CHAPTER 1: INTRODUCTION
1.1 Introduction
Children’s behaviour differs from each child which could be affected by many factors in a classroom. In order to run a classroom, a teacher needs to plan effective strategies in order to manage unpredictable behaviour of children. One of the most effective strategy to run a preschool class is by providing verbal and non-verbal rewards (Priya Vijayan, Srikumar Chakravarthi, John Arul Philips, 2016). Verbal and non-verbal rewards encourages a child’s intrinsic motivation in order to behave and perform well. According to Skinner (B.F. Skinner, Ph.D. and Susan M. Markle, Ph.D, 2016), he was convinced that immediate reinforcement contributed significantly to acquiring new skills or knowledge. He also theorized that individual study with frequent reinforcement would produce faster learning.
In a classroom, children behaviour which is reinforced tends to be repeated & strengthened and behaviour which is not reinforced tends to die out-or be extinguished or weakened. However, the researcher is focusing on the positive reinforcement only for this research. The aim of this research is to find out the effectiveness of rewards, whether it is verbal or non-verbal rewards used in classroom to strengthen and improve children’s behaviour and performance.
1.2 Research Problem
The research problem of this study is the effectiveness of rewards in a classroom on children. More specifically, it is a question of whether we could change the children misbehaviour for the betterment by using rewards in the classroom. Misbehaviour in a classroom could lead to several negative effects such as, other children could not concentrate on the learning and the teacher could not achieve his/her teaching objective for the particular lesson. Thus, rewards is one of the way for the teachers and parents to affect the children’s behaviour positively. This leads to our research questions which are how does reward affect the children’s behaviour, how does behaviour differ in boys and girls from the experimental group and how does the rewarded group’s active participation shown through verbal and non-verbal responses.

1.3 Significance of Study
The significance of this research is mainly for early childhood educators, parents and also for policy makers. First of all, this research helps early childhood educators to find out the importance and the effect of rewards towards children’s behaviour. Through this, they could also promote appropriate behaviour while controlling the level of misbehaviour in their preschool classes as well. In addition, the early childhood educators would also find out that rewards could influence children to be motivated in classroom. When the children are motivated, they will learn better by showing interest in classroom and also the learning objectives will be achieved.

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Besides that, this research assists parents to know more about the effect of rewards towards their children. Children need to learn in both preschool and also at home. Their behaviour starts at home initially and it develops at school. Thus, parents need to understand the importance of nurturing their children with positive behaviour. In order to do that, reward system at home could help the parents. This research will let the parents know that using rewards to their children will make them attain positive behaviour and also motivated while reducing the undesired behaviour.
Other than that, policy makers could also be benefited by this research. Through this research, policy makers such as the Ministry of Education would understand the significance of rewards towards children. Thus, they would amend or create policies that would incorporate rewards in preschool children’s daily life. This step would change the preschool children for the betterment. With rewards, the children would feel motivated which affects their absorption of knowledge positively.
1.4 Research Objective
The objectives of this research are:
1. To investigate the effect of rewards towards children’s behaviour.

2. To examine the behaviour difference in boys and girls from the experimental group.

3. To determine children’s active participation from experimental group through verbal and non-verbal responses.

1.5 Research Questions
The research question of this research are:
1. How does reward affect the children’s behavior?
2. How does behavior differ in boys and girls from the experimental group?
3. How does the experimental group’s active participation shown through verbal and non-verbal responses?
1.6 Hypothesis
The hypothesis of this study are:
H0: There is no significant effect of rewards on children’s behaviour.

H1: There is significant effect of rewards on children’s behaviour.

H0: There is no significant behaviour difference between boys and girls from the experimental group.

H1: There is significant behaviour difference between boys and girls from the experimental group.

H0: There is no significant active participation from experimental group through verbal and non-verbal responses.

H1: There is significant active participation from experimental group through verbal and non-verbal responses.

1.7 Research Framework
1.7.1 Conceptual Framework
Independent Variable Rewards
Praises
Stickers & Stationaries 262863517511 Dependent Variable
Children’s BehaviourVerbal Response
Non-verbal Response
Figure 1.1: Conceptual Framework
Table 1 shows the Conceptual Framework of this research. In this study, the Independent Variable is the rewards given to the experimental group which are the praises and also stickers ; stationaries during the activities conducted. The Dependent Variable of this study is the children’s behavior affected by the rewards which are the verbal response and non-verbal response by them in each activity.

1.7.2 Theoretical Framework
4950946943204972766875110963038875111
Theory
1997560368570B.F.Skinner : Reinforcement
Independent Variable Rewards
Praises
Stickers & Stationaries 262863517511 Dependent Variable
Children’s BehaviourVerbal Response
Non-verbal Response
Figure 1.2: Theoretical Framework
Figure 1.7.2 shows the theoretical framework of this study. This study is based on a behaviorism theory which is the reinforcement theory by the B.F.Skinner. According the behaviorist, behaviour which is reinforced tends to be repeated and strengthened, meanwhile the behaviour which is not reinforced tends to die out-or be extinguished and weakened. In this theory, there are 2 different types of reinforcement are stated, which are the positive reinforcement and negative reinforcement. However, in this study, only the positive reinforcement is focused.

CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
This chapter describes about Literature Review of this study. There are two subtopics such as Rewards ; Verbal and Non-Verbal Responses and Gender Difference ; Behaviour which are relevant to this study.

2.2 Rewards ; Verbal and Non-verbal Response
In this study, verbal and non-verbal response is understood as the children’s performance and their behaviour which has been influenced by the rewards given to them. Previous researcher Evgenia Theodotou (2014) explained the influence of rewards on students’ intrinsic motivation to learn and the findings support the positive impact of intrinsic motivation on children’s learning which leads to the better performance and behaviour. The researcher strong believe that, rewards can reinforce and at the same time forestall young children’s willingness to learn. Besides that, according to B.F.Skinner’s, a fundamental aspect of operant conditioning is that if the occurrence of response is followed by a reinforcing stimulus which is rewards in our study, then the rate of response will increase positively (B.F. Skinner, Ph.D. and Susan M. Markle, Ph.D, 2016).

