributed to my academic pursuit, may God
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bless you all. I also cannot hide my sincere appreciation to
all the staff and volunteers of Positive Health Media
Initiative (PHMI), staffers of Aids Health Foundation (AHF)
and staffers of Centre for Integrated Health Program (CIHP),
my research work would have not been possible if not from the
knowledge generated from your respective organizations. At
this point, I acknowledge my team of programmers Mr Orapine
hycienth and Chiekieze Kelvin for their joint effort as a
team which made this project a success.
AbstractExpert system is a computer system that emulates the decision making ability of ahuman expert. That is, it acts in all respects like a human expert. It uses humanknowledge to solve problems that would require human intelligence. The expertsystem represents expertise knowledge as data or rules within the computer. Theserules and data can be called upon when needed to solve problems. HIV/AIDS is aknotty viral disease that is very common in the modern world. HIV/AIDS is a seriousdisease that affects the white blood cells directly. If left unchecked at the earlystage, it results to serious complications including death. Though the diseasecannot possibly be cured completely for the time being, it can be well managed orcontrolled and the patient can live a very healthy life. Early HIV/AIDS diagnosisplays a crucial role in HIV/AIDS control, and can prevent further medicalcomplications. This study presents the design and development of a medicalexpert system for HIV/AIDS disease and its support diagnosis, gives informationabout complications and acts as HIV/AIDS diagnosis trainer. It uses rule basedapproach to collect data and forward chaining inference technique. This systemprovides a user interactive, menu driven environment. Symptoms and risk factors
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associated with HIV/AIDS are taken as the basis of this study. In case of diagnosis,the system asks a bunch of questions about the symptoms and risk factorsthrough the expert system user to the person diagnosed, where the person gives ayes or no answer to perform risk analysis and a check on possible opportunisticinfections associated with the disease. According to the answers, the system givespercentage possibility and advice for laboratory test where final test result is thengiven out through a colour matching of the test result with some results availablein the deigned expert system. Persons diagnosed to be negative are then advisedthrough the expert system user on how to stay negative, while the personsdiagnosed positive of the virus are enrolled for collection of drugs so as to stayalive and healthy. The system is drawn up with PHP/MYSQL expert system buildingtool in Windows environment where all the knowledge are embedded for effectivedecision.
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TABLE OF CONTENTS
Declaration……………………………………………………………………….ii
Certification……………………………………………………………….……..iii
Dedication………………………………………………………………………..iv
Acknowledgement……………………………..…………………………………v
Abstract……………………………………………………………………..……vi
Table of Contents……………………………………………………………......vii
CHAPTER ONE: INTRODUCTION…………….…………………………........1
1.1 BACKGROUND OF THE STUDY…………………..……………………11.2 STATEMENT OF THE PROBLEM……………………………………….41.3 JUSTIFICATION OF THE STUDY………………….……………………61.4 AIMS AND OBJECTIVES OF THE STUDY……..……………………….71.5 SCOPE OF THE STUDY……………..……………………………………81.6 DEFINITIONS OF TERMS……………………………………………….10
CHAPTER TWO: LITERATURE REVIEW…………………………………….15
2.1 INTELLIGENT SYSTEM EVOLUTION……………………………........15
2.2 EXPERT SYSTEM………………………………………………...............17
2.3 EXPERT SYTEM COMPONENT……………………………………...…23
2.4 EXPERT SYSTEM IN MEDICAL DIAGNOSIS……………………...….30
2.5 MEDICAL DIAGNOSIS SYSTEM……………………...………………..31
2.6 HIV/AIDS…………………………………………………………………33
2.7 DIAGNOSING HIV/AIDS……………………………………………..…35
2.8 VOLUNTARY COUNSELLING AND TESTING……………………….41
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2.9 DRUG PRESCRIPTION AND DISPENSAL…………………………….50
CHAPTER THREE: RESEARCH METHODOLOGY…………………………52
3.1 SYSTEM STUDY AND INVESTIGATION………………………….….52
3.2 DORMAIN AND KNOWLEDGE ACQUISITION…………………..…..56
3.3 KNOWLEDGE REPRESENTATION…………………………………….56
3.4 SYSTEM DEVELOPMENT AND SPECIFICATION……………………64
3.5 USER REQUIREMENTS……………………………………………....…65
3.6 SYSTEM DESIGN AND DEVELOPMENT PROCESS………………….65
3.7 DATABASE……………………………………………………………….73
3.8 DATA SECURITY………………………………………………………...74
CHAPTER FOUR: RESULTS, DISCUSSION AND CONCLUSION…………..75
4.1 DOCUMENTATION……………………………………………………...75
4.2 HARDWARE REQUIREMENTS…………………………………………75
4.3 INSTALLATION GUIDE…………………………………………………76
4.4 SYSTEM TESTING……………………………………………………….77
4.5 TRAINING…………………………………………………………………77
4.6 SYSTEM MAINTENANCE………………………………………………77
4.7 SYSTEM IMPLEMENTATION…………………………………………..78
4.8 SYSTEM SPECIFICATIONS……………………………………………..85
4.9 RESULTS AND DISCUSSION…………………………………………...90
4.10CONCLUSION……………………………………………………………90
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4.11RECOMMENDATIONS AND SUGGESTIONS…………………………91
REFERNCES…………………………………………………………………….93
APPENDIX:
APPEMDIX A: LIST OF TABLES AND FIGURES
LIST OF TABLES
APPENDIX:
APPENDIX A:
LIST OF TABLES AND FIGURES:
LIST OF TABLES
Table 4.0: HADS Database………….…………………………..………………....
Table 4.1: ADMIN Table.................................86
Table 4.2: STAFFS Table………………….……...…………………………….....87
Table 4.3: PATIENTS Table………………….…...………………………………87
Table 4.4: APPOINTMENT Table………………………………………………...87
Table 4.5: Detailed Module specification
Table…………………………………...89
LIST OF FIGURES
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Figure 2.1: Basic components of an expert system
……………………………….21
Figure 2.2: Expert system components and human
interface……………………..23
Figure 2.3: HIV positive, Negative and Invalid test result
with determine test kit..31
Figure 2.4:HIV positive, Negative and Invalid test result
with uni-gold test kit….32
Figure 2.5:HIV positive, Negative and Invalid test result
with stat-pak test kit…..33
Figure 2.6: Serial algorithm for HIV testing……………….
……………………...39
Figure 2.7: parallel algorithm for HIV testing……………………………….
……40
Figure 3.1:Hierachy of expert system
development……………………………….44
Figure 3.2:Modules of the proposed expert system for
HIV/AIDS diagnosis……..45
Figure 3.3:Domain and knowledge acquisition……………………………………48
Figure 3.4: System development procedure……………………………………….55
Figure 3.5: System flow chart……………………………………………………..58
Figure 3.6: Procedural flow of the system.. ……………..
………………………..59
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Figure 3.7: Procedural flow of the system.. ………………………..
……………..60
Figure 3.8:SQL Database management system as used in the
proposed system.…61
Figure 3.9:SQL Database management system as used in the
proposed system….61
Figure 4.1: Administrators page….…………………………….…..……………...66
Figure 4.2: Index (Home) page..…………………....…………………..…………68
Figure 4.3: Analysis page…………….………….....…….………………………..69
Figure 4.4: Risk analysis page………………..…….……………………………..69
Figure 4.5:Determine test page…….……….....………..…………………………70
Figure 4.6: Uni-Gold test page………..…..………….……………………………70
Figure 4.7: Stat-pak page…………….…………..….....…..………………………71
Figure 4.8:Positive test result page…………..….………...
……………………….71
Figure 4.9:Negative test result page…….………………..
………………………...72
Figure 4.10: Client Enrolment page…………………..……………………………72
APPENDIX B:
CODES……………………………………………………………………………..95
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CHAPTER ONE: INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The quality of service delivery all around the world is
continuously improved by the usage of computer-based
applications. These applications are mostly built based on
artificial intelligence which is the area of computer
science that focuses on the creation of machines that can
perform functions considered as intelligent by humans.
These functions performed by the machines are highly
sensitive and require knowledge in the domain where these
machines are designed to act as if originally, they are in
control of situations. The ability to create such machine
has intrigued humans since the advent of technology, and
today, with the introduction of computers and great
research of ages into the field of Artificial Intelligence
programming techniques, the production and design of smart
machines is becoming a reality as researchers can now build
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a system which can mimic human thought and understand human
behaviour via expert system technology (Nilsson, 1990).
An expert system is a computer application that
performs a task that would otherwise be performed by a
human expert, such tasks include but are not limited to
making financial forecast, scheduling routes for delivery
vehicles, diagnosing human illnesses, and several others.
Most expert systems are designed to take human place while
others are designed to aid humans. To design an expert
system, the domain of the knowledge field is required, so
an individual needs to be able to study how the human
expert makes decisions and translate the rules used into
terms that the computer would understand. Expert system is
an example of a symbolic paradigm being one of the two
major paradigms for developing intelligent systems in the
field of artificial intelligence
(http://www.webopedia.com/). To however get a detailed
xvii
understanding about expert systems, a brief history of
Artificial Intelligence is unavoidably necessary.
The quest for Artificial Intelligence is as modern as
the frontiers of computer science and as old as antiquity.
The concept of thinking machine began as early as 2500BC,
when the Egyptians looked to talking statues for mystical
advice (Haack, 2004). Artificial Intelligence as both a
term and a science was coined 120 years later, after the
operational digital computer had made debut. In 1956, Allen
Newell, J.C Shaw and Herbert Simon introduced the first
Artificial Intelligent program, the Logic Theorist to find
the basic equations of logic as defined in principia
mathematica by Bertrand Russell and Alfred North Whitehead.
For one of the equations, the Logic Theorist surpassed its
inventor’s expectations by finding a new and better proof.
Suddenly a true thinking machine that knew more than its
programmers evolved and lead to the development of another
system called the General Problem Solver (G.P.S). They were
xviii
developed to imitate human problem solving protocols
regardless of the information contained in the domain,
however, as time progressed they were said to be weak a
method as they covered weak information about their domain
of study which led to weak performance in problem solving
involving complex domains (Nilsson, 2009).
The foundation of Artificial Intelligence covers
several disciplines including but not restricted to
philosophy, mathematics, psychology, computer engineering
and linguistics. The connectionist paradigm evolved from a
model proposed on artificial neurons that mimics the
structure of human brain, the model was proposed in 1943 by
McColloch and pitts. The rise of Artificial Intelligence
continued as Feigenbaum and others at Stanford began the
heuristic programming project (HPP) to investigate other
problem domains that could benefit from the expert system
technology. By this the next major effort was in the area
of medical diagnosis, MYCIN was developed by Bruce Buchanan
xix
and Dr Edward Shortliffe to diagnose bacterial infection in
the blood using about 450 rules. MYCIN is the most widely
known expert system in the era of the growth of Artificial
Intelligence because of the two reasons below as coined
from (Feigenbaum and Buchanan, 1993)
I Its design was based on interviews with several
doctors that specialized in particular domains,
hence, it contains a number of heuristic rules used
in identifying certain infections by physicians.
II It lead to the later development of EMYCIN (Empty
MYCIN) which was the first expert/knowledge-based
system shell, the development time of EMYCIN was
considerably reduced as compared to MYCIN, the
researchers developed EMYCIN by taking all the
rules out of the system and leaving just an empty
shell in which other developers in other domains
can just plug in their knowledge base.
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From the dark ages also known as the birth of
Artificial Intelligence to the era of great expectations
also known as the rise of Artificial Intelligence, expert
systems have been providing pre-selected rules for decision
making within specialized domains of knowledge but are
limited by the fixed choice and by the date of the expert
opinion embodied in the decision rules. Expert systems have
been found to have profound impacts which include reducing
time of task from days to hours, minutes to seconds. The
benefits of expert system since this time include but are
however not limited to improved customer satisfaction,
improved quality of products and services, accurate and
consistent decision making. They operate in hazardous
environments where humans could be exposed to various risks;
expert systems have featured and make things easier in
various fields such as agriculture, education, manufacturing
industries, banking, medicine, and so on. In medicine,
diagnosis of patients’ complicated conditions, clinical
xxi
laboratory identification of bacterial infectious diseases
and recommendation of treatments, surgery, emergencies,
drugs and toxicology and dentistry are some of the domains
for expert system development. Expert systems emulate the
decision making ability of human experts, they are designed
to solve complex problems by reasoning about knowledge like
an expert, and not by following the procedure of a developer
as in the case in conventional programming (Meech, 2006).
1.2 STATEMENT OF THE PROBLEM
The continuous increase in population without a
corresponding increase in medical infrastructure has
brought about drastic limitations in health care sector,
this has made it necessary to think of designing an expert
system that can assist the health sector in the diagnosis
of HIV/AIDS. The idea of this system is backed by the
following facts which show how limited human expertise is
as compared to an expert system as coined from Juhola, et al.
( 1995);
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Human experts are inconsistent: As each day goes by,
human day to day decisions are rarely consistent, this
leads to invalid decision making in the field of HIV/AIDS
diagnosis, hence the idea of building an expert system that
can work consistently and continuously is deemed necessary.
Human experts die or retire: Human experts do not live
and work forever, they tend to retire with time and others
even die leading to a reduction in workforce.
Human experts are at times deliberately biased: A
diagnostic expert might tend to be deliberately partial in
releasing the result of a test so as to hide certain
information for selfish reasons.
Human experts do not process large amount of data
quickly:The procedure of diagnosis involves a number of
steps before results are made available, handling of this
data are often not easy for the human brain, but as the
computer is capable of handling large data in micro
seconds, the thought of a diagnostic system is necessary.
xxiii
Human expertise is very scarce: It takes considerable
amount of time to understand the procedure for manual
diagnosis of HIV/AIDS since persons who specialize in such
are scarcely available, the design of this system will
counter such limitations as an easy to use manual will be
documented.
Human experts lack confidentiality: One of the
major reasons why most persons are scared of HIV/AIDS
diagnosis is the issue of non-confidentiality of test
results, with the use of a diagnostic system which shall
involve the use of the expert machine, test results will be
secured in a database.
1.3 JUSTIFICATION OF THE STUDY
The relevance of this study cannot be overemphasized as
the numerous challenges faced in the medical area of
HIV/AIDS are so obvious that most health practitioners tend
to shy away from providing services of such nature as
described by this study, this has put much work load on the
xxiv
few agencies offering such services, which are mostly non-
governmental organizations. An expert system for diagnosing
HIV/AIDS is therefore a system with enormous level of
significance that cannot be undermined, this system will be
of great benefit to not just man but also government and
health sectors. The obvious challenges faced by the
government, health sector and individual are enough to
suggest that the relevance of the system are not limited to
but include the following; Professionalism: This system
shall contain valid and well researched algorithm that
shall aid in decision making, this decision support system
shall be written on the basis of the manually collected
data and enhanced through well designed syntax to take
decisions that are seen to be from facts already
programmed, by this the system tends to be very
professional and reliable. The system is also not prone to
mistakes and can be easily updated.
xxv
Reduced time consumption: One of the major advantages of
an expert system is speed, the system to be designed will
reduce the time consumption of record handling and enhance
efficiency as the workload will be reduced to the minimum
level.
Confidence in the system: The fact that computers do not
easily make mistakes, the diagnostic system will ensure a
quick, accurate and real time diagnosis.
Proper data collection: The expert system will use a
secured database management system to safely store
information that can be collected and made reference to when
required.
Confidentiality: The system will handle the issue of
the fear of result and status exposure, people believe that
with the already existing manual system, their results pass
through hands that they should not, with the computerized
system, anonymity and patient’s confidentiality will be
maintained.
xxvi
Ease in learning:The time used in learning the
procedure of proper diagnosis will be reduced as knowledge
of experts using the system will be documented for further
reference by those who will be coming in newly from time to
time, this will improve learning in the domain
1.4 AIMS AND OBJECTIVES OF THE STUDY
The general aim of this study is to design a knowledge
based expert system with a medical encapsulation for the
diagnosis of HIV/AIDS, the system will handle facts about
the domain of study and tend to use this known facts with
the information provided by the users to check how
corresponding it is for an effective decision making.
Furthermore, the aim of this study is also targeted at
implementing a HIV/AIDS diagnostic system having some
things in mind acting as hypothetical objectives for
comparison of the already existing system and the system
designed, these hypotheses are;
xxvii
a To design an expert system that can effectively
diagnose HIV/AIDS and handle treatment plan with
great accuracy
b To test for the effectiveness of knowledge domain
and production rule in the diagnostic system.
c To check if the confidentiality in HIV/AIDS
diagnostic system is more than using the manual
system.
d To perform a comparative analysis on HIV/AIDS
prevalence by means of risk analysis and actual
laboratory testing
1.5 SCOPE OF THE STUDY
The study covers the design of a knowledge based system
in the medical domain of HIV/AIDS diagnosis, the knowledge
based system handles symptomatic fields of relatedness to
the one understudy where patients are checked through
stepwise procedure using the following;
xxviii
- Voluntary pre-test counseling: This link
will handle risk assessment where the person under
diagnosis will be briefly introduced to factors
that transmit HIV virus and other related ailments,
they will also be taught on risk reduction methods
where general advice will be given on how to live a
medically healthy life.
- Voluntary HIV/AIDS testing: This is done using
approved HIV testing protocol which uses three
different HIV/AIDS test kits for HIV/AIDS
confirmatory test before result is given out.
- Voluntary post counseling: This link handles
emotional support and referral, in this aspect,
individuals whose test results are made available
are advised, this advice is of two distinct levels;
1: If diagnosis reads negative, the individual is
advised on how to remain negative and healthy, this
xxix
is done based on what to do and not to do so as to
avoid contacting the virus.
2: If diagnosis reads positive, emotional talks
are delivered to show the patients that positive
test result does not mean the end as people living
with the HIV/AIDS virus can still live a normal and
healthy life like everyone else, further tests are
then carried on for drug placement and dispensing.
All the above are embedded into the knowledge base
of the expert system so that it can work in aspects that are
best fitting, based on information provided, the computer is
however viewed as a dummy that can do nothing on its own but
strictly based on information available to it, by this,
users are advised to be honest since it has to do with
life., this will enable their various queries of the system
to provide valid result.
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1.6 DEFINITIONS OF TERMS
Artificial Intelligence (AI): The phrase “AI” can be defined as
the simulation of human intelligence on a machine, so as to
make the machine efficient to identify and use the right
piece of “Knowledge” at a given step of solving a problem.
(Konar, 2000)
Expert Systems (ES): This is a type of computer
application that makes decision or solves problems in a
particular field such as finance and medicine by using
knowledge and analytical rules defined by domain experts
(Noran, 2000).