2.3 Gender Difference & Prosocial Behaviour
Prosocial behavior, for the purposes of this study, is understood as any action that, as it happens, benefits others, or promotes harmonious relations with others (Erin R. Baker, Marie S. Tisak, John Tisak,2015). In this study, it is related to several actions such as helping, sharing, being nice and listening. Previous researcher found that studies utilizing questionnaire measures show girls to be more prosocial than boys, whereas studies using observational measures ?nd few if any sex differences in the frequency of prosocial behaviour (Eisenberg et al,2006).

CHAPTER 3: RESEARCH METHODOLOGY
3.1 Introduction
This chapter discusses about this study’s research design, location of study, sample of study and also the sampling technique. Besides that, the research procedure, data collection, instrument of study and also the data analysis of this study have been included in this chapter.

3.2 Research Design
This study is based on quantitative research design. Specifically, this study is an experimental quantitative study. Experimental research seeks to determine if a specific treatment influences an outcome. This impact is assessed by providing a specific treatment to one group and withholding it from another and then determining how both group scored on an outcome.
3.3 Location of Study
The location of this study is at a preschool in SJK (T) Batu Caves. It is a government preschool and there are 2 classes called Jeyam and Vetri. This preschool is located in Batu Caves, Selangor.
3.4 Sample of Study
Experimental Group
The experimental group consists of 15 participants where in each activity either 8 boys and 7 girls or 8 girls and 7 boys participated. All the participants were aged 6 years old. Throughout the activities, they were praised and were given stickers or stationaries at the end of the activity. All the 15 participants were chosen randomly from Jeyam class.

Controlled Group
The controlled group consists of 15 participants where in each activity either 8 boys and 7 girls or 8 girls and 7 boys participated. All the participants were aged 6 years old as well. Throughout the activities, they were not given any verbal or non-verbal rewards. 10 out of 15 participants were chosen from Jeyam class and remaining 5 participants were chosen randomly from Vetri class.

3.5 Sampling Technique
The sampling techniques that were chosen for this study were convenience sampling and simple random sampling techniques. The convenience sampling technique were chosen in order to choose the location of this study. Besides that, simple random sampling also was used to choose the participants randomly from Vetri class as 5 participants was shortage because the Jeyam class only had 25 participants and the researcher needed 30 participants.
3.6 Research Procedure

Figure 3.1: Research Procedure
3.7 Data Collection
Activity 1
Participants
Thirty 6 years old children (15 boys and 15 girls) were tested in this experiment. All participants were native Tamil speakers, were recruited from a government preschool in Batu Caves, Selangor and were from mixed socioeconomic backgrounds.

Design
Each child underwent a treatment and a test phase. For the treatment phase, children were randomly assigned to one the two conditions which are the Verbal and Non-verbal Reward Condition and Controlled Condition. The test phase for this experiment was Puzzle sharing Task.

Procedure
Children were tested in a quiet classroom in their school. All testing was done by one female experimenter who explained and structured the task. As for the materials, I’ve used 9 big puzzle pieces which contained different pictures. This task was done by children in a group of 3 from each of their group. Each session was video recorded and lasted about 5 minutes for each of the group.

The puzzles were placed in front of a group of 3 children and introduced to them the original picture of the puzzle that they need to create. In order to make the activity more valuable, I’ve created a slightly competitive setting by telling participants that whoever shares the puzzles with their partner and complete the puzzle faster wins the game.
The treatment phase consisted of two conditions which are the Verbal ; Non-verbal Reward Condition and Controlled Condition. 15 children were randomly assigned to undergo these 2 conditions where one of it was the Rewarded Group were constantly praised and motivated by the experimenter throughout the activity. Besides that, they were also informed that stationaries will be provided as gift for them if they share the puzzle with their partner and complete the puzzle faster. On the other hand, the Controlled Group children were not given any verbal or non-verbal rewards throughout the activity. The test ended when all the children completed the puzzle task.

Activity 2
Participants
Thirty 6 years old children (15 boys and 15 girls) were tested in this experiment. All participants were native Tamil speakers, were recruited from a government preschool in Batu Caves, Selangor and were from mixed socioeconomic backgrounds.

Design
Each child underwent a treatment and a test phase. For the treatment phase, children were randomly assigned to one the two conditions which are the Verbal and Non-verbal Reward Condition and Controlled Condition. The test phase for this experiment was Memory Card task.

Procedure
Children were tested in a quiet classroom in their school. All testing was done by one female experimenter who explained and structured the task. As for the materials, I’ve used 6 pieces of cards that contained 3 pairs of pictures. This task was done by children individually from each of their group (15 children- Rewarded Group, 15 children- Non-Rewarded Group). Each session was video recorded and lasted for about 1+ minute.

The cards were placed (the picture facing them) in front each child and let them observe the cards for 10 seconds. In order to make the activity more valuable, I’ve created a slightly competitive setting by telling participants that whoever completes the memory card task faster wins the game. Then, they have started the task in finding the pair for each picture.
The treatment phase consisted of two conditions which are the Verbal ; Non-verbal Reward Condition and Controlled Condition. 15 children were randomly assigned to undergo these 2 conditions and one of it was the Rewarded Group were constantly praised and motivated by the experimenter throughout the activity. Besides that, they were also informed that sticker will be provided as gift for them if they complete Memory Card task faster. On the other hand, the Controlled Group children were not given any verbal or non-verbal rewards throughout the activity. The test ended when all the children completed the Memory Card task.

Activity 3
Participants
Thirty 6 years old children (15 boys and 15 girls) were tested in this experiment. All participants were native Tamil speakers, were recruited from a government preschool in Batu Caves, Selangor and were from mixed socioeconomic backgrounds.

Design
Each child underwent a treatment and a test phase. For the treatment phase, children were randomly assigned to one the two conditions which are the Verbal and Non-verbal Reward Condition and Controlled Condition. The test phase for this experiment was Playdough with Theme task.

Procedure
Children were tested in a quiet classroom in their school. All testing was done by one female experimenter who explained and structured the task. As for the materials, I’ve used 8 different colours of play dough (white, black, yellow, green, red, blue, pink, orange) for each group. This task was done by children in a group of 5 children (15 children- Rewarded Group, 15 children- Non-Rewarded Group). Each session was video recorded and lasted about 10 minutes.

First of all, children were informed that they will be creating objects using the colourful playdough given according to their theme. The themes that were given to the children were either ‘Fruit Basket’ or ‘Beach’. In order to make the activity more valuable, I’ve created a slightly competitive setting by telling participants that whoever cooperate with their team members to complete the task given wins the game.

The treatment phase consisted of two conditions which are the Verbal ; Non-verbal Reward Condition and Controlled Condition. 15 children were randomly assigned to undergo these 2 conditions where one of it was the Rewarded Group were constantly praised and motivated by the experimenter throughout the activity. Besides that, they were also informed that smiley faces will be provided as gift for them if they complete the Play Dough Theme activity according to the instruction given. On the other hand, the Controlled Group children were not given any verbal or non-verbal rewards throughout the activity. The test ended when all the children completed the Play Dough Theme task.

3.8 Instrument of Study
In this study, I’ve used checklist as my instrument of study. For Activity 1(Sharing Puzzle Task), I’ve used a checklist which contains 4 items for verbal responses such as ‘Call/invite their partners to share along’ and 6 items for non-verbal responses such as ‘share with their partners in less than 30 seconds’. As for the Activity 2(Memory Card Task), I’ve used a checklist which contains 2 items for verbal responses such as ‘say out words that indicates the child knows which card is the match’ and 6 items for non-verbal responses such as ‘complete the activity within 10 seconds’. Next, for the Activity 3 (Playdough Theme Activity), I’ve used a checklist that contains 3 items for verbal responses such as ‘discuss with the team members regarding the task’ and 5 items for non-verbal responses such as ‘help their group members physically in the task’.

3.9 Data Analysis
In this study, all the raw data was analysed by using Statistical Package for Social Sciences (SPSS) Version 24.0. Descriptive statistics were used to obtain the data and percentage. Meanwhile, for inferential statistics, an independent-samples t-test was conducted to compare the significant difference between experimental group’s and controlled group’s behaviour due to the effect of rewards. Besides that, an independent-samples t-test was used to compare the behaviours between boys and girls from experimental group.

CHAPTER 4: RESULT AND DISCUSSION
4.1 Introduction
This chapter discusses the descriptive analysis, the influence of rewards on children’s behaviour, influence of rewards on boys and girls from experimental group and active participation through verbal and non-verbal responses from the experimental group.

4.2 Descriptive Analysis
All the participants in the activities were 6 years old. The pie chart below shows the percentage of boys and girls who were in experimental group during Activity 1, Activity 2, and Activity 3.

Figure 4.1: Percentage of Boys and Girls Participants in Each Activity
(Experimental Group)
According to the Figure 4, it shows that in activity 1, there were 53% (8 participants) of girls and 47% (7 participants) of boys participants were tested. In activity 2, 53% (8 participants) of boys and 47% (7 participants) of girls participants were tested. As for Activity 3, it was similar to Activity 1, there were 53% (8 participants) of girls and 47% (7 participants) of boys participants were tested.
4.3 The effect of rewards on children’s score in Activity 1, Activity 2 and Activity 3.

4.3.1 Independent T-Test
Activity 1

Table 4.1: Independent T-Test for Activity 1
According to the independent t-test that was conducted by SPSS, it has been concluded that there was a significant difference in the scores between experimental group and controlled group; t(28)=10.6 , p= 0.00. This test indicates that, the rewards given affected the participants’ performance and behaviour of the experimental group positively compared to the controlled group.
Activity 2

Table 4.2: Independent T-Test for Activity 2
Referring to the independent t-test that was conducted by SPSS for Activity 2, it has been concluded that there was a significant difference in the scores between experimental group and controlled group; t(28)=5.82, p= 0.00. This test indicates that, the rewards given affected the participants’ performance and behaviour of the experimental group positively compared to the controlled group.
Activity 3

Table 4.3: Independent T-Test for Activity 3
According to the independent t-test that was conducted by SPSS for Activity 2, it has been concluded that there was a significant difference in the scores between experimental group and controlled group; t(28)=6.86, p= 0.00. This test indicates that, the rewards given affected the participants’ performance and behaviour of the experimental group positively compared to the controlled group.
4.3.2 Descriptive statistics
Activity 1
Figure 4.1: Scores Obtained by Experimental Group and Controlled Group in Activity 1
The bar graph above shows the scores obtained by the experimental group and controlled group in Activity 1 where they participated in a puzzle sharing task among their partners. As for the result, it shows that the experimental group scored 51 points more than the controlled group because the experimental group has rewards at the end of the activity and were praised throughout the activity.
Activity 2

Figure 4.2: Scores Obtained by Experimental Group and Controlled Group in Activity 2
The bar graph above shows the scores obtained by the experimental group and controlled group in Activity 2 where they participated in a memory card task individually. As for the result, it shows that the experimental group scored 30 points more than the controlled group as the experimental group scored 48 and the controlled group scored 18 only.

Activity 3

Figure 4.3: Scores Obtained by Experimental Group and Controlled Group in Activity 3
The bar graph above shows the scores obtained by the experimental group and controlled group in Activity 3 where they participated in a themed play dough task in a group. As for the result, it shows that the experimental group scored 30 points more as the experimental group scored 61 while the controlled group scored only 31 points.

4.4 Influence of rewards on boys and girls from experimental group
4.4.1 Independent T-Test
Activity 1

Table 4.4: Independent T-Test for Activity 1
According to the independent t-test that was conducted by SPSS, it has been concluded that there was no significant difference between the scores obtained by boys and girls from experimental group as the p value is more than 0.05; t(13)= -0.342 , p= 0.738. This test indicates that, the rewards affects the scores obtained by girls and boys in experimental group equally in Activity 1.
Activity 2

Table 4.5: Independent T-Test for Activity 2
Referring to the independent t-test that was conducted by SPSS, it has been concluded that there was no significant difference between the scores obtained by boys and girls from experimental group as the p value is more than 0.05; t(13)=0.230 , p= 0.822. This test indicates that, the rewards affects the scores obtained by girls and boys in experimental group equally in Activity 2.