Decision Support System (DSS): This refers to an
interactive computerized system that gathers and presents
data from a wide range of sources, they are systems and sub-
systems that assist people in decision making based on data
collected from a wide range of sources (Marek J. Druzdzel
and Roger R. Flynn, 2002).
xxxi
Intelligence: This is a term for referring to general
mental capability to reason, solve problems, think
abstractly, learn and understand to make decisions
(Microsoft Encarta, 2009).
Fact: This is a concept in philosophy that treats both
the meaning of the word true and the criteria by which we
judge the truth or falsity in spoken and written statements
(Microsoft Encarta, 2009)
Domain: The term, domain, refers to a particular
area of study, it is also used to describe the scope of a
subject and an area of activity over which somebody has
influence (Noran, 2000).
Knowledge: This is a theoretical or practical
understanding of a subject or domain, those who posses
knowledge are called experts, a domain expert is one who has
deep knowledge of both facts and rules and strong practical
experience in a particular domain (Noran, 2000).
xxxii
Domain Knowledge: This is that knowledge which is
specific to a study area and not general or common sense
knowledge (Noran, 2000).
Heuristic Knowledge: These are judgmental knowledge that
underline expertise, they are usually implicit and are not
necessarily being explicit even to the expert.
Knowledge Base: This is the part of a program in which
rules and other methods of representations are used to
store domain knowledge (Noran, 2000).
Inference Mechanism: This provides the reasoning
ability that enables the expert system to form conclusions
(Noran, 2000).
HIV: This is an Acronym for Human Immunodeficiency
Virus, infectious agent that causes acquired
immunodeficiency syndrome (AIDS), a disease that leaves a
person vulnerable to life-threatening infections (Microsoft
Encarta, 2009).
xxxiii
Counseling: Advice or guidance, especially as provided
by a professional in a given field (Microsoft Encarta,
2009).
Pre test counseling: This provides an opportunity for
clients to explore their risk of HIV, to learn about the
strategies for avoiding HIV, and help clients decide whether
to take the HIV test (www.patient.co.uk/health/hiv-and-
aids).
Counselors: They are persons who have received special
training in client centered HIV counseling. They do not only
provide information, they also help the client make an
informed choice about HIV testing, adoption of safe
behavioral practices in order to reduce and minimize HIV
transmission and facilitate coping with the psychosocial
impact of a positive HIV test result
(www.patient.co.uk/health/hiv-and-aids).
Voluntary: It is a self decision that is not based on
force from any one, the decision to pursue HIV testing must
xxxiv
be made by the client after counseling (Microsoft Encarta,
2009).
Window period: The window period is described as the time
it takes for a person who has been infected to test positive
for HIV antibodies (www.patient.co.uk/health/hiv-and-aids).
Adherence: Taking medications exactly as prescribed.
Poor adherence to HIV treatment increases risk for
developing drug resistant (www.patient.co.uk/health/hiv-and-
aids).
CD4 T-cells: CD4 T-cells also known as helper T-cells
acts as a co-coordinator of the immune response, they are
unfortunately the main targets of the HIV. HIV destroys
infected CD4 T-cells leading to an overall weakening of the
immune system (www.who.int/).
Cluster of Differentiation (CD4) Count: This is also known as
CD4 cell count or CD4 Lymphocyte count. It is a laboratory
test that measures the number of CD4 cells in a sample of
blood (www.who.int/)
xxxv
Testing: This is a laboratory procedure for detecting
ailments, in HIV/AIDS diagnosis, it is a way of detecting
antibodies in the serum or plasma, and they include tests
like the Elisa test and the rapid HIV tests. (Microsoft
Encarta, 2009)
Baseline test: Base line testing includes CD4 count,
viral load and resistant testing, the results are used to
guide HIV treatment choices and monitor effectiveness of
Anti-Retroviral Therapy (ART). Baseline is an initial
measurement used as the basis for future comparison
(www.who.int/).
Confirmatory test: A specific test designed to
confirm the result of an earlier test, it is an important
test for eliminating false positive result where a negative
sample will tend to read positive (www.who.int/).
Risk reduction: The goal of HIV counseling is to eliminate
risk, it is discovered that this can be best achieved
xxxvi
through small steps for incremental behavioral changes that
bring a reduction in risk of infection (www.who.int/).
Referral: The act or process of directing somebody or
something to somebody else, especially of sending a patient
to consult a medical specialist (Microsoft Encarta, 2009).
Condom: a close-fitting rubber covering worn by a man
over the penis during sexual intercourse to prevent
pregnancy or the spread of sexually transmitted diseases
(Microsoft Encarta, 2009).
Opportunistic infections: they are infections that take
advantage of a weakened immune system; they include
bacterial infections, fungal infections, pneumonia e.t.c
(Cichocki, 2009).
World Health Organization (WHO): Agency of the United
Nations that organizes and funds health-care programs in
nearly every country in the world. WHO was established in
1948 (Microsoft Encarta, 2009).
xxxvii
UNAIDS: UNAIDS, is the Joint United Nations Program on
HIV/AIDS, it is an initiative partnership that leads and
inspires the world in achieving universal access to HIV
prevention, treatment, care and support (www.unaids.org/).
Antiretroviral Therapy (ART): This is treatment of people
infected with Human Immunodeficiency Virus (HIV) using anti-
HIV drugs. The standard treatment consists of a combination
of at least three drugs (often called Highly Active
Antiretroviral Therapy (HAART) that suppresses HIV
replication. ART has the potential both to reduce mortality
and morbidity rates among HIV-infected people, and to
improve their quality of life( www.who.int/).
xxxviii
CHAPTER TWO: LITERATURE REVIEW
2.1 INTELLIGENT SYSTEM EVOLUTION
As the attributes of personal computing hardware
(speed, memory, storage capacity, and resolution) have
doubled since the 1980s, our society has reached a point
where no serious performance limitations exist for
"intelligent methods" and the computational complexities are
now embedded within or subsumed beneath the Human-Machine
Interface. As a result, these approaches can be applied to
study and solve extremely complex and intricate problems
beyond the ability of the human mind to handle in a time
frame appropriate for process control. Process control has
traditionally tried to maintain a system at a set-point for
as much time as possible in response to upsets or
disturbances in load variables. Nowadays, the set-points
themselves have become disturbances with updates occurring
at increasing frequencies as communication and measurement
xxxix
cycles have sped up to bandwidths previously unimaginable
(Meech, 2006).
The definition of intelligent systems is a difficult
problem and is subject to a great deal of debate. From the
perspective of computation, the intelligence of a system can
be characterized by its flexibility, adaptability, memory,
learning, temporal dynamics, reasoning, and the ability to
manage uncertain and imprecise information
Expert systems technology was originally invented in
the AI laboratories in an attempt to apply the state-space
search, knowledge representation, and inference techniques
developed in early research to some "real-world problems."
The hope of the inventors was to demonstrate, especially to
those always-fickle funding agencies, that AI was possible
and practical and that thinking about thinking machines was
scientifically sound. They succeeded beyond their wildest
dreams. Expert systems have evolved as a highly marketable
offshoot of research in the subfield of computer science
xl
called artificial intelligence (AI). Since its unofficial
inception at the Dartmouth Summer Research Project on
Artificial Intelligence in 1956 (attended by well known
personalities such as Marvin Minsky, Allen Newell, Herbert
Simon, Claude Shannon and John McCarthy), AI has had as one
of its primary goals the creation of ‘thinking machines.’
While this ambitious goal has not yet been attained to
anyone’s acknowledgment, there have been substantial
advances in what we now know about human thinking and
learning. Along the way, research in AI from the late 1950s
to the 1970s at Stanford, MIT and Carnegie-Mellon
Universities provided some very powerful techniques for
codifying human experience and knowledge so that computers
can store it and apply it to solve practical problems. The
mid-1970s saw the emergence of the first expert systems for
applications (Avron and Feigenbaum, 1981).
According to Barr and Feigenbaum (1981), the mid-1970s
saw the emergence of the first expert systems for
xli
applications such as medical diagnosis (Mycin, by
Shortliffe), chemical data analysis (Dendral, by Lindsay and
others), and mineral exploration (Prospector, by Duda and
others). Furthermore, Turing is seen to have made a
significant and characteristic provocative debate in
artificial intelligence. Turing (1950) in his Turing test
defined intelligent behaviour as the ability of human level
performance in all cognitive tasks. The issue of acting
humans springs up when intelligent systems interact with
people. For example, an expert system explaining how it came
to a diagnosis or a natural language processing system has a
dialogue with a user. He later concluded that, for any
complex decision to be made, or problem to be solved,
experts in specific areas have particular knowledge,
specific alternatives, the chances of success, and also the
benefits or costs that may be inquired. Based on these
earlier concepts, intelligent systems were developed and
xlii
have since been very useful to supervisors and managers with
situational assessment and long time planning.
2.2 EXPERT SYSTEM
Expert systems are computer programs that can perform
some tasks which typically require the capabilities of a
skilled human. These tasks are usually of a decision-making
nature rather than physical actions. Examples of such tasks
are managing water levels in a wetland, forecasting weather
conditions, assessing environmental impacts, and selecting
mitigation measures for environmental hazards. As computer
programs that contain human expertise, they are referred to
variously by the labels expert systems, knowledge-based
systems, inference systems or rule-based systems (Abraham,
2005 ).
In the late 1960's to early 1970's, expert systems
began to emerge as a branch of Artificial Intelligence. The
intellectual roots of expert systems can be found in the
ambitions of Artificial Intelligence to develop “thinking
xliii
computers”. Domain specific knowledge was used as a basis
for the development of the first intelligent systems in
various domains. Feigenbaum (1981) published the best single
reference for all the early systems. In the 1980's, expert
systems emerged from the laboratories and developed
commercial applications due to the powerful new software for
expert systems development as well as the new possibilities
of hardware. Feigenbaum (1982) defined an expert system as
"an intelligent computer program that uses knowledge and
inference procedures to solve problems that are difficult
enough to require significant human expertise for their
solution". Differences from conventional programs include
facts such as: An expert system simulates human reasoning
about a problem domain as the main focus is the expert's
problem solving abilities and how to perform relevant tasks,
as the expert does. An expert system performs reasoning over
representations of human knowledge in addition to doing
numerical calculations or data retrieval using the knowledge
xliv
base and the inference engine separately. An expert system
solves problems using heuristic knowledge rather than
precisely formulated relationships in forms that reflect
more accurately the nature of most human knowledge dealing
with symbolic values and procedures.
Shu-Hsien (2004) said that Expert system (ES) is a
branch of applied artificial intelligence community in the
mid 1960’s. The basic idea behind expert system is simply
that expertise, which is the vast body of task-specific
knowledge, is transferred from a human to a computer. This
knowledge is then stored in the computer and users call upon
the computer for specific advice as needed. The computer can
make inferences and arrive at a specific conclusion. Then
like a human consultant, it gives advice and explains, if
necessary, the logic behind the advice. Turban and Aronson
(2001) provided powerful and flexible means for obtaining
solutions to a variety of problems that often cannot be
dealt with by other more traditional and orthodox methods.
xlv
Thus, their use is proliferating too many sectors of our
social and technological life, however, their applications
categories are; rule-based systems, knowledge-based systems,
neural networks, fuzzy expert system, object oriented
methodology, case-based reasoning (CBR), system architecture
development, intelligent agent (AI) systems, modeling,
ontology, and database methodology together with their
applications for different research and problem domains. The
goal of expert systems research is to program into a
computer the knowledge and experience of an expert. Expert
systems are used in medicine, business management, mining
natural resources and much more. An alternative way to
present them is functionally, i.e., according to the types
of problems that they address. The non-exclusive categories
that seem to capture most applications are classification,
prediction, interpretation, planning, monitoring and
control, and analysis. The categorical approach is
advantageous because the user then acquires an appreciation
xlvi
of the broad applicability of expert system methodology
without becoming distracted by details that are specific to
particular applications (Davis and Clark, 1989; The surveys
in Hushon, 1987, Moninger and Dyer, 1988).
The areas explained below are some of the fields where
expert systems are used, according to Alexander and
Fairbridge( 1999). These fields of applying expert system
technologies are however not limited to just the underlisted
fields as the growth in technology advances day-by-day.
Classification problems are the most common type of
application. This is due to the impact of our inherent human
need to classify objects and events as being members of
particular groupings. A salient characteristic of
classification problems is that there is a finite (usually
small) and enumerable list of possible groups; this make
these problems relatively easy to solve. Hence, all problems
that fall into a particular solution group are treated
similarly with respect to action. Diagnosis is a very common
xlvii
application problem, where systems are diagnosed in terms of
the causes of malfunction. These include biological systems
(e.g., trees, crops or fish populations), hydrological and
chemical systems (e.g., lakes and streams), mechanical
systems (e.g., waste treatment) or physical systems (e.g.,
hailstorm severity). The cause may be a pathogen, a
malfunctioning pump, a parasite, a climate change, and so
on. Other non-diagnostic classification systems only seek to
place an object or event into a particular category without
labeling that category as malfunctional; for example,
identification of type of atmospheric inversion,
classification of soils, selection of options in
insecticides, or identification of species.
Another large class of expert systems applications
includes those that deal with prediction, these estimate some
important future characteristic of an environmental system
based on current details about it. Some examples of
prediction problems are forecasting for weather and other
xlviii
environmental phenomena, qualitative modeling of biological
or physical systems (e.g., vegetation change, crop
production and wildlife populations), and damage estimation
(e.g., following toxic contamination, for insect epidemics
or for flooding). When these expert systems select their
predictions from a small set of possible future conditions,
they can also be categorized as classification expert
systems. It should be apparent that there is some overlap
between classification and prediction problems. In fact, all
these categories are non-exclusive, and hence overlaps exist
between most of them. In fact, many systems can be
categorized in multiple ways.
Interpretation problems are similar to prediction problems
except that the characteristic to be estimated is a current
one, rather than a future one. Because this characteristic
condenses and summarizes the information about an
environmental system, it usually carries with it some
important management implications. Ways in which expert
xlix
systems have been applied include hazard and risk ratings
(e.g., fire danger rating, and contamination or toxicity
potential estimation), environmental assessment (e.g.,
impacts of human intervention, cost estimation, and report
evaluation or generation), data interpretation (e.g., model
interpretation, site selection or ranking, species selection
and equipment selection), and management actions (e.g., fire
suppression, and crop production and treatment
prescriptions).
Solutions to the above three categories of problems
most often consist of a single action or parameter estimate.
Planning type problems, on the other hand, are resolved by
specifying an ordered set of actions to be performed.
Because a large number of possible action sequences is
possible, planning problems tend to be much more difficult
to solve and are more computationally costly. Examples of
reported applications in this area are catastrophe
mitigation (e.g., hazardous site cleanup, and fire
l
suppression), forest and agriculture production (planting,
treatment and harvest), construction (e.g., roads or airport
runways), and scheduling and resource planning (e.g., for
regional water quality, landscape and land use). Expert
systems provide a viable approach to solving planning
problems because these problems usually have a fairly well
defined goal that is constrained by certain of their
attributes. Moreover, they are non-quantitative in nature
and require a systematic search through a large number of
possible solutions.
In contrast to the off-line decision making that is
inherent in the problems described above; there are
situations in which decisions are made as part of real-time
operations, Monitoring and control problems are of this type. In
many of these instances monitoring and control activities
are intertwined in the sense that a process is monitored by
an expert system that also takes action when some condition
signals its attention. At other times, an expert system only
li
performs monitoring, and a human being performs the control
action. Examples of monitoring and control applications are
very few in the environmental sciences, and this category is
only mentioned here for the sake of completeness.
A final application for expert systems is in the area
of analysis. Here, an expert system assists with evaluation of
a system, or data about a system, or it enhances the
operation of existing analysis methods. In the first case,
expert systems can help collect or filter data, or suggest
analyses for data; in the latter case they serve as
‘intelligent’ front ends or internal enhancements to
existing software. Expert systems appear as laboratory
recording aides, report generators, data collection and
selection aides, cartographic aides, data error detectors
and correctors, curve shape analyzers, and data quality
assessors. As intelligent front ends and embedded
‘intelligence,’ expert systems have been used with
ecological models, geographic information systems, remote
lii
sensing and cartographic systems. Most of these systems are
designed for in-house laboratory use to enable scientists
and technicians to work better and more efficiently.
Expert systems applications are either of computational
or deterministic applications and heuristics for problem
solving applications, of the two, the best application
candidate for expert system is however those that deal with
heuristics, here, conventional computer programs are based
on factual knowledge, an indisputable strength of computers.
Humans by contrast, solve problems on the basis of mixture
of factual and heuristic knowledge. Heuristic knowledge,
composed of intuition, judgment, and logical inferences, is
an indisputable strength of humans. Successful expert
systems will be those that combine facts and heuristics and
thus merge human knowledge with computer power in solving
problems. To be effective, expert systems must focus on
particular problem domains.
liii
2.3 EXPERT SYSTEM COMPONENTS
Most expert systems consist of several distinct
components. These are knowledge base, working memory,
reasoning engine, explanation subsystem and a user
interface. The knowledge base contains the scientific
knowledge and experience for the particular area of
expertise. Imagine that we are designing an expert system to
diagnose automobile engine malfunctions. We might want to
include knowledge about spark plugs, fuel pump, battery,
starter, fuel injectors, etc., and also how these engine
components affect engine operation. A competent mechanic can
usually pinpoint engine problems fairly quickly with only a
small amount of information about the functioning of the
various parts. Often a specialist, such as a mechanic,
possesses intuition that he or she has acquired through
years of experience. This intuition is often ratified in
rules-of-thumb (or good guesses) that allow the specialist
to solve problems quickly and effectively. For this type of
liv
expert knowledge to be used by a computer it must be
represented in some way that the computer can easily
manipulate. There are numerous techniques for knowledge
representation, but traditionally the most common one is the use
of condition-action rules, the expert system operates either
in consultation mode or knowledge acquisition mode. The
various system components enable it to solve problems for
which it has knowledge in the knowledge base, to interact
with users, and to explain the rationale for the solutions
it reaches. This is further explained in figure 2.1 by Luger
and Stubblefield (1989), as a comprehensive review of the
techniques of the functions of expert system components
(Alexander and Fairbridge, 1999).
Condition–action rules are IF-THEN statements where the
consequent action(s) are performed if the premise conditions
are true. For example, IF battery charged AND battery-cables
= clean AND engine-starting = not cranking THEN check
starter. This method of knowledge representation is popular
lv
because each rule is modular and contains a ‘chunk of domain
knowledge, expert system programmers find rules easy to
program, and experts are often able to express their
heuristic knowledge in the IF-THEN format. Working memory is
like the short-term memory of the expert system. It contains
assertions about the problem currently under investigation.