Activity 3

Table 4.6: Independent T-Test for Activity 3
According to the independent t-test that was conducted by SPSS, it has been concluded that there was no significant difference between the scores obtained by boys and girls from experimental group as the p value is more than 0.05; t(13)= -0.235 , p= 0.471. This test indicates that, the rewards affects the scores obtained by girls and boys in experimental group equally in Activity 3.

4.4.2 Descriptive Statistics

Figure 4.4: The Difference Between Boys’ and Girls’ Scores in Each Activity
According to the chart in the above, it shows that in Activity 1 which was the puzzle sharing task, 89.5% points were obtained by girls compared to boys who got 88% points. For Activity 2, the highest score, 84.37% points were obtained by boys compared to girls who only got 82.14% points. Lastly, for Activity 3, the girls obtained higher score compared to boys, which was 85% and the boys only got 80%.

4.5 Experimental Group’s Participation through Verbal and Non-verbal Responses.
4.5.1 Descriptive Statistics
Activity Responses Items Percentage (n)
Activity 1
Verbal Responses 1. Say out words to encourage sharing. 66.7% (10)
2. Call/invite their partners to share along. 93.3% (14)
3. Discuss during the activity. 100% (15)
4. Provide words of encouragement for their partners. 80% (12)
Non-Verbal 1. Show excited gestures (e.g smiling, clapping). 100% (15)
2. Share with partners in ;30 seconds. 100% (15)
3. Share with partners in ;30 seconds. 0% (0)
Activity 2
Verbal Responses 1. Say out words that indicates the participant knows which card is the correct match. 53.3 % (8)
2. Answers with excitement. 100% (15)
Non-Verbal Responses 1. Flip the card confidently as knowing the correct match. 100% (15)
2. Complete the activity in ;10 seconds. 66.7% (10)
3. Complete the activity in ;10 seconds. 33.3% ( 5)
Activity 3
Verbal Responses 1. Discuss with the team members regarding the task. 86.7% (13)
2. Encourage the team members. 73.3% (11)
3. Provide guidance verbally to team members. 86.7% (13)
Non-Verbal Responses 1. Help their team members physically in their task. 60% (9)
2. Complete the task in ;10 minutes. 100% (15)
3. Complete the task in ;10 minutes. 0% (0)
Table 4.7: Percentage of Verbal and Non-Verbal Responses by experimental group
Table 4.7 shows the percentage of verbal and non-responses for each items by the experimental group participants in each activity. In Activity 1, for verbal responses criteria, 66.7%, which were 10 out of 15 of the participants said out words to encourage sharing such as ‘let’s share’ or ‘here, have this’ and 93.3%,which were 14 out of 15 participants called or invited their partners to share along the puzzles. Besides that, 100% of the participants discussed with their partners during the activity and 80% which were 12 participants provided words of encouragement for their partners during the activity too. As for the non-verbal responses, 100% of the experimental group participants showed excited gestures such as smiling or clapping and also all of them shared the puzzles with their partners in less than 30 seconds.
Next, in Activity 2, for verbal responses criteria, 53.3%, which were 8 out of 15 participants said out words that indicates that they knew which card is the correct match such as ‘Oh, I know this!’ or ‘This is the one!’ before flipping the cards and 100% of the participants answered with excited tone too. As for non-verbal responses in Activity 2, all of the participants flipped the card confidently as knowing the correct match. 10 out of 15 participants (66.7%) completed the activity in less than 10 seconds while the rest completed the activity in more than 10 seconds.
In Activity 3, for verbal responses criteria, 86.7% of participants (13 participants) discussed with their team members in order to decide each members’ task according to the theme given. Besides that, 73.3% of them, which were 11 out of 15 participants encouraged their team members and 86.7% of the participants (13 participants) provided guidance verbally to their team members throughout the activity such as ‘try to do like this’ or ‘look at mine and follow’. As for the non-verbal responses, 60% of the participants (9 out of 15 participants) helped their team members physically in their task and 100% of the experimental group participants completed the task within 10 minutes.
4.6 Discussion
Based on the result for all the activities, it is confirmed that rewards do influence children’s behaviour. This study’s result is relevant is consistent with previous researches which stated that ‘there was a main effect of reward, with those promised a reward performing better than those who were not'(Sheppard DP, Kretschmer A, Knispel E, Vollert B, Altgassen M, 2015).
During the activities, it can be seen that the children who has been praised and rewarded showed more interest and eagerness to complete the task well compared to the controlled group participants. Besides that, they appeared to be more excited and confident while doing each activity. These responses from the experimental group were cause by the provided praises throughout the activity and the cue provided about the reward to be given at the end of the activity. The praises and rewards had been the motivation for the children to try their level best in each activity such as to share the puzzle with their partners, to memorise the positions of the cards better and to come up with themed play dough creations.
In addition, according to the descriptive statistics, it was shown that girls scored more in 2 of the activities than the boys. Those 2 activities were the group activity in which the participants should show prosocial behaviours in order to get more scores. This finding is similar to previous researchers Alicia A. Bower and Juan F. Casas2 (2015) found that studies utilizing questionnaire measures show girls to be more prosocial than boys. During the activities, I found that the girls participants were more excited and happier due to the praises given throughout the activity and often inquired about the rewards that will be given at the end of the activity. However, with the data obtained from SPSS, it has been concluded that there was no significant difference between the boys and girls participants’ performance which has been affected by the rewards given.

Other than that, based on the Activity 2’s result, 33.3% the experimental group took more than 10 seconds to complete the task. It is because probably those participants are still strengthening short term and long term memory. According to Preoperational stage in Piaget’s Theory of Cognitive Development, children in this stage have not use cognitive operations such as use logic, transforming and combine (Saul McLeod, 2018) which affects the memory level of a child too. Thus, they are still developing their cognitive operation which caused them to complete the memory task in more than 10 seconds.
CHAPTER 5: CONCLUSION, IMPLICATION AND RECOMMENDATION
5.1 Introduction
This chapter discusses several subtopics which are the conclusion of study and implication of study. In addition, limitation of study and recommendation for future researchers also been discussed in this chapter.

5.2 Conclusion of Study
Rewards, whether it is verbal reward or non-verbal reward affects children’s behaviour positively in order to speed the learning, improve performances, reduce misbehaviour and increase prosocial behaviours. It has been proven that rewards affects children’s behaviour positively and it affects boys and girls equally as well. Besides that, it has been concluded that the verbal and non-verbal response from rewarded children were better than the controlled group children where they were not given praises and materialistic rewards. Thus, in my opinion, it is important to include verbal and non-verbal rewards when are dealing with children as it benefits both sides. Thus, the hypothesis achieved for this research are:
H1: There is significant effect of rewards on children’s behaviour.

H2 : There is no significant behaviour difference between boys and girls from the experimental group.

H3: There is significant active participation from experimental group through verbal and non-verbal responses.

5.3 Implications of Study
This study has implications on early childhood educators, parents and also policy makers. This research helps early childhood educators to find out the importance and the effect of rewards towards children’s behavior. Through this, they could also promote appropriate behavior while controlling the level of misbehavior in their preschool classes as well. Besides that, this research assists parents to know more about the effect of rewards towards their children as parents need to understand the importance of nurturing their children with positive behavior. This research will let the parents know that using rewards to their children will make them attain positive behavior and also motivated while reducing the undesired behavior. In addition, through this research, policy makers such as the Ministry of Education would understand the significance of rewards towards children. Thus, they would amend or create policies that would incorporate rewards in preschool children’s daily life
5.4 Limitation of Study
The first limitation of this study is the period given to conduct this study. This factor affects this study as the time to conduct the research and to collect the data were in a short period of time, which caused me to only conduct 3 activities. The following limitation is the sample size of this study. Since the time was limited, only 30 participants were chosen to be the sample size of this study. Next, the access to literature was one of the limitation as for this study, I’ve decided to use the very latest literature within 5 years range and there were not many literature related to this study directly.
5.5 Recommendation for Future Researchers
I would recommend the future researchers to consume more time in order to complete this research. If they would consume more time, they also can increase the sample size and the frequency of activity. Future researchers need to consider this factor because it would increase the level of accuracy for the result. This is because, in the current study, I could not form a significant difference between boys and girls behaviour who has been rewarded even though from the descriptive analysis I found a slight difference. Besides that, I would also recommend the future researchers to conduct their experiments towards children which varies in children’s developments such as emotional development, physical development and cognitive development.
REFERENCES
BIBLIOGRAPHY Booth, A. L. ( March/April 2014). Motivated by Meaning: Testing the Effect of Knowledge-Infused Rewards on Preschoolers’ Persistence. Child Development, Volume 85, Number 2, Pages 783–791.

Booth, A. L. (March/April 2014). Child Development. Motivated by Meaning: Testing the Effect of Knowledge-Infused Rewards on Preschoolers’ Persistence, Volume 85, Number 2, Pages 783–791.

Cimini, L. (2015). The Effects of Positive Examiner Verbal Comments and Token Reinforcement on the . 171.

Daniel Patrick Sheppard, A. K. (2015). The Role of Extrinsic Rewards and Cue-Intention Association in Prospective Memory in Young Children, PLoSONE 10(10):e0140987.doi:10.1371/journal.pone.0140987.

F.Casas, A. A. (23 September 2015). What Parents Do When Children Are Good: Parent Reports of Strategies for Reinforcing Early Childhood Prosocial Behaviours, 1-6.

Gambino, T. (2016). PSI CHI JOURNAL OF PSYCHOLOGICAL RESEARCH. The Effect of Verbal Praise on Maze Completion, 1-6.

Gresham, N. M. (2014). Research Into Practice. Differential Effects of the Mystery Motivator Intervention Using Student-Selected and Mystery Rewards, 1-14.

Hid, S. (22 April 2015 ). Revisiting the Role of Rewards in Motivation and Learning: Implications of Neuroscientific Research, 1-34.

Julia Ulber, K. H. ( July/August 2016). Extrinsic Rewards Diminish Costly Sharing in 3-Year-Olds. Child Development, Volume 87, Number 4, Pages 1192–1203.

Kelly M. Schieltz, D. P. (23 December 2016). Effects of Signaled Positive Reinforcement on Problem Behavior Maintained by Negative Reinforcement, 1-15.

Priya Vijayan, S. C. (March 2016). The Role of Teachers’ Behaviour and Strategies in Managing a Classroom Environment . International Journal of Social Science and Humanity, Vol. 6, No. 3, Page 1-8.

Theodotou, E. (April 2014). RESEARCH IN TEACHER EDUCATION . Early years education: are young students intrinsically or extrinsically motivated towards school activities? A discussion about the effects of rewards on young children’s learning, 1-5.