These assertions may be obtained from the user (via
queries), from external programs, from a real time process,
or from external data files. Assertions may be facts
gathered from the above sources, or they may be hypotheses
which have been inferred from other facts that are already
known. Because the ultimate goal of knowledge system
consultation is to infer problem solutions, some of these
intermediate hypotheses will eventually be solutions. All
facts and hypotheses in the working memory together describe
the current context, or the current state, of a consultation
session. Usually a closed world assumption is assumed, i.e.,
only those assertions that are present in the working memory
lvi
are true and all other possible assertions about the state
of the world are assumed false. While the knowledge base and
working memory are passive entities, the reasoning engine
navigates through the knowledge base and registers
established assertions in the working memory. A reasoning
engine operating on a knowledge base and working memory is
how an expert system solves problems. Navigation is
performed by the particular control strategy that the
reasoning engine employs. A control strategy determines the
order in which knowledge base elements (such as rules) are
examined in order to arrive at the solution to a problem.
Assertions are established as true by the particular
inference mechanism used. In a rule-based knowledge
representation, the inference method is usually used and
rules are selected for evaluation either by the content of
their premise conditions (data-driven control) or by their
consequent actions (goal-driven control). Details of how the
reasoning engine operates are determined by the knowledge
lvii
representation method used, what types of assertions must be
made, and the overall problem-solving methods that are
applied. The purpose of an explanation subsystem is to enable
the expert system to display to users an understandable
account of the motivation for all of its actions and
conclusions. Explanation is part of the larger issue of
human factors engineering, which also includes the user
interface – i.e., the how’s and why’s of a computer system’s
interaction with users. Explanation systems are not involved
with the correct execution of an expert system. Instead,
their purpose is to convince the user that the system’s
conclusions are reasonable, to explain how it reached those
conclusions, and to aid system developers in debugging the
knowledge base and the reasoning methods (Alexander and
Fairbridge, 1999).
The term user interface refers to the physical and sensory
interaction between computer and user. Functionally, this
means how the user inputs information to the system and how
lviii
information is returned to the user. The more natural (i.e.,
intuitive and understandable) this interface is, the more
effective the human computer interaction will be.
Traditionally, this interaction has been serial and text
based using the conventional, interactive terminal format.
Recent advances in computer interfaces enable expert systems
to utilize display graphics, hot graphics (graphical objects
that perform some action when activated), point-and-click
operations, video, sound and animation. For most software
users, the interface is the application, and hence expert
systems may fall into disuse if they lack good user–
interface capabilities, figure 2.1 shows the basic
components of an expert system.
lix
Fig 2.1: Basic components of an expert system
According to (Schmoldt, 1999), other major
components of expert systems that have to be understood are;
Knowledge engineer: This refers to the engineer who
encodes the expertise in a declarative format of the
knowledge base.
Domain expert: This refers to the individual or set of
individuals who are currently experts, solving the
problems in a more manual way which the system is
designed to solve.
System user: These are individuals who will be consulting
with the system to get advice which have already been
encoded by the experts.
System engineer: The individual who builds the user
interface, designs the declarative formats of the
knowledge base and implements the inference engine
lx
Depending on the size of the system to be designed, the
knowledge engineer and the system engineer might be the
same person. For a custom built system, the design of the
format of the knowledge base and the coding of the domain
knowledge are closely related. The format has a significant
effect on the coding of the knowledge. The development of
expert systems may enable a major acceleration in several
areas of human endeavours, for instance computer programs
have important advantages over books as medium for the
recording of knowledge, in that they can be updated rapidly
and are necessarily more precise and unambiguous. The
availability of the expertise of a leading practitioner in
a field in a fully precise and directly testable form may
well enable others to find improved ways of teaching the
underlying skills. A refined form of the knowledge might
again be stored in the form of an expert system, a valuable
benefit of designing an expert system, which has been
little exploited so far, is the possibility that it may be
lxi
directly used as an aid for training or educating or other
services. Although the pace of development in the expert
system field in recent years is extremely impressive, it is
hard to escape the feeling that we are still only
scratching the surface of a major new technology with
potentials which are yet barely appreciated.
Figure 2.2 shows by Unified Modeling Language (UML),
how an expert system interacts with its component
User
Domain
Expert
User Interface
lxii
Expertise
System
Engineer
Knowledge
Engineer
Encoded
Expertise
Fig 2.2: expert system components and human interface
(Source:
www.myreaders.info/html/artificial_intelligence.html)
For a perfect expert system design, all users are
put into consideration and their major functions and
activities are linked to them, also, those having
relatedness are also linked perfectly to each other as
demonstrated in the diagram above.
Inference
Engine
Knowledge
Base
Working
Storage
lxiii
2.4 EXPERT SYSTEM IN MEDICAL DIAGNOSIS
Expert systems for medical diagnoses are interactive
computer programs, designed to assist health professionals
with decision making tasks. The clinicians interact with the
system using both the clinician knowledge and the system to
make a better analysis of the patient’s data than either
humans or software could make on their own.
Intelligent systems, particularly expert systems for
diagnosis and treatment, have been developed for use in a
range of medical contexts:
MYCIN: It was the first well known medical expert system
developed by Shortliffe at Stanford University (Buchanan and
Shortliffe, 1984) used for diagnosis and remedy of bacterial
infections. It uses backward chaining inference procedure. It
helps doctors, not expert in antimicrobial drugs to prescribe
such drugs for blood infections. The limitation of MYCIN is
that its knowledge base is incomplete since, it does not
cover anything like the full spectrum of infectious diseases.
lxiv
Running it would have required more computing power than most
hospitals could afford at that time (1976). Doctors do not
relish typing at the terminal and require a much better user
interface than that provided.
PERFEX: It is a medical expert system that supports solving
problems clinicians currently have in evaluating perfusion
studies (Ezquerra et al., 1992). The heart of the PERFEX
system is the knowledge base, containing over 250 rules. They
were formulated using the expertise of clinicians and
researchers at Emory University Hospital. PERFEX limitation
resides in its output. It is mostly numerical.
INTERNIST-I: It is a rule-based expert system designed at the
University of Pittsburgh in 1974 (Kumar et al., 2009) for the
diagnosis of complex problems in general internal medicine.
ONCOCIN: It is a rule-based medical expert system for
oncology protocol management (Wiederhold et al., 2001)
developed at Stanford University. ONCOCIN was designed to
assist physicians with the treatment of cancer patients
lxv
receiving chemotherapy.
Dxplain: It is a decision support system which uses a set of
clinical findings (signs, symptoms, laboratory data) to
produce a ranked list of diagnoses which might explain (or be
associated with) the clinical manifestations (Elhanan et al.,
1996). The Dxplain provides justification for why each of
these diseases might be considered, suggests what further
clinical information would be useful to collect for each
disease and lists what clinical manifestations, if any, would
be unusual or typical for each of the specific diseases.
PUFF: It is an expert system for the interpretation of
pulmonary function tests for patients with lung disease
(Shortliffe et al., 1984). PUFF was probably the first AI
system to have been used in clinical practice.
2.5 MEDICAL DIAAGNOSIS SYSTEM
Medical diagnosis, simply termed often as diagnosis
refers both to the process of attempting to determine or
identify a possible disorder or disease. The history of
lxvi
medical diagnosis began in earnest from ancient Egypt and
the day of Hippocrates (The father of medicine) in ancient
Greece. In Traditional Chinese Medicine, there are four
diagnostic methods namely inspection, auscultation-olfaction
(to study sounds arising within organs such as the heart,
lung, and stomach prior to treatment), interrogation and
palpation (a method of clinical examination using gentle
pressure of the fingers to detect growths, changes in the
size of underlying organs, and unusual tissue reaction to
pressure) (Berger, 1999)
Esagil-kin-apli (1069-1046 BC) introduced the use of
empiricism, logic and rationality in the diagnosis of an
illness or disease, the book made use of logical rules in
combining observed symptoms on the body of a patient with
its diagnosis and prognosis. There are a number of methods
and techniques that can be used in diagnostic procedure
including differential diagnosis or following medical
algorithms (Berger, 1999).
lxvii
Differential Diagnosis: The method of differential diagnosis is
based on finding as many candidate diseases or conditions as
possible that can possibly cause the signs and symptoms,
followed by a process of elimination or at least rendering
the entries more or less probable by further medical test.
Pattern recognition: In a pattern recognition method the
provider uses experience to recognize a pattern of clinical
characteristics. It is mainly based on certain symptoms or
signs associated with certain diseases or conditions, not
necessarily involving the more cognitive processing involved
in a differential diagnosis
DIAGNOSTIC CRITERIA
The term diagnostic criteria designate the specific
combinations of signs, symptoms and test results that the
clinician uses to attempt to determine the correct diagnosis
(www.patient.co.uk/health/diagnostic_criteria).
lxviii
2.6 HIV/AIDS
HIV stands for Human Immunodeficiency Virus. This is
the virus in the group of viruses called retrovirus. HIV
destroys cells in the body called CD4 T cells. CD4 T cells
are a type of lymphocyte (A white blood cell). These are
important cells involved in protecting the body against
various bacteria, viruses and other germs. HIV actually
multiplies within CD4 cells, it cannot be destroyed by white
blood cells as it keeps changing its outer coat so as to
protect itself (www.patient.co.uk/health/hiv-and-aids).
AIDS stands for Acquired Immunodeficiency Syndrome.
This is the term which covers the range of infections and
illness which can result from a weakened immune system
caused by HIV. Because ART has altered the way we think
about the condition, the term late stage HIV is being used
instead of AIDS (www.patient.co.uk/health/hiv-and-aids).
From the above, it can be noted that, HIV and AIDS are
not the same thing and persons with HIV infections do not
lxix
automatically develop AIDS. AIDS is even unlikely to develop
in people who have been treated in the early stage of HIV
infection. Even in people who do not receive treatment, the
time lag is usually several years between first being
infected with the virus and then developing infection and
other AIDS problems, this is because it usually takes
several years for the number of CD4 T cells to reduce to a
level where our immune system is weakened
(www.patient.co.uk/health/hiv-and-aids).
CONTACTING HIV According to www.patient.co.uk/health/hiv-
and-aids, the commonest ways of being infected with HIV
include but are however not limited to the following
- Sexual transmission: This is the most common way to
pass the virus on. In 2010, it accounted for about 19
in 20 new confirmed cases in the United Kingdom.
Semen, vaginal secretion and blood from an infected
person contain HIV, the virus can enter the body
through the lining of the vagina, vulva, penis,
lxx
rectum or mouth during sex. Having vaginal or anal
sex with an infected person is the most common route.
Oral sex carries a much lower risk, but this
increases if you have a condition which affects the
defense barriers of the mouth like ulcer,
bleeding/damaged gums or sore throat. One cannot be
infected with HIV by coming into contact with the
saliva of an infected persons, HIV is also not passed
on by coughing and sneezing.
- Needle sharing: HIV (and other viruses such as
hepatitis B and hepatitis C) can be passed on by
people who are dependent on inject-able drugs and
share needles, syringes and other injecting equipment
which are contaminated with infected blood. However,
needle-exchange services run by hospitals, clinics
and drug dependency units and the more ready
availability of medicines taken by mouth has
lxxi
drastically reduced needle sharing as a source of
infection.
- Infected blood: In the past, quite a number of
cases occurred from infected blood transfusions. This
is now rare as since 1985, all blood products are
checked for HIV before being used. However, in
developing countries, it is still a significant
problem.
- From Mother to Child: HIV can be passed to an unborn
child from a HIV infected mother. However, with
appropriate treatment, the vast majority of babies
born to HIV-positive mothers will not have HIV.
Achieving this depends on detecting HIV before
pregnancy, or, in early pregnancy, when anti
retroviral medicines can be taken by the mother.
Having a caesarean section to deliver the baby
reduces the risk even further. HIV can occasionally
be passed to babies through breast milk during breast
lxxii
feeding. If formula milk is available, mothers with
HIV are encouraged not to breast feed.
2.7 DIAGNOSING HIV/AIDS
HIV tests are used to detect the presence of the human
immunodeficiency virus (HIV), the virus that causes acquired
immunodeficiency syndrome (AIDS), in serum, saliva, or
urine. Such tests may detect antibodies, antigens, or RNA.
HIV has been found in saliva, tears, nervous system
tissue and spinal fluid, blood, semen (including pre-seminal
fluid, which is the liquid that comes out before
ejaculation), vaginal fluid and breast milk. However, only
blood, semen, vaginal secretions and breast milk generally
transmits infection to others (www.about.com/Diagnosis of
AIDS_HIV.htm). Mandel, Bennet and Dolin (2007) however,
stated that AIDS begins with HIV infection. People infected
with HIV may have no symptoms for 10 years or longer, but
they can still transmit the infection to others during this
symptom-free period. If the infection is not detected and
lxxiii
treated, the immune system gradually weakens and AIDS
develop. The symptoms of AIDS are primarily the result of
infection that does not normally develop in individuals with
healthy immune system. These are called opportunistic
infections. People with AIDS have had their immune system
damaged by HIV and are very susceptible to these
opportunistic infections. Common symptoms are chills, fever,
sweating (particularly at night), swollen lymph glands,
weakness, weight loss and others.
The first stage of contracting HIV is known as the
primary infection. About 8 in 10 persons develop symptoms at
this time. The three most common symptoms (sometimes known
as the classic triad) are sore throat, fever and a blotchy
red rash. Other symptoms can include feeling sick, diarrhea,
swollen glands, headache, tiredness and general aches and
pains. The symptoms can last up to three weeks and are often
thought of as flu or mild viral illness. After any primary
infection settles, the individual can remain without any
lxxiv
symptoms for several years hence even without treatment,
there are often no symptoms for a long time (often up to 10
years) so as many do not even realize they are infected,
however, the virus continues to multiply, the number of CD4
T cells tends to gradually fall and the virus can be passed
on to others. During this time, some persons develop
persistent swollen lymph glands or night sweats and with
time, experience problems such as recurring mouth ulcers,
recurring herpes or shingles infections, old Tuberculosis
(TB) infections may reactivate in some cases even before
AIDS develops, especially in people in the developing world,
other symptoms of HIV that may be experienced before AIDS
include diarrhea, skin rashes, tiredness and loss of weight
(www.patient.co.uk/health/hiv-and-aids.)
The term AIDS is used to describe the advanced stage of
HIV infection, people who have an early HIV diagnosis and
treatment do not develop this stage. AIDS is a general term
lxxv
which includes various diseases which can result to a
weakened immune system. Typically, a person with AIDS has:
- A very low CD4 T cells (around 200 cells per cubic
millimeter of blood or below), and/or
- One or more opportunistic infection such as
pneumonia, severe thrush in the vagina or mouth,
fungal infections, Tuberculosis, etc. these
infections can cause a range of symptoms such as
sweats, fever, cough, diarrhea, weight loss and
generally feeling unwell.
In addition, people with AIDS often have increased risk
of developing other conditions as;
- Certain cancers: Kaposi’s sarcoma is a cancer which
is actually only seen in people with AIDS. There is
also an increased risk of developing cancer of the
cervix and lymphoma.
- An AIDS-related brain illness such as encephalopathy
(AIDS dementia).
lxxvi
- A severe body wasting syndrome.
The laboratory diagnosis of HIV infection is usually
made on the basis of the detection of antibodies to HIV.
Serological tests for detecting antibodies to HIV are
generally classified as screening assays (sometimes referred
to as first-line assays) or supplemental assays (sometimes
referred to as confirmatory assays). First-line assays can
provide the presumptive identification of antibody-positive
specimens, and supplemental assays are used to confirm
whether specimens found reactive with a particular screening
assay contain antibodies specific to HIV and/or HIV antigen.
The most widely used screening assays are enzyme
immunoassays (often referred to as EIAs or ELISAs) as they
are the most appropriate for screening large numbers of
specimens on a daily basis, e.g. blood donations. The
earliest assays used purified HIV lysates (1st generation),
and often lacked sensitivity and specificity. Improved
assays based on recombinant proteins and/or synthetic
lxxvii
peptides, which also enabled the production of combined HIV-
1/HIV-2 assays, became rapidly available (2nd generation).
The so-called 3rd generation or sandwich EIAs, which use
labeled antigen as conjugate, are extremely sensitive and
have reduced the window period considerably. Enhanced EIAs
have been developed that detect both HIV antibody and
antigen (4th generation assays) leading to earlier detection
of HIV infection and further reducing the window period
(Duong et al, 2007).
A variety of simple, instrument-free assays are now
available, including agglutination, immunofiltration (flow-
through tests), immunochromatographic (lateral-flow tests)
and dipstick tests. Specimens and reagents are often added
to the test device by means of a dropper. A positive result
is indicated by the appearance of a colored dot or line, or
by an agglutination pattern. Most of these assays can be
performed in less than 20 minutes and are therefore called
rapid assays. Other simple assays are less rapid and their
lxxviii
procedures require 30 minutes to 2 hours. The results are
read visually. In general, these assays are most suitable
for use in testing and counseling centers and laboratories
that have limited facilities and process low numbers of
specimens daily. When a single screening assay is used for
testing in a population with a very low prevalence of HIV
infection, the probability that a person is infected when a
positive test result is obtained (i.e., the positive
predictive value) is very low, since the majority of people
with positive results are not infected. This problem occurs
even when an assay with high specificity is used. Accuracy
can be improved if a second supplemental assay is used to
retest all those specimens found reactive by the first
assay. The negative predictive value will generally always
approach near to 100%, irrespective of prevalence. A third
assay may also be required to elucidate the correct status
(www.who.int/diagnostics_laboratory/en/).
ASSAYS FOR LABORATORY DIAGNOSIS OF HIV
lxxix
An assay is a quantitative or qualitative test of a
substance to determine its components; frequently used to
test for the presence or concentration of infectious agents
or antibodies e.t.c (Advanced English Dictionary)
According to Jeffery et al (2006), the commonly used
assays for HIV rapid tests in laboratories today are;
Determine HIV Rapid Test
The test kit which can appear in any of the form shown
in figure 2.3 is used to detect HIV antibodies in serum or
plasma. It is termed as first line test, it is the first kit
used on the patient, if patient is found reactive, the
second line is introduced for conclusion, else the test
result is given as negative.
lxxx
Fig 2.3:HIV positive, negative and invalid test result with
Determine Rapid test kit
Uni-Gold Recombigen HIV-1 Test
The Uni-Gold assay which can appear in any of the form
shown in figure 2.4 is a lateral flow immunochromatographic
procedure for the qualitative determination of HIV-1
antibodies in finger-stick or venipuncture whole blood,
serum, and plasma. It is termed the second line test kit as
it is used when the first line (Determine) test result is
reactive, it is a confirmatory test kit and when its result
comes out positive, the client is positive, and else the
third line is introduced.
lxxxi
Fig 2.4:HIV positive, negative and invalid test result with
HIV uni-gold test kit
HIV 1/2 Stat-Pak
A qualitative immunochromatographic assay which can
appear in any of the form shown in figure 2.5 is used for
the detection of antibodies to human immunodeficiency virus
types 1 and 2 (HIV-1 and HIV-2) in human serum, plasma and
whole blood. It is termed as the third line test also known
as chain breaker, when used, the result is always final. If
the patient test positive to the first two lines and
negative to the third, the patient is advised to come back
in three months time for testing again
lxxxii
Fig 2.5:HIV positive and HIV negative test result with HIV
1/2 Stat-Pak
2.8 VOLUNTARY COUNSELLING AND TESTINGAccording to Saeed (2001), ever since the beginning of
AIDS epidemic in 1981, the number of people infected and
affected by HIV/AIDS is on the rise. During the course of
infection, a broad range of physical, social and
psychological needs and problems is experienced. Changing
nature of the illness imposes a variety of psychological and
emotional strains on individuals and those closest to them.
Taking into account the dilemmas associated with it, the
effects of HIV epidemic are enormous. AIDS, in fact, is seen
more as a psychosocial phenomenon than a disease. HIV/AIDS
counseling assists people to make informed decisions, cope
better with their condition, live more positive lives, and
prevent HIV transmission. HIV/AIDS counseling is important
because infection with HIV is forever. Role of counseling in
lxxxiii
HIV/AIDS is perhaps more important than in any other
disease.
HIV COUNSELLING
HIV counseling is a confidential dialogue between a
client and counselor aimed at enabling the client to cope
with stress and take personal decisions related to HIV/AIDS.
The counseling process includes evaluating the personal risk
of HIV transmission and discussing how to prevent infection.
It concentrates specifically on emotional and social
issues related to possible and actual infection with HIV and
AIDS. HIV counseling has as its objectives both prevention
and care. It is important for counselors to have a basic
understanding of the HIV antibody tests that may be
performed, as well as the necessity of confirmatory HIV
antibody testing (Nigerian Federal Ministry of Health,
2011).
Pre-test Counseling
lxxxiv
Pre test counseling should focus on two main topics:
(a) the person's personal history of risk behaviors or
having been exposed to HIV, and (b) assessment of the
person's understanding of HIV/AIDS (including modes of
transmission), and the person's previous experiences in
crisis situations. The aim of pre-test counseling is to
provide information about the technical aspects of testing
and the possible personal, medical, social, psychological
and legal implications of being diagnosed as either HIV
positive or negative. Information should be up to date and
given in a manner that is easy to understand. Testing of
blood donors is different from testing of those suspected of
having HIV/AIDS, however, both require enquiring about risk
behaviors. Testing should be discussed as a positive act
that is linked to changes in risk behavior, coping and
increasing the quality of life (Nigerian Federal Ministry of
Health, 2011).
Post-test Counseling
lxxxv
The counseling session should begin by trying to put
the person at ease. If possible, the room should be quiet,
without the fear of being disturbed. Arrange the chairs so
that bright light will not shine in anyone's eyes. The
counselor should then tell the person the test result in a
clear and direct manner. The result (either positive or
negative) should then be discussed, including how the person
feels about the result. Providing further information might
be necessary although the person may be shocked (no matter
what the result), and may not fully take in all the
information. However, in some circumstances, this might be
the only chance to counsel this person and so asking them to
repeat the information, or have some basic facts written
down will be helpful. It is important for the person to have
time to reflect on the result and understand the next course
of action. Ideally, couple and/or family counseling should
be started and further counseling follow-up arranged
(Nigerian Federal Ministry of Health, 2011).
lxxxvi
HIV - negative Test Result Counseling
If the HIV test is negative, then counseling about
risk behaviors and methods of prevention are vitally
important. Also, the counselor must explain about the
"window period" (between 3-6 months) when a negative result
may be a false negative, if there is concern about the HIV
status of the person, counsel him to return for a repeat
test in 3-6 months. Ensure protection in the meanwhile,
explaining that the client could become infected at any
time. This is an ideal time to discuss sexual practices and
preferences and potential drug abuse (particularly
intravenous drug use) and other risk behaviours. The person
will probably be more open to learning about safe sex
practices and modifying risk behaviors and be willing to
consider necessary behaviour changes. Free condoms can be
given out during this session together with advice on how to
use them and where to get more when needed (Nigerian Federal
Ministry of Health, 2011).
lxxxvii
HIV-positive Test Result Counseling
(The positive test result will only be given after the
second HIV test confirms a positive result.) The counselor
should tell the person as gently as possible, providing
emotional support and discussing how best to cope with the
result. This is not the time for speculation, but time to
give clear, factual explanations of what the news means.
Assess the emotional impact of the news and validate the
person's reactions as normal. Fear of dying, job loss,
family acceptance, concern about the quality of life, the
effects of treatment and response by society might be
explored. If there is a concern that the person might not
return for follow up counseling, then information about
relevant related services might be included, such medical
treatment for opportunistic infections, social services for
financial and ongoing psychosocial support etc. However, if
follow up counseling is an option, then it would be
advisable to leave this information to a later date when the
lxxxviii
person is more able to absorb the details and explore some
options. Assess the person's understanding and ability to
use preventive methods. Free condoms can be given out during
this session together with advice on how to use them and
where to get more (Nigerian Federal Ministry of Health,
2011).
HIV TESTING
According to the National guidelines for HIV Counseling
and testing by the Nigerian Federal Ministry of Health in
November 2011, HIV testing is mainly carried out using anti-
body detecting techniques, which include enzyme-linked
Immunosorbent Assay (ELISA), simple and rapid tests. Testing
is carried out in public and private health facilities
including Non-Governmental Organizations (NGOs) and Faith
Based Organizations (FBOs) at the following tiers of care:
1 Tertiary health facilities like Teaching
hospitals, Federal medical centers and Research
institutes.
lxxxix
2 Secondary health facilities like General
hospitals and state specialist hospitals.
3 Primary health clinics, community health
centers, NGO’s and alone HCT centers, health
posts and mobile clinics.
The indications for HIV testing include:
1.Need to know one’s health Status
2.Screening of donated Blood for organ transplant and
transfusion.
3.HIV prevalence surveillance in a given population
4.Diagnosis of HIV infection in individuals
5.Treatment Monitoring
6.Research.
LABORATORY HIV TESTING
Persons who become infected with HIV produce antibodies
over a period of three(3) months according to the Nigerian
Federal Ministry of Health Guidelines for HIV counseling and
Testing presentation in November 2011. Different types of
xc
tests are available for the detection of these antibodies in
adults and children over 18 months of age.
TYPES OF HIV TESTS
- Rapid Test: Rapid tests are recommended for HCT
services because they are fast, simple and accurate. It
takes about 15 – 30 Minutes to perform; it can be
performed even in clinics without laboratories or
specialized laboratory equipment and are accurate when
the instructions are strictly followed.
The test is performed using a small sample of blood
(taken from the clients finger tip), serum or plasma and
the result is ready within 15 Minutes (Nigerian Federal
Ministry of Health, 2011).
- Enzymes Linked ImmunoSorbent Serologic Assays (ELISA):
ELISA test results usually take longer to obtain, and
was originally developed for donor blood screening and
therefore is more suitable for batch testing in settings
where large number of clients are seen daily. Only
xci
trained medical laboratory scientist are to perform this
test (Nigerian Federal Ministry of Health, 2011).
- Virology Test: Virology testing detects the presence of
the viral particles and gives the most accurate results,
examples include Deoxyribonucleic acid (DNA) and
Ribonucleic acid (RNA) by Polymerase Chain Reactions
(PCR) tests, P24 antigen tests and viral culture. These
tests are not used in HIV counseling and testing services
because they are expensive and require high level of
skills (Guidelines for HIV Counselling and Testing,
November 2011). The test is however recommended for Early
Infant Diagnosis (EID) in children less than 18 months of
age (Nigerian Federal Ministry of Health, 2011).
RECOMMENDED HIV TEST KITS
An essential requirement of all HIV testing is accuracy of
the test result. The rapid test kits used are those approved
by health agencies as part of the algorithm by HIV/AIDS
xcii
Division of federal ministry of health (Nigerian Federal
Ministry of Health, 2011).
TESTING ALGORITHMS
Testing algorithms show the strategies to be used for
HIV testing, there are three strategies defined by World
Health Organization (WHO), based on different principles or
methods known as testing algorithm (Nigerian Federal
Ministry of Health, 2011).
Serial Testing: With serial testing, an innitial blood
sample is taken and tested using the more sensitive kit. If
the result is negative, the result is given to the client as
HIV negative. If the result is positive, the blood sample is
tested using a second HIV rapid test kit, if the second test
is also positive, the result is given to the client as HIV
positive. However, if the second test is negative, a tie
Breaker is used as the third test kit and the result of the
tie breaker becomes final (Nigerian Federal Ministry of
xciii
Test Specimen with Screening Test
Test Result Negative
Test Result Positive
Report as Negative Test Specimen using a second rapid test with a different antigenic specifity
Test Result Negative
Test Result Positive
Report as PositiveTest Specimen using Tie breaker
Test Result Negative
Report as Negative
Test Result Positive
Re-test client in 3 months
Health, 2011). The serial testing algorithm flow is shown in
the figure 2.6 below.
xciv
Test specimen with two rapid test kits of different antigenic specifity
at the same time
Both Test Kits give same result?No
Test Specimen on a different Third Test Kit (Tie-Breaker)
Fig 2.6: Serial Algorithm for HIV testing.(Source: Nigerian Federal Ministry of Health, 2011)
Parallel Testing:Parallel testing strategy involves use of
blood samples (plasma, Serum or whole blood) with two HIV
test kits based on different test principles simultaneously
(in parallel) and the result issued if both test gives the
same result (concordant result), however, if one result is
positive and the other is negative (discordant result), the
tests are repeated using the same test kits. If the result
is still discordant, a recommended tie breaker is used and
the result from the tie breaker is given to the client. In
cases where the tie breaker is not available, the client is
referred to a reference laboratory (Nigerian Federal
Ministry of Health, 2011). Parallel algorithm is further
explained by the figure 2.7 below.
xcv
Yes
Report Test Result as seenReport Test Result as seen
Fig 2.7: Parallel Algorithm for HIV testing.
(Source: Nigerian Federal Ministry of Health, 2011)
2.9 DRUG PRESCRIPTION AND DISPENSAL
In the early 1980s, when the HIV/AIDS epidemic began,
patients rarely lived longer than a few years. But today,
there are many effective medicines to fight the infection,
and people with HIV have longer, healthier lives. Although
there is still no cure for HIV, treatment is now effective
at allowing people with HIV to live their lives as normally
as possible. Since the introduction of medicines to treat
xcvi
HIV, the death rate of AIDS has reduced dramatically. With
effective treatment, very few people go on to develop AIDS.
HIV is now a treatable medical condition and most
people with the virus remain fit and well on treatment.
Since the 1990’s, a number of medicines have been developed
called antiretroviral medicines. Antiretroviral medicines
work against HIV infection by slowing down the replication
of the virus in the body, newer medicines are more effective
than medicines in the past. There are several classes of
these medicines which include Neucleuside Reverse
Transcriptase Inhibitors (NRTIs), Neucleutide Reverse
Transcriptase Inhibitors (NtRTIs), Protase Inhibitors (PIs)
and Non- Neucleuside Reverse Transcriptase Inhibitors
(NNRTIs). Newer classes of medicines have recently been
introduced which are Integrase Inhibitors, Fusion Inhibitors
and CCR5 antagonists. The medicine in each class works in
different ways but all work to stop the HIV from replicating
itself. This method of treatment is called Anti-Retroviral
xcvii
Therapy (ART), it is still occasionally referred to as
Highly Active Antiretroviral Therapy (www.MedlinePlus.htm).
As a general rule, drug dispenser is normally started
when
- CD4 T cells has fallen below a certain level (around
350 cells per cubic millimeter of blood or less) even
without symptoms, the exact level when drug is
dispensed depends on various factors which doctors do
discuss with the infected persons during post
counseling. These include any symptom present and the
rate of decline of the CD4 T cells.
- Opportunistic infections or other AIDS-related problems
develop. Opportunistic infections are usually treated
with anti-biotics, anti-fungals or anti-TB medicines
obviously depending on which infection develops, even
if infections have not developed, once the CD4 T-cells
fall to a low level, regular doses of one or more
antibiotics is being advised or other medicines to
xcviii
prevent certain infections from developing
(www.MedlinePlus.htm).
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 SYSTEM STUDY AND INVESTIGATION
The proposed expert system, ‘An Expert System for
HIV/AIDS Diagnosis’ (HADS), is a rule based medical expert
system for the diagnosis of HIV/AIDS. Though the system is
built as a standalone application that works offline with the
xcix
computer system running as the system host with the use of a
local host server, a web browser is needed to display user
interfaces for interactions between the system and its users,
therefore, the system uses Personal Home page Hypertext
Preprocessor (PHP) scripting language with Structured Query
Language (SQL) database as the programming languages. Forward
chaining inference mechanism is employed in HADS. This is a
menu based interactive system where systems communicate with
users in common understandable language. The system consists
of multiple options for diagnosis, how to use the system and
also answers some frequently asked questions related to
HIV/AIDS, it also keeps track of patients that miss their
scheduled appointments and documents treatments of those
found positive during the diagnosis which involves step-by-
step questioning by the system users and recording of answers
in the counseling procedure which aid the patients to live a
normal life Those found negative are also advised on how to
continue living a HIV/AIDS free life. The system uses plain
c
English language to interact with users, no special knowledge
is required for individuals to use it. In the diagnosis
option, based on the individual’s answer, the system analyses
the risk level of patients and calculates the percentage
possibility of positivity/negativity of the patient. The
proposed expert system is however not a substitute for
physicians, the expert system will provide a generic
conclusion based on user inputs. The application will
identify the patient’s risk level but cannot be used as a
conclusive result of the patient’s status, the application
will further advice the patients to go for a laboratory
testing where their laboratory results will be entered and
final conclusions can then be made basically by the actual
laboratory result generated and keyed into the system. The
research methodology and system design actually follow the
hierarchy represented in the figure below
ci
Fig 3.1: Hierarchy of Expert System development process
From figure 3.1, the background, concepts and problem
selection are discussed under the same heading as the system
study and investigation, where a procedure is undertaken in
learning about HIV/AIDS and its various symptoms and
available treatment before looking for a way of designing a
system that will be able to use these selected problems to
diagnose the ailment. By this, it was learnt that, to be
diagnosed, the patient has to go through a process known as
cii
Voluntary Testing and Counseling (VCT). The process therefore
consists of the basic steps used in the design of the
proposed system as it basically involves pre–test counseling,
actual testing and post test counseling, by this, the
HIV/AIDS Diagnostic System (HADS) is divided into modules to
handle the above tasks.
HIV/AIDS DIAGNOSTIC SYSTEM MODULES
Fig. 3.2: Modules of the Proposed Expert system for HIV/AIDS
Diagnosis
From the above module in Figure 3.2, the pre-test
counseling module is an interactive module that serves as a
dialogue room between the counselor and the patient
VOLUNTARY COUNSELING AND TESTING
PRE-TEST COUNSELING
TESTING
POST-TEST COUNSELING
ciii
(client), during this session, the counselor helps the
client to decide whether or not to be tested for HIV, this
module encapsulates the following areas;
(a) Reasons for wanting the test
(b) Giving information and rectifying misconceptions
about HIV and its transmission
(c) Assessment of personal risk
(d) Explanation of the test, procedure, meaning of a
positive result and positive implications
(e) Assessment of social support system, if the test
result turns out to be positive (partner, family,
friends, etc): coping with a positive result
(f) Development of personal risk reduction plan
(g) Informed consent/dissent for the HIV antibody test
giving freely
After the entire session, the patient (client) is given
adequate time to ask questions and digest new information.
Some clients will tend to defer the following procedure
civ
(testing) while others will go ahead and perform the test
at that instance, all the above processes are included in
the design of this module.
The testing module handles the laboratory procedure of
taking small amount of blood from the client’s arm using
needle and syringe, or by pricking the client’s finger tip
to get blood on a test kit for laboratory examination. The
result (positive), shows the presence of antibodies in the
blood which indicates that the body is trying to defend
itself against the virus. An infected client will develop
these antibodies within three months of getting infected.
REACTIVE (POSITIVE) TEST RESULT
When a line appears adjacent to control and adjacent to
test on the device (test kit) where a blood sample is
collected, a positive test is read, this is however
performed again using another test kit for confirmation,
when the same lines appears, it implies a reactive result is
confirmed from the sample collected.
cv
NON-REACTIVE (NEGATIVE) TEST RESULT
A negative result is read when a line only appears
adjacent to the control line but no line appears adjacent to
the test line, if this occurs at the baseline level, another
sample is collected on another test kit and if same occurs,
a negative result is confirmed.
INVALID RESULT
Invalid results are of two kinds, results are said to
be invalid when after a sample is collected, there is no
line on either the control line or the test line and/or if
there happen to be just a single line adjacent to the test
line but the control line is blank, when this happens, the
test is performed again as the kit used might be faulty or
an error occurred during the procedure.
The next module is the post test counseling module,
this covers the after test talks where the patient(client)
is taught how to live with his/her result, a positive
result, is counseled and advised to perform further test
cvi
that suggests the treatment procedure of the positive
client, the client performs further test known as CD4 test
to ascertain the level of the viral load so as to commence
his treatment, a negative result counseling however differs,
the client in this case is taught on how to stay negative
and live a HIV free life.
3.2 DOMAIN AND KNOWLEDGE ACQUISITION
Knowledge acquisition includes the elicitation,
collection, analysis, modeling and validation of knowledge.
It is one of the most difficult phases in the building of an
expert system according to Chakraborty (www.myreaders.info).
However, it is not really surprising that it should be
difficult to extract rules from an expert whose skills will
generally lie in performing a given task and not in
explaining to others how it should be done. Diagnosticc
knowledge concerns the way a HIV/AIDS diagnosis is
performed. It is distiguished in two types. The first type
procedural diagnostic knowedge, refelcts the diagnostic
cvii
procedure. Diagnosis of HIV/AIDS is a two fold procedure. An
initial diagnosis, called early diagnosis, it is performed
based on the body fluid samples such as blood, semen, urine,
vaginal fluid and clinical data of the patient. This is then
used as a reference base for another test known as a
confirmatory test which the patient is adviced to undergo
six month after the early test. This later diagnosis may or
may not coincide with the initial. If it does, there is a
full assurance of the initial result. The second type of
diagnostic kowledge, heuristic diagnostic knowledge,
represents experience accumulated through years and concerns
the way an expert uses the patient data to make diagnoses.