APPENDIX
Checklist for Activity 1

Checklist for Activity 2

Checklist for Activity 3

Chapter 1: Introduction

1.1 Introduction
This chapter describes about the background of an overview of ventilated car seat, function analysis, problem statements, objective, research methodology, methodology and benefits for the project.
1.2 Overview
According to a press release issued by market research agency Nielsen in the year of 2014 (Nielsen, 2014) Malaysia placing third in the world with 93 percent car ownership, and the country also has the highest incidence of multiple car ownership globally with 54 percent of households having more than one car, thus car seat is the most important integral part of automobile. From the time begin when there existed simple benches until today with massaging chairs, where automobile seats have changed immensely over time.
However, hinder the heat and moisture transport from the human back to the environment bringing thermal discomfort for a seated person. A seated person exposed to air flow while the bottom and the back are well surrounded with the seat structure material. In fact, a seated person dissipates heat from the back and bottom leads to raise in temperature of the seats and adversely rises the temperature of the back (Hatoum et al., 2017). Thus, moisture accumulation at the back affecting thermal comfort.
Ventilated car seat is a feature to cool down seat for improving thermal comfort. This feature has been most commonly offered for the front seats. In recent times, with the implementation of modern three-point seatbelt along with airbags it made drivers safer. Besides, Heating and cooling features has turn car seats into ambient zones on-the-go thus our modification mainly improved thermal comfort and quick vary in temperature. Conclusively, the excessive of features and functions on present car seats turned them into an extremely complex system like automated ventilation car seats.
In order to manufacture our Ventilated Car Seat, fabrication is using low cost material to upgrade existing car seats to ventilated car seats with cooling and heating effects thus applicable to hot and cold weather. Furthermore, for design drawing SOLIDWORK 2017 was used and decision matrix method was used for selection. Besides, Arduino, Powertrain Control Module (PCM), wiring diagram, Matlab and programming maybe needed.
Our targeted customer are car owners and automobiles manufacturer where their goal is to drag attention of the market and provide comfortable car seats to people. Moreover, ventilated car seats could provide people with pleasant journey.
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1.3 Function Analysis
Before solving the problem, building a functional model allow us to analyze the interactions between various components and focus into the problem. Table 1 shows the system, subsystem, and supersystem components of the car seats.
System Subsystem Supersystem
Car Seats Seat track Seat cushion wire User
Headrest Cushion Headrest metal structure Car
Backrest Cushion Seat backrest metal structure Moisture
Seat base Cushion Seat base metal structure Sunlight
Seatbelt Height adjuster components Heat
Seat back inclination adjustment
Table 1: System of Car seats.
Note: Headrest Cushion, Backrest Cushion and Seat base Cushion are named as Cushion.
Figure 1: Function analysis of car seats problems
Based on Figure 1, factor that causes raise in temperature is sunlight and user contact with cushion thus high temperature is harmful to user. Therefore, cushion heat is the problem that make user discomfort since sunlight is unavoidable circumstances.?
1.4 Problem Statements
Scant knowledge in the field, and limited research, has led to very few advancements in regards to ventilation car seat. The system has not much significantly differences over the timespan, their Main parameter value is to cool the occupant more effectively, but constraint is less changes to the current seat structure as possible to maintain comfortability. Besides, observed through multiple scientific articles, the complex biology of the humans combined with the uniqueness of body leads to a challenge in creating a universal ventilated car seats.
When driving long journey sitting on the seat will causes raise in temperature, since the heat are unable to dissipated, hence leads to hips and back feels hot from cushion and uncomfortable, besides it could easily lead to various diseases. Due back and hips without ventilation, the driver can easily get acne, eczema and other health problems on hips. Furthermore, drivers got sweat on hips and back cause driver feels sticky and uncomfortable then driver lost concentration causes traffic safety problems might happens. (Shenzhen car life Technology Co., Ltd., 2016) However, nowadays cars are equipped with air-conditioning, but the cold air are unable to reach driver and passenger hips and back. Although there are some cushion designed to be inflated or filled with water, this type of cushion unable to reduce temperature significantly and when user sitting on it have swing feel, as it’s extremely unsafe.
Besides that, the other reason car seats is hot due to the sunlight coming through the car’s windows. The car acts as a greenhouse, and heats up objects in the car as the car seats, dashboard, and other object can reach up to 40-50 degrees Celsius in direct sunlight (Staff, 2014). Those objects mentioned give off energy, and that is what heats up the air inside the car thereby when user open the car door, user feels the hot air inside the car and the car seats is hot causes user unlike to sit immediately exceptional case will be the user is in a rush yet have no choice but to sit on it. Moreover, the constantly changing driving conditions, and a weather system differing from place to place has put up extreme challenges towards the development of seat ventilation.
Ventilation car seat is a modified car seat to allow users to sit comfortably. This phenomena in turn lead to many problems including the user need to waste time on waiting the car seat to be cold, or by placing something on the car seat.
1.5 Objectives

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1.5.1 The objective of the capstone project are to design a Ventilated Car seat that provides additional cooling ability to the user is the priorities in this modification so that user can have pleasant driving experiences.

1.5.2 To design a ventilated car seats allow users can choose not only cooling effects but also introducing heating effects for chilly late night.

1.5.3 To fabricate the ventilated car seat that can speed up the cooling effects on the car seats.

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1.6 Research Methodology
Research methodology need to be done before beginning the project. To collect useful information for the aim of the capstone project objectives this is important process to go through. Thence, the information collected can be used to develop the project and to achieve the objectives. There are several ways of methodology to be used for research and to run the project. Hence, the information research from articles, journal, patent, book, internet, and survey from people were used in this project.
Information research is a key to develop a ventilated car seats, the history, type, components, materials selection for ventilated car seats, the related information has to be studied and determined. By doing so, the problem statement for the existing car seats can be determined thus improvement can be made to build a comfortable ventilated car seats.
Moreover, survey form is conducted in this project. This survey form is to research on what customers need and ask for their ideas on improvement. Nowadays google survey form is common used to gather opinions from society and environmentally friendly. Therefore, to achieve and improve the project will be more liable.

Furthermore, SOLIDWORK 2017 will be used for design purpose. This is a powerful tools to draw 3D design, SOLIDWORKS is well known 3D CAD software tool. Besides, it consists of simulation allow us to test the designs and make the decisions to improve quality. Moreover, enables us to determine product mechanical resistance, product durability, natural frequencies, and test heat transfer.

In addition, the software Mindview 7 can be used in drawing the Gantt chart for the milestone and the timeline of the project. Ensure the project was complete on time, perform this is to arrange the time wisely and accurately.
1.7 Methodology

(Excellent product design methods/routes are described in detail, and practicable. Clear process flow and various modern tools are utilised to solve all anticipate problems.)