Heuristic knowledge is acquired by actually interviewing
experts in the field and constructing a diagnosis tree based
on criteria such as their sex and the age of the
patients(clients), the existence and the acuteness of
symptoms like pains, fever, etc, these are all based on
qualitative features, such as whether the concentration of
cviii
smptoms is uniform or not, and quantitative features such as
whether the sickness is normal, slightly increased, or
persistent e.t.c. These real parameters will then act as the
used attributes. The knowledge of physicians consist of
general knowledge they may have obtained from medical books
plus their experiences connected with cases they have
treated themselves or colleagues have told them about.
Particularly, in diagnostic tasks, the thought of physicians
circle around typical cases. They consider the difference
between current patients and typical or known exceptional
cases. The main purpose of such generalised knowlegde is to
guide the retrival process and most times, to decrease the
amount of memory requirements by erasing redudant cases.
Much of the efforts in building a case based system goes
into case collection. Cases in the case library should be
able to provide much coverage as possible about achieving
reasoning goals (Eriksson, 1992). With all the above, the
system knowledge is acquired for the proposed HIV/AIDS
cix
Diagnostic system (HADS) and its basis is further
illustrated in figure 3.3 below.
Fig. 3.3: Domain and knowledge acquisition
From the perspective of the designed system, the system
was designed following the procedure listed below;
1. Planning of knowledge base (the content of the
knowledge base, relevant inputs and outputs, strategy for
testing, knowledge dictionary, concepts etc) were
identified.
2. Domain experts and knowledge sources were then
carefully selected
3. Knowledge Acquisition was carried out by visiting
organizations and establishments practicing HIV/AIDS
diagnosis.
KNOWLEDGE BASE
DOMAIN KNOWLEDGE
KNOWLEDGE ENGINEER
cx
4. Formulation and representation of knowledge (knowledge
is formulated in the form suitable for inference).
5. Implementation of knowledge base (knowledge is encoded
in machine-readable form.)
6. Testing of knowledge base depending on the results.
3.3 KNOWLEDGE REPRESENTATION
Knowledge representation is important and crucially
affects the case and speed with which the inference engine
can use it. Knowledge representation implies a systematic
means of encoding what an expert knows about a knowledge
domain in an appropriate medium (Goodall, 1985). A number of
knowledge acquisition techniques have been developed.
(Turban, 1993) discussed a variety of techniques, the
selection of a technique depends on the type of knowledge
that should be retained in the knowledge base. Knowledge can
be classified according to him (Turban, 1993) as Surface
knowledge, to put declarative and procedural knowledge into
heuristic to solve a problem quickly or deep knowledge,
cxi
which involves fundamental knowledge of domain including the
definitions, axioms, general laws, principles and causal
relationships upheld by the knowledge. Surface knowledge is
the basis for most common expert systems using production
rules. Production rules are widely used and quite efficient
in diagnostic problems. They are used to encode rules of
thumb also called heuristics used by humans (Turban, 1995).
According to Beynon-Davies (1991) knowledge
representation is the systematic means of encoding knowledge
of the human expert in an appropriate medium. Knowledge can
be represented as;
Predicate calculus
Business applications in the form of production rules
Semantic networks, which organize knowledge through
nodes in graphs rather than data structure and
represent relationships between the facts by links
between the nodes, and
cxii
Frames or structured objects that use data structure
to store all structural knowledge of specific objects
in one place.
Logic itself is not a way for computers to store
knowledge, but proves to be a vital tool to think about
how computers store knowledge. According to Goodall
(1985), logic is part of mathematics and can be used in
various forms to reason about the correctness of
computation and inferences. The forms of knowledge
include:
- Programming languages such as PROLOG (PROgramming in
LOGic).
- Pre-positional logic or calculus that consist of
building blocks such as elementary sentences joined
by “and”, “or” and “not”. The internal structure of
the elementary sentence is irrelevant, and
- Predicate logic with its basic building block objects
and relations such as “is-a”, and “has-a” between
cxiii
them to build statements. The relations are called
predicates and deal with the logic operators “and”,
“or” and not.
The above provide a theory to formalize the study of
reasoning, determining valid knowledge representations.
It is used to prove the correctness or determine that
certain types of inferences are correct or incorrect.
However, the basic forms of knowledge representation
according to De-Kock (2003) often used in expert
systems are;
Rules, rules are often called production rules and the
programs that reason with rules, a production system,
especially when the inference is data directed and forward-
chaining(matching the current state with the rules,
antecedents or conditions in the knowledge base), this implies
that, every knowledge base consists of facts and rules and a
rule interpreter to match the rule condition against the facts
with a means of extracting this knowledge so that to derive a
cxiv
new knowledge. Most expert systems represent knowledge as
rules and therefore the knowledge base is often refered to as
the rule base. The reason for its popularity is that almost
every piece of knowledge can be written as a rule. Many expert
systems exist that require rules as inputs and tempt knowledge
workers to express knowledge as such. Rules are natural and
the only way to codify some knowledge. Rules are a simulation
of the cogntive behaviour of human experts. They represent
knowledge, but also represent a model of actual human
behaviour. Rules are easy for a human expert to read,
understand and maintain. If the message is expressed as data
and not encoded in the program control mechanism, it can be
returned to the user in form of explanations. Production rules
involve simple syntax that is flexible and easy to understand.
They are quite efficient in diagnosing problems of the form:
If (condition)
Then(conclusion)
cxv
Each production rule in a knowledge base implements a chunk
of expertise and when fed to the inference engine, as part
of a set, should synergestically yield a better result than
any of the rules individually. In reality, rules are highly
independent and adding a new rule may contradict other rules
or cause other rules to be revised. Rule system can broadly
be classified into simple, all rules on the same level and
available to every search cycle, and structured rule base
systems where searches are limited to segments of the rule
base, thus improving the efficiency of the search. A rule
set is a named collection of individual rules pertaining to
a distinct aspect of a problem and helps in comprehending
and maintaining the rule base. This structure is a kind of
meta-knowledge that is imposed on the knowledge base. Each
sub problem could have its own rule set (Klein and Methlie,
1995).
Semantic Nets is a popular and easy to understand way of
representing non-rule knowledge. Semantic network organises
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knowledge through nodes in a graph rather than a data
stucture. Links or arcs presents relationship between the
named nodes. The links or arcs represents relationships such
as is-a, has, is, own, needs and reflects the association
between concepts. An expert system that stores information
as a semantic network incprporate an inference engine
devoted to operations like inheritance. Such an iference
engine will consist of two parts, one part will deal with
rules by forward chaining, backward chaining or some other
method. The other part will handle net operations matching
relevant links in the net to deduce facts. Objects can be
described by a number of features or attributes, many of
which stay constant from one instant to the next.
A Frame is a piece of structured data about typical
characterisics of an object, act or event. The knowledge is
more descriptive than procedural. Similar to rules, frames
must be able to deal with uncertainty and missing values.
Frames may have default values and slot filling procedures
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associated with the slot to cope with missing values. Frames
enable reasoning about objects features such as inheritance
and the occurance of exceptions. The reasoning process
starts by identifying a frame as applicable to the current
situation. Matching the set of frames against the facts
available selects an appropriate frame. The use of frame is
relevant to non-monotonic logic. Non-monotonic reasoning
expresses reasoning with default attributes (Kock, 2003).
Case-based reasoning is a process that uses similar problems
to solve the current problem, it consists of two steps:
1 Find those cases in memory that solved problems
similar to the current problem.
2 Adapt previous solutions to fit the current
problem.
The case library forms an extra important component in
case based reasoning. The inference engine, using case based
reasoning consist of retrieving solutions, adapting
solutions and testing solutions.
cxviii
The critical step is to find and retrieve a relevant
case from the case library. Cases are stored using indexes.
The stored case contains a solution, which is then adapted
by modifying the parameters of the old problem to suit the
new situation resulting in a proposed solution. The solution
is tested and if found successful, added to the case library
(Klein and Methlie, 1995). Knowledge acquisition is easier
in case based reasoning because of the granularity of the
knowledge. The knowledge representation of the proposed
system (HIV/AIDS Diagnostic System) is also cased-based as
most of the results from the system are read from the
knowledge of known and stored details(cases). By that, users
only key in answers to asked questions and actions are
performed using the answers, for instance, in the aspect
where result is being displayed, users only select from a
list of available results, the best that suits their case
and the client result is told based on the selected case.
Similarly, questions asked in assessing clients’ risks are
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based on cases stored in the knowledge base, from those
cases, the user is given a percentage possibility of his/her
client’s status.
3.4 SYSTEM DEVELOPMENT AND SPECIFICATION
The proposed system, ‘HIV/AIDS Diagnostic System’
(HADS), is a case based medical expert system for the
diagnosis of HIV/AIDS using PHP to enable proper interface
design and coding of instructions (syntax) with MYSQL
technology as the programming languages. Forward chaining
inference mechanism is employed in the system design. This
is a menu based interactive system where systems communicate
with user in common understandable language. The system
consists of multiple options for diagnosis and training help
manual. As the system uses plain English language to
interact with users, no special knowledge is required for
individuals to use it. In the Diagnosis option, based on the
individual’s answer, the system checks the possibility of
the individual having HIV antibodies, if the result is found
cxx
positive it also checks the CD4 T cells and advices the
pattern for treatment. The system is also provided with
HIV/AIDS step-by-step counseling options which can be used
to develop awareness among the people. The proposed system
is however, not a substitute for physicians, the system will
provide a generic conclusion based on user input. The
application will identify the individual’s risk possibility
and advice for some laboratory test from time to time.
Furthermore, from the design specification as required
by users of the manual system due to its limitations, the
new system can preserve knowledge for future use and other
references in both diagnostic and research work.
3.5 USER REQUIREMENTS
The requirements for the proposed system for HIV/AIDS
diagnosis will comprise of any computer set that is
compatible with the WAMP(Windows APACHE My-sql PHP)-SERVER ,
this implies that the proposed system will be able to run on
any computer system with a web server, My-sql(structured
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PHASE 3: Development of a prototype systemChoose a tool for building an intelligent systemTransform data and represent knowledgeDesign and implement a prototype systemTest the prototype with test cases
PHASE 1: Problem AssessmentDetermine the Problem’s characteristicIdentify the main participants in the projectSpecify the projects objectivesDetermine the resources needed for building the system
PHASE 2: Data and Knowledge AcquisitionCollect and Analyze data and knowledgeMake key concepts of the system design more explicit
PHASE 4: Develop a complete systemPrepare a detailed design for a full scale systemCollect additional data and knowledgeDevelop the user interfaceImplement the complete system
Query Language), PHP(Personal Homepage Hypertext Pre-
Processor) and a web browser as its basic requirements.
3.6 SYSTEM DESIGN AND DEVELOPMENT PROCESS
The system design and development process followed a
phase by phase procedure, each of the phases followed are
first of all explained below with a diagrammatical flow
represented in figure 3.4 below for more understanding;
cxxii
PHASE 4: Develop a complete systemPrepare a detailed design for a full scale systemCollect additional data and knowledgeDevelop the user interfaceImplement the complete system
PHASE 5: Evaluation and Revision of the SystemEvaluate the system against the performance criteriaRevise the system as Necessary
PHASE 5: Integration and Maintenance of the SystemMake arrangement for technology transferEstablish an effective maintenance program
Fig. 3.4 System development procedure
Problem assessment phase: During this phase, the problem
characteristics are determined, project participants
identified, specify the project’s objectives and determine
what resources are needed for building the system.
To characterize the problem, we need to determine the
problem type, input and output variables and their
cxxiii
interactions, and the form and content of the solution as
well as identify the problem type which is a medical
diagnostic problem.
Data and knowledge acquisition phase: During this phase,
further understanding of the problem domain is obtained by
collecting and analyzing both data and knowledge, and making
key concepts of the system’s design more explicit. The data
collection was specific from recognized Non-Governmental
Organizations in Benue state, mostly from Positive Health
Media Initiative (PHMI) located opposite S.R.S Junction,
University of Agriculture Makurdi park in North Bank Makurdi
where the program manager, Mr. Innocent Ogidi acquainted the
researcher with manual testing procedures and practically
sent the researcher with some team of volunteers to the feed
where we did the manual testing and counseling. Dr Ochalebe
Peter of Centre for Integrated Health program located off
Atom Kpera road in Makurdi also provided some helpful
knowledge on test procedures and went ahead to connect with
cxxiv
Aids Health Foundation (AHF) also in Makurdi, Benue State,
while at Aids Health Foundation, a volunteer for the
organization was contacted to acquire adequate knowledge
required for the research work during which villages like
Abinsi in Guma Local Government, Agasha in Guma Local
Government, Wannune Local Government, Tse-Kucha in Gboko
Local Government and others all in Benue State of Nigeria
were visited to perform manual testing and counseling for
basic understanding of the manual procedure for effective
design of the computerized diagnostic system.
Development of a prototype system phase: This
actually involves creating a small version of the system and
testing it with a number of test cases. A prototype system
can be defined as a small version of the final system. It is
designed to test how well we understand the problem, or in
other words to make sure that the problem-solving strategy,
the tool selected for building a system, and techniques for
representing acquired data and knowledge are adequate to the
cxxv
task. It also provides us with an opportunity to persuade
the skeptics and, in many cases, to actively engage the
domain expert in the system’s development.
Development of a complete system phase: As soon as
the prototype begins functioning satisfactorily, what is
actually involved in developing a full-scale system can then
be assessed. A plan was structured, schedule and budget for
the complete system was made, and also a clear definition of
system’s performance criteria. The main work at this phase
is often associated with adding data and knowledge to the
system.
Evaluation and revision of the system phase: Intelligent
systems, unlike conventional computer programs, are designed
to solve problems that quite often do not have clearly
defined ‘right’ and ‘wrong’ solutions. To evaluate an
intelligent system is, in fact, to assure that the system
performs the intended task to the user’s satisfaction. A
formal evaluation of the system is normally accomplished
cxxvi
with the test cases selected by the user. The system’s
performance is compared against the performance criteria
that were agreed upon at the end of the prototyping phase.
The evaluation often reveals the system’s limitations and
weaknesses, so it is revised and relevant development phases
are repeated.
Integration and maintenance phase: This is the final
phase in developing the system. It involves integrating the
system into the environment where it will operate and
establishing an effective maintenance program. By
‘integrating’, it means interfacing a new intelligent system
with existing systems within an organization and arranging
for technology transfer. It must be checked that the users
knows how to use and maintain the system. Intelligent
systems are knowledge-based systems, and because knowledge
evolves over time, it is necessary to be able to modify the
system.
cxxvii
ENTER CD4-COUNT AND OPPORTUNISTIC
INFECTION RESULT
Take a Diagnostic test
Pre-Test Counseling
Correctly counseled?
VIEW & ATTEND
TO REQUESTS
DISPENSE DRUGS
Enter password
Start
Password correct?
Staff page
HCT STAFF DOCTOR LABORATORY
PHARMACIST
CONSULTANT
StopStop
From the above described phases, a model of the
proposed system was built using the flow represented below
in figure 3.6, figure 3.7 and figure 3.8
NO
YES
cxxviii
ENTER CD4-COUNT AND OPPORTUNISTIC
INFECTION RESULT
VIEW NEWLY
DIAGNOSED
VIEW APPOINTMENT LIST
VIEW INDIVIDUAL HISTORY
StopStop
Stop
Stop
Laboratory Testing
Stop
Correctly counseled?
Save record
Want a lab test?
1
Case 3Case 1Case 2
1
LABORATORY TESTING
NO YES
Fig. 3.6 System Flow Chart
KIT A cxxix
Invalid RESULT
Positive HIV antibodies result
Case 1
Case 2
KIT BNegative HIV antibodies
result
Negative Post-Test Counseling
STOP
Positive HIV
antibodies result
Case 1
Case 2
Negative HIV antibodies result
Positive HIV antibodies
result
KIT C
Test for Opportunistic infections2
STOP
YES
Fig. 3.7 Procedural flow of the system
Test for Opportunisticinfections
2
Negative HIV
cxxx
Fig. 3.8 Procedural flow of the system
Reoccurringinfections
CD4 >500 &viral load
CD4 >=200 ||<=500 viral
CD4 <200 &viral load
Immediatetreatment
Keep monthlycheck and
Keep monthlycheck and
Immediatetreatment
STOP
cxxxi
3.7 DATABASE
A database is a collection of information organized
in such a way that a computer program can quickly select
desired pieces of data. It can be thought of as an
electronic filing system. They are organized in fields,
records and files where a field is a single piece of
information; a record is one complete set of fields; and a
file is a collection of records. A database management
system (DBMS), which is a software system designed to allow
the definition, creation, querying, update and
administration of databases and includes software like
oracle, Microsoft access, dBASE, FoxPro, MySQL, SQLite,
helps in maintaining the database. For the proposed system,
MySQL Database Management System was used for data
cxxxii
collection and manipulations, the sample of a database
management system in MYSQL Query Browser format is shown in
figure 3.9 and 3.10 below.
Fig 3.9: Sample of SQL Database management system as used in the proposed
system
Fig 3.10: Sample of SQL Database management system as used in the proposed
system
3.8 DATA SECURITY
Data security has to do with safe keeping of collected
data in the system, the most important part of the designed
system is its database as the entire system operations
revolve round it. From the system specifications, the
manual system had problems of privacy and other issues like
cxxxiii
loss of data, since this system is an expert system, such
issues will not come-up and data security will be guaranteed
using the following steps:
1 The system usage is restricted to only registered
staff with passwords and unauthorized entry will not
be possible
2 There is staff organizational hierarchy which limits
staff functions, by this, most sensitive functions
are performed only by administrative staff
3 Patient’s diagnosis cannot be altered by staff for
any personal reason.
4 Saved records can remain in the system for as long as
required without being tempered with.
5 The system is properly built and packaged after
several error test at various
design levels.
cxxxiv
CHAPTER FOUR: RESULTS, DISCUSSION AND CONCLUSION
4.1 DOCUMENTATION
The HIV/AIDS diagnostic system (HADS) is a medical
expert system that aids in the diagnosis of HIV antibodies
and in detecting the extent of the infection so as to
recommend treatment options in infected persons, it contains
answers to some frequently asked questions about the
disease, it has a help module that assists the users, it has
its operational terms and condition module, the system also
contains many secured modules that are used for its actual
design purposes. These modules are made secured so as to
ensure that usage is only by authorized personnel and
restriction to diagnostic procedures is guaranteed. The
system is to be however used following recommendations of
its designer which revolve around the presence of a human
expert in any medical establishment using the system.
cxxxv
4.2 HARDWARE REQUIREMENTS
There are great varieties of hardware available for
various computer information system, the requirement for the
proper usage of any expert system depends on the task
performed by the system, due to high processing operation of
the designed system, powerful microcomputers with very high
processing speed are required, hence the system will
function well in a well ventilated environment where there
is constant power supply with the following components
connected together for as many as available users;
A computer Central Processing Unit (CPU) with at least 1GB
memory and 100GB hard disk capacity and a 200GB external
hard disk for backup
A computer Visual Display Unit (VDU) otherwise known as a
Monitor of at least 14 inches
A computer Keyboard, and
HP Laserjet Printers of model P1100 and above
cxxxvi
All the Central Processing Units (CPU) must have been
installed with a Web Server (APACHE) which acts as the
system local host, My-SQL My Admin which is used for the
system database, PHP which is the scripting language used
for the system design and there must be a web browser like
Google chrome browser, torch browser or any other web
browser to enable Graphical User Interface (GUI).