1.8 Benefits of the project
An innovative ventilated car seats will improve customer satisfaction, safety and health benefits. Moreover, able to drag the attention of market in automobiles owners and manufacturer.
On the other hand, the benefits of the project will be the opportunity to demonstrate the skills and knowledge we have learned. Besides, allow us to build skills in problem analysis, market research, problem analysis, product development, business case preparation, presentation and public speaking. In addition, enhance project management, teamwork and problem solving skills. Furthermore, develop expertise in car seats problem area while understanding circumstance and constraints, for example social, legal, economic, cultural conditions and etc.?
Chapter 2: Literature Review

2.1 Introduction
This chapter describes about the history of a ventilated car seat, type of car seat, component of ventilated car seat and material used and type of material duct for ventilated car seat.
2.2 History
Car was invented before modern car seat is created. The origin of the idea of the automobile came from Europe. Inventors began to test automobiles with engines operate using steam during the eighteenth century. Nicolas Cugnot from France had designed, constructed and operated a tractor that powered by a steam engine back in 1769. Unfortunately, the funding for Cugnot’s road vehicle trails presumably ended with one of Cugnot’s supporter deceased after a series of automobile accident. During the early 1800s, Richard Trevithick from England constructed a steam-powered carriage which leads to various other British engineers creating and commercially operated steam vehicles which can carry passengers. However, the limitation of uses of such vehicles on the public roads hindered their efforts of constructing steam operated vehicles. Innovation of railroads was made when they were forced to turn their attention to conducting trains or carriages on private rails. During 1860, a French engineer named Etienne Lenoir invented an internal combustion engine that used illuminating gas as the fuel and ignition with electric sparks. This engine was used to drive machinery and rapidly became the first commercial gas engine. In 1866, Otto and Langen from Germany developed the four-stroke cycle which is widely known today when they tried to improve the gas engine which is previously made by Etienne Lenoir. A German named Daimler used the Otto cycle in a gas vapor engine and the following year he applied his petrol engine to a motor car in 1885. The very first car or automobile was built and sold in 1892 by the Daimler Motoren Gesellschaft. Daimler’s engine was used in France by Emile Levassor who then designed a vehicle which set the basic mechanical pattern for modern automobiles (Nyamwange et al., 2014).
Many modifications and changes had been made on automobile since then to improve the safety of those who drive or ride on a motorized vehicle. The first car seat appeared in the 1930s. Since the main purpose of the car seat is to keep the children in place when car was moving, there was no any safety consideration on it. A company named Bunny Bear Company produced a seat which is basically a booster seat that hooks onto the back of an actual car seat in 1933. The main purpose of this seat is for the parents to keep an eye on their children. In the 1940s, another type of car seat which has a metal frame attached to it. This type of car seat allows children to get a better view out from the window but it was not designed for safety but more to convenience. Safety of car seat was not prioritized until 1960s. Briton Jean Ames and Leonard Rivkin took child safety in their mind while creating car seat which include seat belts on it. Briton Jean Ames designed a rear-facing seat that featured a Y-strap which is similar to the modern seat while Leonard Rivkin created a seat that had a metal frame surrounded by a buckle like a high chair. But their idea was not well received by people since the public were not educated on the benefits of safety in a moving vehicle. After that, Ford developed the Tot-Guard in 1968 which is a plastic chair that contains padded area in front of the child’s face. Shortly after that, General Motors (GM) also released ‘Love Seats’ that came in two versions, one for children and one for infants. Seat belts were meant to keep children in place. Then there came the Bobby Mac convertible seat. Several laws and regulations were then adopted to improve the safety of car seats. Seat belt is one of the most common and important feature of modern car seat. The use of seat belts on car seat enhances the safety of vehicle by a lot. Vehicles are now produced which have a significant safety content for occupant restraint, crash-worthiness and crash avoidance. The major developments in restraint systems during the early 1980s were focused to improve their comfort in order to increase the likelihood of the seat belt being worn. From the mid-1980s onwards, enhancement of the occupant safety has been emphasised. Seat belts help to link the occupant directly to the passenger compartment or the car seat which then allow the occupant to ride down the crash as the vehicle’s front-end crushes. Later product introductions aim to control occupant trajectories in accidents which prevent the driver to get thrown out of the car due to inertia and limit the effects of contact with vehicle interior to prevent additional injuries. Usage of seat belt on car seat had significantly improves the effectiveness of the total occupant protection system of car seat. (King et al,. 1996)
2.3 Type of car seat
2.3.1 Side-Slip Seat
Side-slip seat is a relatively new type of seat founded in 2007 by Molon Labe, LLC (company). This type of seat was introduced because of its potential to reduce the aircraft boarding time under operational conditions. Side-slip seat is a seat where the middle seat is fixed and the 2 seat beside can be move.

(a) (b) (c)
Figure 2.1: Side-slip seat
With the innovative technology of the Side-Slip Seat, the available infrastructure could be dynamically changed to support the boarding process by providing a wider aisle that allow two passengers to pass each other in a convenient way. During boarding phase, the aisle seat or the outer seat is hand-pushed half over the middle seat, which is in a staggered position like shown in figure 2.1(c). The passenger or stewardess can simply grabs the seat at the side and pull out into a locked position to unfold the seat to normal position. Before the aircraft takes off, all seats have to be in the normal position and locked which need the passenger or crew to press a mechanical button on the side which lock the seat and prevent it from being pushed or pulled during the flight.

Figure 2.2: Example of Side-slip seat
The developed boarding model is adapted to allow the parallel movement of two passengers along the aisle. Furthermore, the dynamic status of the seat row (folded/unfolded) is implemented to enable or disable the parallel movement. If both sides of the aisle are in the initial folded condition, a second passenger can pass without reducing the walking speed. If only one side is folded, the walking speed is reduced to 50%. If both sides are used by passengers and the Side-Slip Seats are unfolded, only one passenger is allowed to move in the aisle (Schultz, 2017).

2.3.2 Infant Car Seat
The rear-facing Infant Car Seat (ICS) was designed to meet the federal and state legal requirements for transporting children which is less than 1 year old. Infant Car Seat is a type of seat which main purpose is to protect an infant in the event of a crash or car accident. However, since they are used for child which is 1 year old when they could not move effectively on their own, they also often serve as a form of transport for infant over short distances since the infant car seat is portable and convenient. Most of the modern ICSs can be attached to a stroller to create a so called “travel system” so that it can be carried around easily. To remove ICS from a car, we need to rotate the carrying handle from a locked position to carrying position, then unlock ICS from the secure base, lift and place it in a stroller. A review of ICSs available in the market (from large retailers) revealed that the weight of ICS is approximately 4.5kg and it can hold infant with maximum weight of 13.6kg.