4.3 INSTALLATION GUIDE
The installation for the system is done by getting
WAMP(Windows APACHE Mysql and PHP) server software which
contains the APACHE as a host, My-SQL as a database and PHP
as the scripting language, this software is then installed
on the number of central processing units required by the
agencies using the designed system, after the installation,
the WAMP is then located in drive C of the CPUs, opened to
locate a folder known as BIN which houses another folder
called PHP that contains PHP configuration settings. When
located, settings are done by the installer as it suits the
cxxxvii
CPUs in use. The PHP My Admin is also located using the same
procedure by locating WAMP and further locating the MyAdmin
folder which houses Config.inc, this file is opened and the
password setting is done on the application installed to
ensure security of the database in use.
4.4 SYSTEM TESTING
System testing is a crucial aspect of implementation
activity. It requires careful planning on the part of the
designer. System testing involves running of the program
with data representation of all the anticipated processing
conditions that will be encountered so as to detect possible
errors and fix them in the course of the system design.
Before a system is put to use, this procedure is very
important as it is indeed a programming practice to
extensively test a program before compiling it. In the
course of this design, a prototype of the HIV/AIDS
diagnostic system was first designed and tested before the
complete system design was carried out, this procedure was
cxxxviii
of great help as it reduced the errors during system testing
of the complete design to the barest minimum and only few
corrections where made during this stage.
4.5 TRAINNING
The training of the system users of the designed system
should be properly ensured in all expert system designs,
this is for the fact that, an expert system does not however
eliminate the need for a human expert, it only fastens the
job of human experts, by this, each and every center where
this system is to be used must have competent computer
operators who are properly trained, the system itself
contains a help module that further gives some basics of
usage to persons that have already been oriented on the
usage.
4.6 SYSTEM MAINTENANCE
This stage has to do with the monitoring, evaluating
and modification of the system to suit desirable and
necessary improvements, this aspect is to be handled by an
cxxxix
expert who is mostly the program designer as it requires
some special skills for proper modifications to be effected
on the system. The programmer if not available at any point
in time is required to pass the administrative security to
someone who is trusted by the establishment so that the
person can have access to maintenance tools.
4.7 SYSTEM IMPLEMENTATION
The system implementation phase describes the completed
system based on its mode of operation, at this stage, the
system definition is checked practically as end users are
trained, an operational team is built as a productive
environment is set for required performance.
The designed system helps clients detect with great
reliability and assurance of security their HIV status in
testing centers by entering test results based on test and
control lines on test kits into the system. The system is
built with analytical operational analogies conforming to
that of the national interim algorithm for HIV serology as
cxl
defined by the Nigerian Federal Ministry of Health, by their
definition, Test kit 1 represents the first line kit which
in the case of the designed system, the first line test kit
is “determine”, Test Kit 2 is “uni-Gold” and Test Kit 3 is
“Stat pak”. The result is determined by the appearance of
certain lines on the above mentioned test kits, these lines
are recorded into the result form as designed in the system.
The designed system contains numerous pages for effective
implementation such as;
Admin page: The admin page shown in figure 4.1 is the most
secured and most important page of the designed system, the
access to the page is granted by the system designer to the
head of the establishment where the system is to be used. It
cxli
is an important page because the person who is made the
administrator controls and gives accesses to other staff of
the establishment, the page is as shown below;
Fig 4.1: administrator’s page
Index Page: The index page or home page of the system
shown in figure 4.2 contains some introductory messages that
explain the system, it also contains two login information
for both newly created staff and old staff, at the creation
of staff by the system administrator, the staff is created
with some default details, hence the login for new staff is
a link, that takes them to a page that validates their login
with their own preferred passwords, by the change of their
default details, they are then granted access to the staff
area of the system by proper login from the index page which
contains fields for Username and Passwords. The username is
automatically created during staff creation by the system
administrator, it contains both variables and characters
cxlii
which are concatenated together. Samples of some staff
usernames are shown below.
Hads5449
Hads3082
Hads2122
Hads1971
The usernames are randomly created and do not follow
each other serially, the method improves the system security
a lot, the index page is as shown below.
Fig 4.2: index (home) pagecxliii
Staff Page: On successful login, the staff is taken to
his/her respective page to perform their functions, the
available staff pages on the system are the counselors’
page where counseling and testing are carried out, the
laboratory page where laboratory test results are recorded,
the doctor page where drug prescription is done, the
pharmacy page where drug dispensing is done and finally the
consultant page where clients who fail to stay healthy
after taking drugs are sent for proper checking. The
activities performed by the counseling and testing staff
involve risk assessment of clients so as to know how to
cxliv
perform counseling properly, the assessment page is as
shown in figure 4.3 below;
Fig 4.3: analysis page
During the above analysis, client risk and opportunistic
infection analysis are performed by counting from his/her
response during analysis, the result aids the staff on
counseling. The possibilities are calculated as seen below
in figure 4.4;
cxlv
Fig 4.4: Risk analysis page
Testing page: The test page is of three sectors, the
determine page is the first test page, its contains three
test result using determine as line one (1) test procedure,
the results are the positive result, negative result and the
invalid result. The uni-gold test page is also similar to
the determine and so also is the stat-pak test page as they
all have test results of type positive, negative and
invalid. The images of the three test pages which are the
determine test page, uni-gold test page and stat-pak test
page are respectively represented below in figure 4.5,
figure 4.6 and figure 4.7 respectively.
cxlvi
Fig 4.7: stat-pak test page
Result page: The test result page represented in
figure 4.8 and figure 4.9 declares the status of the client,
during testing, there are two possible test results to be
expected, a Positive test result as seen in figure 4.8
indicates that the antibody responsible for HIV infection is
found present in the client while a negative result as shown
in figure 4.9 shows that the client is free of such
antibody. The result pages for positive and negative results
are respectively shown below;
cxlviii
Fig 4.8: Positive test result page
Fig 4.9: Negative test result page
Enrolment page: The enrolment page shown in figure
4.10 handles client enrolment into treatment plan for those
found to be positive, the page collects clients’ details and
records into the system database for continuous treatment
cxlix
procedures since the cure for HIV is not yet available, the
page is shown below;
Fig 4.10: Client enrolment page
4.8 SYSTEM SPECIFICATIONS
DATABASE SPECIFICATION
The database used in the system design is MySQL
database, the choice is due to its flexibility and easy
ability to communicate with windows applications. The system
has several tables in the database, the tables aid easy
information movement in and out of the database. The system
database is named using the abbreviation of HIV and AIDS
cl
Diagnostic System (HADS), the HADS database tables are as
shown below in table 4.0;
Table 4.0: HADS Database
Each table in the database contains fields in rows and
columns, they are designed to house variables as defined for
the purpose of the diagnostic system. A look at few of the
system tables to see their data type and data sizes are
cli
shown below in figure 4.1, figure 4.2, figure 4.3 and figure
4.4;
Table 4.1: ADMIN Table
Table 4.2: STAFF Table
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Table 4.3: PATIENTS Table
Table 4.4: APPOINTMENT Table
PROGRAM MODULE SPECIFICATION
The HIV/AIDS Diagnostic System is divided into several
modules, these modules were merged together to produce the
whole system, the modules are;
1 The Login Module
2 The Staff module
3 Counseling and Testing module
4 Laboratory Module
5 Prescription module
6 Drug dispenser module
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7 The history module
The above modules all work together to form the whole
diagnostic system, the function of each of the modules is
further explained using table 4.5
S/NO MODULE NAME PROGRAM MODULE ACTIVITY MODULE
1 Login
Module
Myindex.php Grants access to registered
staff
2 Staff
Module
Staffpage.php Provides links to varying
locations due to staffcliv
profession and clearance code
3 Counseling
and Testing
Module
Analysis.php Accesses clients’ risks and
use risk analysis to counsel
client before testing client
4 Laboratory
Module
Viewrequest.ph
p
Views client’s test request,
performs and records the
required test on client for
proper prescriptions by
doctors
5 Prescriptio
n Module
Prescribe.php Client’s drugs are prescribed
and recorded for future
references
6 Drug
Dispenser
Module
Dispensed.php Pharmacist dispenses drugs to
positive clients and records
drugs dispensed for history
purpose
7 History
Module
Viewhistory.ph
p
The history module handles
client’s drug collection
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history, it is important as
in time of drug failure, the
client’s history is checked
and forwarded to a consultant
for proper consultations
Table 4.5: Detailed Modules specification Table
4.9 RESULTS AND DISCUSSION
The result from the merged system produced wonderful
output, the system was able to build confidence in clients
as most persons show interest in computer-based systems as
compared to manual systems, by that, the usage presented
great deal of reliability as clients tend to attend to users
of the diagnostic system during test procedure and hence
increasing convenience in the side of both the clients and
system users.
The effectiveness of Knowledge domain was also proven
as during the risk analysis stage, clients risk count was
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performed and an analysis of possibilities was also given
based on the knowledge embedded inside the knowledge domain
of the system, the result phase was also built on the bases
of knowledge domain as selection based on colour change
produces a test result for clients.
The entire system also shows a result regarding its
financial implications, though the initial cost of
installing the system is high, it however reduces the number
of staff in each and every organization interested in the
use of the system, by these, the cost involvement of
HIV/AIDS diagnosis in establishments can reduce drastically
with time. However, the output from the few hands tends to
be more as compared to the manual system.
4.10 CONCLUSION
Medical expert systems have by all means proven
effective in medical establishments, by these, the use of
medical diagnostic system has become very popular in medical
establishments of recent. The proposed system can help
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establishments that use it in effective and confidential
counseling and testing. The system gives with great amount
of accuracy due to clients responses the possibility of a
client being infected with the virus before displaying the
result, though the surest way is by testing, the
effectiveness of its risk analysis cannot be undermined as
during its testing phase, a count on those infected due to
high risk analysis and opportunistic infection analysis
shows that persons with high percentage above 50% end up
having the virus when an actual laboratory test is
performed.
4.11 RECOMMENDATIONS AND SUGGESTIONS
RECOMMENDATIONS
There should be a human expert who is knowledgeable in
the manual operation of the previous system, the human
expert will monitor the expert system and certify it after a
period of time.
clviii
Back-up files should be used and from time to time
archived in safe locations away from areas prone to accident
so that a recovery can be done in case of accidents.
The system should be installed and properly monitored
in establishments of needs so that accurate data capturing
can be guaranteed, by these, data analysis will become
easier when it comes to medical research involving HIV/AIDS.
SUGGESTIONS
The system design had a lot of challenges which created
some limitations to the system, if proper studies are done,
the system can be upgraded to cover more areas and by the
coverage further studies can be carried so that medical
diagnosis of HIV/AIDS through blood implantation can be made
possible.
Government and other external bodies should encourage
sponsorship on projects involving HIV/AIDS, by these,
seminars and campaigns should be organized to spread
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knowledge and open other possible work areas on HIV/AIDS
diagnosis
A system that does HIV/AIDS diagnosis together with
other opportunistic infection diagnosis jointly will be
important as patients tend to have many opportunistic
infections after contracting HIV, by detecting the both
jointly, patients’ conditions become more certain as it will
be possible to tell if the patient is on HIV infection or
AIDS stage.
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Berger, D. (july 1999). A brief history of medical diagnosis and the birth of the clinical laboratory. www.mlo-online.com.
Beynon-Davies, P. (1991). Expert Database Sytems: A gentle introduction. McGraw-Hill.
Chakraborty, R. www.myreaders.info.David E. Alexander and Rhodes W. Fairbridge. (1999).
Encyclopaedia of Environmental Science. Boston: Kluwer Academic Publishers.
Edward Feigenbaum and Buchanan. (1993). Dendral and metadendral:Roots of Knowledge System and Expert System Applications. Artificial Intelligence, 59:233-240.
Galina S, Mariusz D, Wioletta S, Monika P, Tomasz K. (2009).Artificial Intelligence Approach to Diabetes Diagnostics . International Book Series "Information Science and Computing" pp209.
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Goodall, A. (1985). The guide to expert systems. Medford: Learned Information, inc.
Haack, S. (. (July 2004). Abrief history of Artificial Intelligence. www.atariarchives.org/deli/artificial_intelligence.php.
Health, F. M. (November 2011). National Guideline for HIV Counselling and Testing. Nigeria.
Jeffery L. Greenwald et al. (2006). A Rapid Review of Rapid HIV Antibody Tests: Current Infectious Disease Reports . Boston: Current Science Inc.
Jiang Ming-yan and Chen Zhi-jian. (1997). Diabetes Expert System-IEEE International Conference on Intelligent Processing System.
Juhola M, Auroma Y, Kentala E, pyykko I. (1995). An essay on power of Expert Syatem versus human expertise. London: Med infrom .
Kock, E. D. (2003). Decentralizing the Codification of Rules in a Decission Suport Expert Knowledge base. University of Pretoria: unpublished.
Konar, A. (2000). Artificial intelligence and soft computing: Behavioral andcognitive modelling of the human brain. United State of America: CRC press LLC.
Klein M.R and Methlie L.B. (1995). Knowledge-Based Decision Support Systems with Applications in Business. England: John Wiley &Sons.
Marek J. Druzdzel and Roger R. Flynn. (2002). Decision Support Systems. New York: Marcel Dekkar, Inc.
Mark Cichocki, R. (May 02, 2009). About.com.AIDS/HIV. Meech, J. A. (June 2006). The Evolution of Intelligent Systems in the
Minning Industries. Sudbury, Ontario.Meech, J. A. The Evolution of Intellingent system in the Mining Industries.
Columbia.
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Microsoft Encarta 2009. (1993-2008). Encarta Dictionaries. Microsoft Corporation.
Nilsson, N. J. (1990). Logic and Artificial Intelligence. Stanford: Elsevier Science Publishers B.V.
Nilsson, N. J. (2009). The Quest for Artificial Intelligence: A History of Ideas and Achievements. Cambridge University Press.
Noran, O. (2003 ). Case Study: A course advisor expert system, Advances in Artificial Intelligences. Griffith University School of Computing and information technology Australia: SpringerLink .
Noran, O. S. (2000). Evolution of Expert Systems. Griffith University School of Computing and information technology Australia: Springer Link .
Saeed, D. A. (August 2001). Counseling for HIV/AIDS. Schmoldt, D. L. (1999). Expert Systems and the Environment.
Encyclopaedia of Environmental Sciences.Turban, E. (1993). Decision support and expert systems: Management
support systems. New York: Macmillan.Turban, E. (1995). Decission Support and Expert Systems: Management
Support Systems. Englewoods Cliffs, N.J: Prentice Hall.UNAIDS and WHO. (September 2003). A History of The HIV/AIDS Epidemic
with Emphasis on Africa. New York.
APPENDIX BCODES
CONNECTIONS<?php
//database connection
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$connection=mysql_connect("localhost","root","smartest");if (!$connection){die ("database connection
failed".mysql_error()); }//database selecrion
$db_select=mysql_select_db("hads",$connection);if (!$db_select){die ("database selection
failed".mysql_error()); }?>SESSION
<?php session_start();function logged_in(){return isset($_SESSION['username']);
}function confirmed_logged_in(){ if(!logged_in())
{ header("Location:myindex.php");}}?>HEADER<html><head>
<title>HIV/AIDS DIAGNOSTIC SYSTEM</title><link href="stylesheets/default.css" rel="stylesheet"
media="all" type="text/css"></head>
<body bgcolor="#6699FF"><table width="1300" border="0" align="center"> <tr>
<td colspan="7"><div align="center"><imgsrc="images/header.JPG" width="1200" height="160"
/></div></td> </tr><tr bgcolor="#FFFFFF">FOOTER<tr>
<td colspan="5" bgcolor="#FF0000"><div align="right"class="H"><em><strong> <div align="left">
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<div align="right">DESIGNED BY CHIICHII ORSEER HOSEACopyright ©
<?php //This code displays the year when the site designed
to the current date<br /> /*NOTE that the start means when the site was designed
and the <br /> start year can be set by you (i.e $startYear = 2006;)
*/ ini_set('date.timezone', 'Europe/London');
$startYear = 2013; $thisYear = date('Y');if ($startYear == $thisYear) { echo $startYear; }else {echo "{$startYear}/{$thisYear}";} </td></tr></table><?php //close connectionif (isset($connection)){mysql_close($connection);
}?>INDEX CODE<?php require_once("includes/session.php");?> <?php require_once("includes/connection.php")?> <p> <?php include("includes/header.php") ?> <?php if(isset($_POST['submit'])){ $userid=$_POST['userid']; $password=$_POST['password'];$hash_password=sha1($password); $query="SELECT userid,password FROM staffs WHERE userid='{$userid}' AND password='{$hash_password}'"; $result=mysql_query($query,$connection); if(!$result){ die("Database Query Failed Due to: ".mysql_error());} if(mysql_num_rows($result)==1){ if($found_user=mysql_fetch_array($result)){$_SESSION['password']=$found_user['password'];
$_SESSION['username']=$found_user['userid'];if($_SESSION['pa
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ssword']= $password) {header("Location:staffpage.php?userid={$_SESSION['username']}&&status={$field}");}}else {header("Location:errorpage.php?userid={$_SESSION['username']}");} }else{header("Location:errorpage.php");}} ?> <form name="form1" method="post" action="myindex.php"> <table width="1200" border="0" align="center"> <tr> <td width="338"><font color="#CC0000"><em><strong>NEW STAFF SHOULD <a href="home.php">CLICK HERE</a></strong><a href="home.php"></a></em></font></td> <td width="575" rowspan="3" background="includes/images/bgimage.jpg"><p align="center"><strong><font color="#000066">STAFF LOGIN</font></strong></p> <p align="center"><font color="#000000">USERNAME:</font> <strong <input name="userid" type="text" id="userid" size="25"> </strong></p> <p align="center"><font color=""#6699FF"">PASSWORD</font><strong> <input name="password" type="password" id="password" size="25"> </strong></p> <div align="center"> <p> <input type="submit"name="submit" id="submit" value=" LOGIN"></p> <p> </p></div> </form> <p align="center"> </p></td> <td width="338"> </td> </tr> <tr> <td height="164" width="150"><p align="left"><a href="myindex.php">Home</a>|| ||<a href="basis/mission.php">Mission</a>|| ||<a href="vission.php">Vission</a>|| ||<a href="basis/help.php">Help</a></p> <p><img src="includes/images/side.JPG" width="310" height="133" /></p></td>
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<td><div align="justify"><font color="#000000">HIV/AIDS has been an epidemic not only in Nigeria but the world in general, many people have died due to this epidemic, the death rate is very high due to many reasons including lack of awareness, this system tend to provide this awareness to individuals and groups for proper handling of people living with the virus and also educates people on how to stay free from it.............</font></div></td> </tr> <tr> <td height="143"><p><font color="#000000">The HIV/AIDS diagnostic system is a medical diagnostic system used in medical establishments trained by the system designers to cover HIV/AIDS related conditions, it helps in diagnosing and treating clients, it is easy to use and reliable for medical establishments...</font></p></td> <td><div align="right"><img src="includes/images/index13.jpg" width="330" height="155" /></div></td> </tr> <tr> <td height="25" colspan="2"><div align="right"><a href="basis/contact.php"> <font color="#CCCCCC">Contact Us</a>|| ||<a href="basis/help.php">Help</a>|| ||<a href="basis/faq.php">F.A.Q</a>|| ||<a href="basis/terms.php">Terms & Conditions</a></div></td></tr> <?php include("includes/footer.php") ?>STAFF PAGE<?php require_once("includes/session.php");?><?php require_once("includes/connection.php")?><?phpinclude("includes/header.php") ?><?php if(isset($_GET['userid'])){ }?><?phpif(isset($_POST['submit'])){ $query = "SELECT * ";
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$query .= "FROM staffs "; $query .= "WHERE id = '{$id}' ";$result = mysql_query($query, $connection); $found_staff =mysql_fetch_array($result); header("Location:confirm.php?userid={$_SESSION['username']}&&status={$found_staff['field']}"); }?> </p> <tr align="center" class="RED"> <tdbgcolor="#FFFFFF"><div align="center"> <p><ahref="myindex.php">LOGOUT</a> </p> </div></td></tr><table width="1200"border="1" align="center"> <trbgcolor="#FF0000"> <td bgcolor="#66FF00"><divalign="right" <?php //Date echo "Today is ".date("l F d,Y");?> </div> <div align="right"></div></td> </tr><tr bgcolor="#FF0000"> <td height="23"><palign="center"><strong><font color="#000000">WELCOME TO THEDIAGNOSTIC SYSTEM, PLEASE SELECT YOUR FIELD OFSPECIALIZATION</font></strong></p></td> </tr> <tr><td height="44" bgcolor="#66FF00"><div align="center"class="white"> <form id="form1" name="form1" method="post"action=""> </form> <strong> <a href="confirm.php?id=<?php echo $_SESSION['username'] ?>">HCT STAFF</a> || ** ||<a href="confirmd.php?id=<?php echo $_SESSION['username'] ?>">DOCTOR</a> ||** || <a href="confirmp.php?id=<?php echo$_SESSION['username'] ?>">PHARMACIST</a> ||** || <ahref="confirml.php?id=<?php echo $_SESSION['username'] ?>">LABORATORY TECHNICIAN</a> || ** ||<ahref="confirmcon.php?id=<?php echo $_SESSION['username'] ?>">CONSULTANT</a></strong></div></td> </tr> <tr> <tdbgcolor="#66FF00"><div align="center"><imgsrc="images/imageis.jpg" width="549" height="261"align="middle" /></div> <divalign="center"></div></td> </tr> <tr> <td colspan="4"bgcolor="#FF0000"><div align="right" class="H"><em><strong>
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<div align="left"> <div align="right">DESIGNED BYCHIICHII ORSEER HOSEA Copyright © <?php//This code displays the year when the site designed to thecurrent date<br /> /*NOTE that the start means when thesite was designed and the <br /> start year can be setby you (i.e $startYear = 2006;) */ini_set('date.timezone', 'Europe/London'); $startYear =2012; $thisYear = date('Y'); if ($startYear ==$thisYear) { echo $startYear; } else { echo "{$startYear}/{$thisYear}"; }?></tr></table></body></html>CREATE CLIENT PAGE<?phprequire_once("../includes/session.php");?><?phprequire_once("../includes/connection.php")?><p><?phpinclude("../includes/header.php") ?><?php //Date $date=date("l F d, Y");?> <?php $rand = rand(000,900);?><?php$rand = "HOSP"."/".$rand."/"."HS"?><?php $query4 = "SELECT *"; $query4 .= "FROM count "; $query4 .= "WHERE sno = '0' ";$result4 = mysql_query($query4, $connection); $found_count =mysql_fetch_array($result4); $mtotal =$found_count['mtotal']; $mtotal = $mtotal + 1; $query5 ="UPDATE count SET mtotal ='{$mtotal}' WHERE sno='0'";$result5 = mysql_query($query5, $connection);?> <?php$query4 = "SELECT * "; $query4 .= "FROM count "; $query4 .="WHERE sno = '0' "; $result4 = mysql_query($query4,$connection); $found_count = mysql_fetch_array($result4);$mtotal = $found_count['mtotal']; $ftotal =$found_count['ftotal']; $total = $found_count['total'];$total = $mtotal + $ftotal; $query6 = "UPDATE count SETtotal ='{$total}' WHERE sno='0'"; $result6 =mysql_query($query6, $connection); ?><?php if
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(isset($_GET['id'])) {$id = $_GET['id']; $id =@$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROM client"; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1);$_SESSION['id']=$found_client['id']; }?> <?php $yes_status ='unchecked'; $no_status = 'unchecked'; $selected_radio =@$_POST['select']; if ($selected_radio==8) { $yes_status ='checked'; }else if ($selected_radio == 0){$no_status ='checked';}$selected_radio1 = @$_POST['select2']; if($selected_radio1==8) {$yes_status = 'checked'; }else if($selected_radio1 == 0) {$no_status = 'checked';}$selected_radio2 = @$_POST['select3'];if($selected_radio2==8) {$yes_status = 'checked'; }else if($selected_radio2 == 0){ $no_status = 'checked';}$selected_radio3 = @$_POST['select4'];if($selected_radio3==8){$yes_status = 'checked';}else if($selected_radio3 == 0){$no_status = 'checked';}$selected_radio4 = @$_POST['select5']; if($selected_radio4==10){$yes_status = 'checked'; }else if($selected_radio4 == 0){$no_status = 'checked';}$selected_radio5 = @$_POST['select6'];if($selected_radio5==8){$yes_status = 'checked'; }else if($selected_radio5 == 0){$no_status = 'checked';}$selected_radio6 = @$_POST['select7']; if($selected_radio6==8){$yes_status = 'checked';}else if($selected_radio6 == 0){$no_status = 'checked';}$selected_radio7 = @$_POST['select8'];if($selected_radio7==8){$yes_status = 'checked';}else if($selected_radio7 == 0){$no_status = 'checked';}$selected_radio8 = @$_POST['select9']; if
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($selected_radio8==8){$yes_status = 'checked'; }else if($selected_radio8 == 0){ $no_status = 'checked';}$selected_radio9 = @$_POST['select10'];if ($selected_radio9==8){$yes_status = 'checked'; }else if($selected_radio9 == 0){ $no_status = 'checked';}$selected_radio10 = @$_POST['select11'];if($selected_radio10==8){$yes_status = 'checked';}else if($selected_radio10 == 0){$no_status = 'checked';}$selected_radio11 = @$_POST['select12']; if($selected_radio11==10){$yes_status = 'checked';}else if ($selected_radio11 == 0){$no_status = 'checked';}$selected_radio12 = @$_POST['select13']; if($selected_radio12==10){$yes_status = 'checked';}else if ($selected_radio12 == 0){$no_status = 'checked';}$selected_radio13 = @$_POST['select14']; if($selected_radio13==10){ $yes_status = 'checked'; }else if($selected_radio13 == 0){ $no_status = 'checked';}$selected_radio14 = @$_POST['select15']; if($selected_radio14==10){ $yes_status = 'checked'; }else if($selected_radio14 == 0){ $no_status = 'checked';}$selected_radio15 = @$_POST['select16'];if ($selected_radio15==10){ $yes_status = 'checked'; }elseif ($selected_radio15 == 0){ $no_status = 'checked';}$selected_radio16 = @$_POST['select17']; if($selected_radio16==10){ $yes_status = 'checked'; }else if($selected_radio16 == 0){ $no_status = 'checked';}$selected_radio17 = @$_POST['select18']; if($selected_radio17==0){$yes_status = 'checked'; }else if ($selected_radio17 == 10){$no_status = 'checked';} $selected_radio18 =@$_POST['select19']; if ($selected_radio18==10)
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{ $yes_status = 'checked';}else if ($selected_radio18 == 0){$no_status = 'checked';} $selected_radio19 =
@$_POST['select20']; if ($selected_radio19==10){ $yes_status= 'checked'; }else if ($selected_radio19 == 0){ $no_status ='checked';} $selected_radio20 = @$_POST['select21']; if($selected_radio20==10){ $yes_status = 'checked'; }else if($selected_radio20 == 0){ $no_status = 'checked';}$selected_radio21 = @$_POST['select22']; if($selected_radio21==10){ $yes_status = 'checked'; }else if($selected_radio21 == 0){ $no_status = 'checked'; }$opt_analysis = @$selected_radio7 + @$selected_radio8 +@$selected_radio9 +@$selected_radio10 + @$selected_radio11 +@$selected_radio19 + @$selected_radio20 +@$selected_radio21; $opt_analysis =$opt_analysis."%";$risk_analysis = @$selected_radio + @$selected_radio1 +@$selected_radio2 + @$selected_radio3 + @$selected_radio12 +@$selected_radio13 + @$selected_radio14 + @$selected_radio15+ @$selected_radio16 + @$selected_radio17; $risk_analysis =$risk_analysis."%"; ?> <?php if ( isset($_POST['submit'])){ $query = "UPDATE client SETopt_analysis='{$opt_analysis}', risk_analysis='{$risk_analysis}' WHERE id='{$_SESSION['id']}'";$result=mysql_query($query,$connection); if ($result)header("Location:labTest.php?id={$_SESSION['id']}&opt_analysis={$opt_analysis}&risk_analysis={$risk_analysis}");if(!$result){ die("Database query failed as:".mysql_error());}} ?> <form action="createcleintm.php"method="post"> <table align="center"> <td width="361"><tablewidth="1200" border="1" align="center"> <tr> <td
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colspan="3" bgcolor="#FF0000"><div align="center"class="RED"> <div align="center"><font color="#0000FF"size="+1"><strong>*****DIAGNOSTIC PROCEDURE*****</strong></font></div> </div></td></tr><tr><td colspan="3"bgcolor="#FFFFFF"><div align="center"><fontcolor="#0000FF"><strong>HIV COUNSELLING AND TESTING: CLIENTINTAKE FORM</strong></font></div></td></tr><tr><tdcolspan="3" bgcolor="#FF0000"><div align="right"> <?php//Dateecho "Today is ".date("l F d, Y");?></div></td> </tr><tr><td colspan="3" bgcolor="#FF0000"><ahref="../staffpagec.php">BACK</a></td> </tr> <tr> <tdheight="120" colspan="3" bgcolor="#66FF33"><palign="center">CLIENT'S NAME: <input name="name"type="text" id="name" value="<?php echo$found_client["name"]?>" />AGE:<input name="age" type="text"id="age" value="<?php echo $found_client["age"]?>" />DATE OFVISIT:<input name="dov" type="text" id="dov" value="<?phpecho $found_client["dov"]?>" />STATE OF RESIDENCE:<input name="state" type="text"id="state" value="<?php echo $found_client["state"]?>" /></p> <p align="center">L.G.A OF RESIDENCE:<inputname="lga" type="text" id="lga" value="<?php echo$found_client["lga"]?>" />Marital Status: <inputname="status" type="text" id="status" value="<?php echo$found_client["status"]?>" maxlength="20"/> ContactNumber:<input name="number" type="text" id="number"value="<?php echo $found_client["number"]?>"maxlength="20"/>
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Sex:<input name="sex" type="text" id="sex" value="<?php echo$found_client["sex"]?>" maxlength="20"/></p> </td></table> <table width="1200" border="0"> <tr> <td colspan="4" bgcolor="#66FF00"><divalign="center">CLIENT IDENTIFICATION NUMBER:: <inputtype="text" name="id" id="id" value="<?php echo$found_client["id"]?>" readonly="readonly"/> </div></td></tr> <tr> <td colspan="2" bgcolor="#66FF00"><divalign="center"><strong><font color="#FF0000"size="+2">Knowledge Assessment</font></strong></div></td><tdcolspan="2" bgcolor="#66FF00"><div align="center"><fontcolor="#FF0000" size="+2">HIV RiskAnalysis</font></div></td> </tr> <tr> <td width="375" bgcolor="#66FF00">Previously TestedNegative to HIV?</font></td> <td width="186" bgcolor="#66FF00">YES <inputtype="radio" name="select" value="8" />NO <input type="radio" name="select" value="0" /></td><tdwidth="413" bgcolor="#66FF00">Ever Had Sexual intercourse?</font></td><td width="198" bgcolor="#66FF00">YES <inputtype="radio" name="select13" value="10" />NO <inputtype="radio" name="select13" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client informed about HIV transmissionroutes?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select2" value="8" />NO <inputtype="radio" name="select2" id="radio4" value="0" /></td><td bgcolor="#66FF00">Did you had any blood transfusion 3Month ago?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select14" value="10" />NO <inputtype="radio" name="select14" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client Informed about Risk Factors for
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HIV Transmission?</font></td> <td bgcolor="#66FF00">YES<input type="radio" name="select3" value="8" />NO <inputtype="radio" name="select3" id="radio" value="0" /></td><td bgcolor="#66FF00">Have more than one sexpartner?</font></td><td bgcolor="#66FF00">YES <inputtype="radio" name="select15" value="10" /> NO <inputtype="radio" name="select15" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client Informed on methods ofprevention?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select4" value="8" /> NO<input type="radio" name="select4" value="0" /></td> <tdbgcolor="#66FF00">Unprotected sex with casual partner in thelast 3 months</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select16" value="10" />NO <inputtype="radio" name="select16" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client informed about possible testresult?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select5" value="10" />NO <inputtype="radio" name="select5" value="0" /></td> <tdbgcolor="#66FF00">Unprotected sex with regular partner inlast 3 months?</td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select17" value="0" /> NO <inputtype="radio" name="select17" value="10" /></td> </tr> <tr><td bgcolor="#66FF00">Client consent given for HIV testing?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select6" value="8" />NO<inputtype="radio" name="select6" value="0" /></td> <tdbgcolor="#66FF00">Have you ever been infected with anyS.T.I's?</font></td> <td bgcolor="#66FF00">YES<input type="radio" name="select18" value="10" />NO<inputtype="radio" name="select18" value="0" /></td> </tr> <tr>
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<td colspan="2" bgcolor="#66FF00"><divalign="center"><strong><font color="#FF0000"size="+2">Clinical TB Screening</font></strong></div></td><td colspan="2" bgcolor="#66FF00"><divalign="center"><strong><font color="#FF0000"size="+2">Syndromic STI Screening</font></strong></div></td></tr> <tr> <td bgcolor="#66FF00">Coughing for more thantwo weeks?</font></td> <td bgcolor="#66FF00">YES<input type="radio" name="select8" value="8" />NO<inputtype="radio" name="select8" value="0" /></td> <tdbgcolor="#66FF00">Notice of urethral discharge/burning whenurinating?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select20" value="10" />NO<inputtype="radio" name="select20" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Weight loss in last 4weeks?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select9" value="8" />NO<inputtype="radio" name="select9" value="0" /></td> <tdbgcolor="#66FF00">Notice of scrotal sweeling andpain?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select21" value="10" /> NO <inputtype="radio" name="select21" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Sweeling of the LymphNode?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select10" value="8" /> NO <inputtype="radio" name="select10" value="0" /></td> <tdbgcolor="#66FF00">Complain of genital sores with or withoutpain?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select22" value="10" />NO <inputtype="radio" name="select22" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Fever for more than two
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weeks?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select11" value="8" />NO<input type="radio" name="select11" value="0" /></td><td bgcolor="#66FF00"> </td> <tdbgcolor="#66FF00"> </td> </tr> <tr> <tdbgcolor="#66FF00">Night sweats fore more than 2weeks?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select12" value="10" />NO <inputtype="radio" name="select12" value="0" /></td> <tdbgcolor="#66FF00"> </td> <tdbgcolor="#66FF00"> </td> </tr> <tr> <tdcolspan="4" bgcolor="#66FF00"><div align="right"><input name="submit" type="submit" id="submit"value="NEXT" /> </div></td> </tr> </table> <p align="center"><?php if(!empty($message)){echo "<fontcolor=\"#330033\">{$message} </font>"; }?> </p> <?php include("../includes/footer.php") ?>
RISK ANALYSIS AND OPPORTUNISTIC INFECTIONS ANALYSIS CODE<?phprequire_once("includes/session.php");?><?phprequire_once("includes/connection.php")?><p> <?phpinclude("includes/header.php") ?><?phpinclude("includes/function.php") ?><?php if (isset ($_GET['id'])){$id = $_GET['id'];}?><?php$id = @$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROMclient "; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1); ?> <?php
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$yes_status = 'unchecked'; $no_status = 'unchecked'; if(isset($_POST['submit'])){ $id = $_GET['id'];$selected_radio = @$_POST['answer']; if($selected_radio=='yes'){ $yes_status = 'checked'; }else if($selected_radio == 'no'){ $no_status = 'checked';} }?><?php if (@$selected_radio == 'no'){ header("Location:thanks.php"); }else{ if (@$selected_radio== 'yes') header("Location:det.php?id={$_SESSION['id']}");}if (isset($_POST['submit'])){ $id =$_GET['id']; $query1="SELECT * FROM client WHEREid='{$id}'";$id= $_GET['id']; $opt_analysis = @$_GET['opt_analysis'];$risk_analysis = @$_GET['risk_analysis']; $query = "UPDATEclient SET opt_analysis='{$opt_analysis}', risk_analysis='{$risk_analysis}' WHERE id='{$id}'";$result=mysql_query($query,$connection);if(!$result){ die("Database query failed as:".mysql_error());} if(mysql_affected_rows()==1){ $message="Update was successful!"; }else{
$message="Update Failed! ".mysql_error();}}?></p><table align="center"> <td width="361"><tablewidth="1200" border="1" align="center"> <tr> <tdcolspan="3" bgcolor="#FF0000"><div align="center"class="RED"><div align="center"><font color="#0000FF"size="+1"><strong>*****DIAGNOSTIC PROCEDURE*****</strong></font></div> </div></td> </tr> <tr> <tdcolspan="3" bgcolor="#FFFFFF"><div align="center"><fontcolor="#0000FF"><strong>HIV COUNSELLING AND TESTING: CLIENTINTAKE FORM</strong></font></div></td> </tr> <tr> <tdcolspan="3" bgcolor="#FF0000"><div align="right"> <?php//Date echo "Today is ".date("l F d, Y");
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?> </div></td> </tr> <tr> <td colspan="3"bgcolor="#FF0000"><a href="../staffpagec.php">BACK</a></td></tr> <tr> <td height="120" colspan="3"bgcolor="#66FF33"><p align="center">CLIENT'S NAME:<input name="name" type="text" id="name" value="<?php echo$found_client["name"]?>" />AGE: <input name="age"type="text" id="age" value="<?php echo $found_client["age"]?>" />DATE OF VISIT:<input name="dov" type="text" id="dov" value="<?php echo$found_client["dov"]?>" />STATE OF RESIDENCE: <input name="state" type="text"id="state" value="<?php echo $found_client["state"]?>" /></p> <p align="center">L.G.A OF RESIDENCE:<input name="lga" type="text" id="lga" value="<?php echo$found_client["lga"]?>" />Marital Status:<input name="status" type="text" id="status" value="<?phpecho $found_client["status"]?>" maxlength="20"/>ContactNumber: <input name="number" type="text" id="number"value="<?php echo $found_client["number"]?>"maxlength="20"/>Sex:<input name="sex" type="text" id="sex" value="<?php echo$found_client["sex"]?>" maxlength="20"/></p> </td></table> <table width="1200" border="0" align="center"><tr> <td colspan="4" bgcolor="#66FF00"><divalign="center">CLIENT IDENTIFICATION NUMBER:: <inputtype="text" name="id" id="id" value="<?php echo$found_client["id"]?>" readonly="readonly"/> </div></td></tr> <tr> <td width="327" rowspan="3"><imgsrc="images/images1.jpg" width="411" height="324"></td><td width="385"><div align="center"><fontcolor="#FFFFFF">THANKS FOR GIVING US YOUR
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TIME!!!</font></div></td> <td width="268"rowspan="3"><img src="images/imagesnnn.jpg" width="395"height="317"></td> </tr> <tr> <tdbgcolor="#66FF33"><div align="center"> <p>THE CLIENTOPPORTUNISTIC INFECTION ANALYSIS PRESENTS A <fontcolor="#FFFFFF"><?PHP echo @$_GET['opt_analysis'];?></font>POSSIBILITY, WHILE RISK ANALYSIS SHOWS A<fontcolor="#FFFFFF"> <?PHP echo@$_GET['risk_analysis'];?></font> POSSIBILITY!!!</p></div></td> </tr> <tr> <td bgcolor="#66FF33"><divalign="center"> HOWEVER, THE SURE WAY OF CONFIRMING YOUR STATUS IS BYLABORATORY TESTING AND CONFIRMATION, DO YOU WISH TO PERFORMA LABORATORY TEST <form name="form1"method="post" action="labTest.php"> <div align="center">Yes<input type="radio" name="answer" value="yes"> No<input type="radio" name="answer" value="no"> <br/><input type="submit" name="submit" value="OKAY"> <br/> </div></form> </p> <?phpinclude("includes/footer.php") ?>DETERMINE TEST KIT CODE<?php require_once("includes/session.php");?><?php require_once("includes/connection.php")?><?phpinclude("includes/header.php") ?><?php $positive_status = 'unchecked'; $negative_status ='unchecked'; $invalid_status = 'unchecked';$selected_radio=""; $status ="";
if (isset($_POST['submit'])){$selected_radio =$_POST['selection']; if ($selected_radio=='positive'){
$positive_status = 'checked'; }else if ($selected_radioclxxx
== 'negative'){ $negative_status = 'checked'; }else if($selected_radio == 'invalid'){ $invalid_status ='checked';} $lab_test = $selected_radio; $id =$_SESSION['id'];$query = "UPDATE client SET lab_test ='{$lab_test}' WHEREid='{$_SESSION['id']}'"; $result=mysql_query($query,$connection); if($result){ if($positive_status == 'checked'){header("Location:uni.php?id={$_SESSION['id']}");} elseif($negative_status == 'checked'){header("Location:finishn.php?id={$_SESSION['id']}");}else if($invalid_status == 'checked'){header("Location:det1.php?id={$id}");} } else{$message="The result could not berecorded".mysql_error()."<br/>";}} ?> <form name="form1"method="post" action="det.php"> <table width="1200"border="0" align="center"> <tr> <td width="250"bgcolor="#66FF00"> </td> <td width="462" rowspan="2"bgcolor="#66FF00"><div align="center"> <p><fontcolor="#000000" size="+1"><strong>*****LABORATORYPROCEDURE*****</strong></font></p> <p> <input type="text" name="id" id="id" value= "<?php echo$_GET['id'];?>" align="middle" readonly/> </p></div></td> <td width="268" bgcolor="#66FF00"> </td></tr> <tr> <td bgcolor="#66FF00"><divalign="right">HOME|| ||NEWS ||HELP</div></td> <tdbgcolor="#66FF00"><a href="staffpage.php">STAFF AREA</a> |||| <a href="home.php">LOGOUT</a></td> </tr> <tr> <tdheight="34" colspan="3" bgcolor="#66FF00"><p align="center"><p align="center"><font color="#FFFFFF"><strong>CHOOSE FROMTHE UNDERLISTED TEST KITS, THE EXACT ONE THAT LOOKS LIKEYOUR RESULT</strong></font></p> <div align="center">
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<p><br/> </p> </div> </tr> <tr><td bgcolor="#66FF00"><div align="center"><imgsrc="images/determine p.JPG" width="110" height="200"></div><td bgcolor="#66FF00"><div align="center"><imgsrc="images/determine n.JPG" width="110" height="200"></div><td bgcolor="#66FF00"><div align="center"><imgsrc="images/determine i.JPG" width="110" height="200"></div><tr> <td> <div align="center"> <inputtype="radio" name="selection" value="positive"> </div><td> <div align="center"> <input type="radio"name="selection" value="negative"> </div> <td><div align="center"> <input type="radio"name="selection" value="invalid"> </div> </tr><tr> <td colspan="3" bgcolor="#66FF00"><divalign="center"> <input type="submit" name="submit"value="SUBMIT RESULT"> </div> </form> <tdwidth="2"></td> </tr> <?php include("includes/footer.php") ?>UNI-GOLD TEST CODE<?php require_once("includes/session.php"); ?><?phprequire_once("includes/connection.php")?><?phpinclude("includes/header.php") ?> <?php$positive_status = 'unchecked'; $negative_status ='unchecked'; $invalid_status = 'unchecked';$selected_radio=""; $status =""; if(isset($_POST['submit'])){ $selected_radio =$_POST['selection']; if ($selected_radio=='positive'){$positive_status = 'checked';}else if ($selected_radio == 'negative'){ $negative_status ='checked'; }else if ($selected_radio == 'invalid'){ $invalid_status = 'checked';}$lab_test = $selected_radio;
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$id = $_SESSION['id']; $query = "UPDATE client SET lab_test='{$lab_test}' WHERE id='{$_SESSION['id']}'";$result=mysql_query($query,$connection); if($result){ if($positive_status == 'checked'){header("Location:finishp.php?id={$_SESSION['id']}");} elseif($negative_status == 'checked'){header("Location:stat.php?id={$_SESSION['id']}");} elseif($invalid_status == 'checked'){ header("Location:uni1.php?id={$_SESSION['id']}");}} } ?><form name="form1" method="post" action="uni.php"> <tablewidth="1200" border="0" align="center"> <tr> <tdwidth="250" bgcolor="#66FF00"> </td> <tdwidth="462" rowspan="2" bgcolor="#66FF00"><divalign="center"> <p><font color="#FF0000"size="+1"><strong>*****LABORATORYPROCEDURE*****</strong></font></p> <p> <input type="text"name="id" id="id" value="<?php echo $_GET['id'];?>"align="middle" readonly/> </p> </div></td> <tdwidth="268" bgcolor="#66FF00"> </td> </tr> <tr><td bgcolor="#66FF00"><div align="right">HOME|| ||NEWS ||HELP</div></td> <td bgcolor="#66FF00"><ahref="staffpage.php">STAFF AREA</a> || || <ahref="home.php">LOGOUT</a></td> </tr> <tr> <tdheight="34" colspan="3" bgcolor="#66FF00"><p align="center"><p align="center"><font color="#FFFFFF"><strong>CHOOSE FROMTHE UNDERLISTED TEST KITS, THE EXACT ONE THAT LOOKS LIKE THERESULT FROM YOUR DIAGNOSTIC </strong></font><strong><font color="#FFFFFF">BASELINE TEST</font></strong></p> <div align="center"> <p><br/></p> </div> </tr> <tr> <tdbgcolor="#66FF00"><div align="center"><img src="images/uni
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P.JPG" width="200" height="143"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/uniN.JPG" width="200" height="143"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/uniI.JPG" width="200" height="143"></div> <tr> <td> <divalign="center"> <input type="radio" name="selection"value="positive"> </div> <td> <div align="center"><input type="radio" name="selection" value="negative" </div><td> <div align="center"> <input type="radio"name="selection" value="invalid" </div> </tr> <tr> <tdcolspan="3" bgcolor="#66FF00"><div align="center" <inputtype="submit" name="submit" value="SUBMIT RESULT"> </div></form> <td width="2"></td> </tr> <?phpinclude("includes/footer.php") ?>STAT-PACK TEST CODE<?php require_once("includes/session.php");?><?php require_once("includes/connection.php")?> <?phpinclude("includes/header.php") ?><?php $positive_status = 'unchecked'; $negative_status ='unchecked'; $invalid_status = 'unchecked';$selected_radio=""; $status =""; if(isset($_POST['submit'])){ $selected_radio =$_POST['selection']; if ($selected_radio=='positive'){ $positive_status = 'checked';}else if ($selected_radio == 'negative'){ $negative_status ='checked'; }else if ($selected_radio == 'invalid'){ $invalid_status = 'checked';} $lab_test = $selected_radio;$id = $_SESSION['id'];$query = "UPDATE client SET lab_test ='{$lab_test}' WHEREid='{$_SESSION['id']}'"; $result=mysql_query($query,$connection); if($result){ if($positive_status == 'checked')
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{header("Location:finishp.php?id={$_SESSION['id']}"); }else if($negative_status == 'checked'){header("Location:finishn.php?id={$_SESSION['id']}");} elseif($invalid_status == 'checked'){header("Location:stat1.php?id={$_SESSION['id']}"); }}}?> <form name="form1" method="post" action="stat.php"><table width="1200" border="0" align="center"> <tr> <tdwidth="250" bgcolor="#66FF00"> </td> <td width="462"rowspan="2" bgcolor="#66FF00"><div align="center"><p><font color="#FF0000" size="+1"><strong>*****LABORATORYPROCEDURE*****</strong></font></p> <p> <inputtype="text" name="id" id="id" value="<?php echo$_GET['id'];?>" align="middle" readonly/> </p></div></td> <td width="268" bgcolor="#66FF00"> </td></tr> <tr> <td bgcolor="#66FF00"><divalign="right">HOME|| ||NEWS ||HELP</div></td><tdbgcolor="#66FF00"><a href="staffpage.php">STAFF AREA</a> |||| <a href="home.php">LOGOUT</a></td> </tr> <tr> <tdheight="34" colspan="3" bgcolor="#66FF00"><p align="center"><p align="center"><font color="#FFFFFF"><strong>CHOOSE FROMTHE UNDERLISTED TEST KITS, THE EXACT ONE THAT LOOKS LIKE THERESULT FROM YOUR DIAGNOSTIC </strong></font><strong><font color="#FFFFFF">BASELINE TEST</font></strong></p> <div align="center"><p><br/> </p> </div> </tr> <tr> <tdbgcolor="#66FF00"><div align="center"><img src="images/statP.JPG" width="127" height="160"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/statN.JPG" width="127" height="160"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/statI.JPG" width="127" height="160"></div> <tr> <td>
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<div align="center"> <input type="radio"name="selection" value="positive"> </div> <td><div align="center"> <input type="radio"name="selection" value="negative"> </div> <td><div align="center"> <input type="radio"name="selection" value="invalid"> </div> </tr> <tr><td colspan="3" bgcolor="#66FF00"><div align="center"><input type="submit" name="submit" value="SUBMIT RESULT"></div> </form> <td width="2"></td> </tr> <?phpinclude("includes/footer.php") ?>POSITIVE RESULT CODE<?phprequire_once("includes/session.php");?<?phprequire_once("includes/connection.php")?><?php include("includes/header.php") ?><?php $id =@$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROM client"; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1); $sex = $found_client["sex"];$opt_analysis = $found_client["opt_analysis"];$risk_analysis = $found_client["risk_analysis"]; ?> <?php if($sex == 'Male'){ $query4 = "SELECT * "; $query4 .= "FROMcount "; $query4 .= "WHERE sno = '0' "; $result4 =mysql_query($query4, $connection); $found_count =mysql_fetch_array($result4); $pmale = $found_count['pmale'];$pfemale = $found_count['pfemale']; $ptotal =$found_count['ptotal']; $ptotal = $ptotal + 1; $pmale =$pmale + 1; $ptotal = $pmale + $pfemale; $query5 = "UPDATEcount SET pmale ='{$pmale}', ptotal = '{$ptotal}' WHEREsno='0'"; $result5 = mysql_query($query5, $connection); }else if ($sex == 'Female'){ $query4 = "SELECT * "; $query4.= "FROM count "; $query4 .= "WHERE sno = '0' "; $result4 =
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mysql_query($query4, $connection); $found_count =mysql_fetch_array($result4); $pfemale =$found_count['pfemale']; $pmale = $found_count['pmale'];$ptotal = $found_count['ptotal']; $ptotal = $ptotal + 1;$pfemale = $pfemale + 1; $ptotal = $pmale + $pfemale;$query5 = "UPDATE count SET pfemale ='{$pfemale}', ptotal ='{$ptotal}' WHERE sno='0'"; $result5 = mysql_query($query5,$connection); } ?> <?php if ($opt_analysis >= 12.5 &&$risk_analysis >= 50){ $query0 = "SELECT * "; $query0 .="FROM count "; $query0 .= "WHERE sno = '0' "; $result0 =mysql_query($query4, $connection); $found_count =mysql_fetch_array($result0); $risk = $found_count['risk'];$risk = $risk + 1; $query0 = "UPDATE count SET risk='{$risk}' WHERE sno='0'"; $result0 = mysql_query($query0,$connection); } ?> <table width="1200" border="0"align="center"> <tr> <td width="262"bgcolor="#66FF00"><div align="right"></div></td> <tdwidth="619" bgcolor="#66FF00"><div align="center"> <p><fontcolor="#000000"size="+1"><strong><fontcolor="#FF0000">*****LABORATORYPROCEDURE*****</strong></font> </p> </div></td> <tdwidth="305" bgcolor="#66FF00"> </td> </tr> <tr><td height="34" colspan="3" bgcolor="#66FF00"><palign="center"><font color="#FFFFFF"><strong>THANKS FORGIVING US YOUR TIME</strong></font> <p align="center"><strong><font color="#FFFFFF">YOUR RESULT DETAILS ARE ASSHOWN BELOW</font></strong> <palign="center"><strong><font color="#FFFFFF">ID NUMBER:<input name="id" type="text" id="id" value="<?php echo$_GET['id'];?>"> </font></strong><fontcolor="#FFFFFF">NAME:</font> <input name="name"
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type="text" id="name" value="<?php echo$found_client["name"]?>"> <font color="#FFFFFF"> HIVSTATUS: </font> <input name="lab_test" type="text"id="lab_test" value="<?php echo $found_client["lab_test"]?>"> <p align="center"><font color="#FFFFFF">YOUR TEST RESULTSHOWS THAT THE CLIENT IS POSITIVE TO HIV ANTIBODY</font> <palign="center"><font color="#FFFFFF">CLIENT SHOULD BEENROLLED FOR PROPER MEDICATION</font> <palign="center"><font color="#FF0000">AIDS IS REAL!!! HELPSPREAD THE NEWS </font> <div align="center"> <p><br/></p> </div> </tr> <tr> <td colspan="4"bgcolor="#66FF00"><div align="center"><ahref="createpatient.php">ENROL CLIENT</a></div> </form></tr> <?php include("includes/footer.php") ?>NEGATIVE RESULT CODE<?php require_once("includes/session.php");?> <?phprequire_once("includes/connection.php")?><?phpinclude("includes/header.php") ?><?php$id = @$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROMclient "; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1);?><table width="1200" border="0"align="center"> <tr> <td width="262"bgcolor="#66FF00"><div align="right"></div></td> <tdwidth="619" bgcolor="#66FF00"><div align="center"> <p><fontcolor="#000000" size="+1"><strong><fontcolor="#FF0000">*****LABORATORYPROCEDURE*****</strong></font> </p> </div></td> <tdwidth="305" bgcolor="#66FF00"> </td> </tr> <tr><td height="34" colspan="3" bgcolor="#66FF00"><p
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align="center"><font color="#FFFFFF"><strong>THANKS FORGIVING US YOUR TIME</strong></font> <p align="center"><strong><font color="#FFFFFF">YOUR RESULT DETAILS ARE ASSHOWN BELOW</font></strong> <palign="center"><strong><font color="#FFFFFF">ID NUMBER:<input name="id" type="text" id="id" value="<?php echo$_GET['id'];?>"> </font></strong><fontcolor="#FFFFFF">NAME:</font><input name="name" type="text"id="name" value="<?php echo $found_client["name"]?>"> <fontcolor="#FFFFFF"> HIV STATUS: </font> <inputname="lab_test" type="text" id="lab_test" value="<?php echo$found_client["lab_test"]?>"> <p align="center"> <fontcolor="#FFFFFF">WE CONGRATULATE YOU AND ADVICE YOU TOPROTECT YOUR SELF AD STAY NEGATIVE.</font> <palign="center"><font color="#FF0000">AIDS IS REAL!!! HELPSPREAD THE NEWS </font> <div align="center"><p><br/> </p> </div> </tr> <tr> <tdcolspan="4" bgcolor="#66FF00"><div align="center"><ahref="staffpagec.php">GO HOME</a></div> </form></tr> <?php include("includes/footer.php") ?
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