Figure 2.3: Infant car seat (ICS).
There is also a problem where it is difficult and potentially dangerous task to lift the infant car seat because of the awkwardness of the posture combined with the weight of baby and the ICS itself (Clamann et al, 2012).

2.3.3 Ergonomics Seat
Ergonomics or human factors engineering can simply be defined as the science of designing for people. Knowledge about human characteristics and capabilities were being applied to the design of car seat. Gathering knowledge about people involves multiple approaches with emphasis on anthropometry, biomechanics, psychology, statistic and so forth. Every discipline has an important role in the car seat development process. Ergonomic chair or seat is a critical step in preventing health problems in people who is in a sitting position for a long period of time. With the ergonomics approach, sitting is viewed as a specific, specialized activity which is influenced by the way that a person who is sitting interacts with his environment. Car seat is just one of the features contributing to automotive ergonomics. Automotive ergonomics used formula to optimize the car environment like the positioning of the driver, height of the waistline of the car relative to the driver’s hips and eyes, form of the bonnet and etc (Gkikas, 2013).

2.3.4 Folding Seat
Folding seat is a type of seat where one can fold it down. This type of seat is usually used by big cars.

Figure 2.4: Folding seat
Some of the rear right seats are foldable to enhance movement of passengers during boarding and alighting as shown in the figure above (Tetteh et al, 2017).

2.3.5 Bench Seat
The bench seat was the traditional seat installed in most of the American or Australian automobiles. Bench seats are usually supported by metallic frames and upholstered. A bench seat usually only reaches up to about the shoulder level of an adult sitting on it. Bench seats are only being used in the second row of seating in most of the common cars or the third row of SUVs and minivans (Tetteh et al, 2017).

Figure 2.5: Bench seat.

2.3.6 Bucket Seat
A bucket seat is a type of seat found in motorized vehicles that is intended for a single person and is usually defined in contrast to a bench seat where bench seat is intended for more than 1 person. Bucket seat has head and neck support compare to bench seat. It also often equipped with a head rest. Bucket seat is the most common kind of driver’s seat for common cars but this is not the case for driver’s seats in trucks. Many trucks are designed with a bench seat in the front.

Figure 2.6: Bucket Seat

Summarize of all type of car seat:
Type of seat Safety Comfort Convenience Health Cost
Side-slip seat – – + – –
Infant car seat + + – – –
Ergonomics seat + + – + –
Folding seat – – + – +
Bench seat – – – – +
Bucket seat – + – – +
Table 2.1: Overall view for type of seats

From Table 2.1, pros from each seat were chosen and integrated into the design. From side-slip seat, no feature could be taken into the design because this type of seat is designed for airplane and allow passenger to board with ease. Seat belt is a must for safety purpose, so seat belt feature from the type of seat above was taken and put into the design. For folding seat, the folding feature which allows driver or passenger to fold the car seat is good and was taken into consideration of our design. For bucket seat, we use this type of seat as the basic model of our design as this is the most commonly seen type of car seat on the market now.
2.4 Component of ventilated car seat
The main purpose of seat ventilation is to prevent perspiring occupants from feeling uncomfortable by sticking to leather-covered seats, for example. At the same time, thermal regulation creates an agreeable microclimate that keeps the driver comfortable longer. The processes that take place where the seat and occupant are in contact are vitally important for efficient moisture removal. The surface of the seat receives no direct airflow, only ventilation from behind. In order to allow the airflow here to run parallel to the seat surface, the structure below the seat cover must also be sufficiently permeable. For example like the picture below shows a configuration with eight fans on the Mercedes SL driver’s seat, where the fans draw in air from below or, in the case of the seat back, from behind and blow it out over the two exposed seat surfaces. A reverse flow of direction can also be achieved without any major difference in the resulting flow volume.

2.4.1 Car seat backrest

Figure 2.4.1 upholstery of a backrest.
A plastic front seat backrest is shown in Figure 2.4.1 are made of high-strength composite material, enabling design freedom on seat backrest for new premium interior styling. For example, The combined first-row composite seatbacks like Weigh almost 20% less than conventional seatbacks, reducing CO2 emissions over the life of the vehicle by an estimated 100 kilograms and Are 15% thinner than the industry’s thinnest seats, leading to 10 litters of additional interior cabin volume. The lighter weight can yield improved fuel performance for internal combustion, hybrid and all-electric vehicles; and less fuel consumption means fewer emissions of greenhouse gases. At the same time, the significantly thinner seatbacks allow designers either to provide more leg room to the second-row occupants or to shorten the overall length of the vehicle, thereby further reducing its total weight. The seatback is a technically mature system that has been fully validated for reliability, safety and comfort. Designers now have entirely new opportunities to customize and adapt seatbacks in vehicles. Since they are created with injection molding systems, the composite seatbacks allow for novel shapes and accessories to be added for the comfort of front seat occupants and the convenience of second-row passengers (Vinod, 2016).
2.4.2 Thermoelectric device
A thermoelectric device as shown in Figure 2.4.2 was used to control the temperature of the car-seat surface: the warm temperature in the summer and cold temperature in the winter. The characteristics of the thermoelectric device for the car-seat were analysed in relation to the input voltage and output temperature of the device (Bell. 2013).

Figure 2.4.2 thermoelectric cooling system

2.4.3 Compact centrifugal fan or radial fan for car seat ventilation
A fan device is show in Figure 2.4.3 which is built into a vehicle chair, and is arrange to ventilate away air that is drawn through the covering and filling of the vehicle chair, which has an electrically driven fan of radial type attached at the bottom of the chair. The fan wheel extends from the driving cover of the motoer, which extends up into the inlet of the fan. The fan is attached to a carrying means in the chair which is located on the underside of the filling and has passages for the ventilating air adjacent to the fan inlet.

Figure 2.4.3 radial fan device
2.4.4 SPA Seat Cushion

Figure 2.4.4 Backrest of an SPA seat Figure 2.4.5 Ventilated cushion of an SPA seat
Ventilated backrest from an SPA seat without massage function. The bigger cluster of holes is in the upper back area, while the lower back area has only four small holes. Another typical feature is grooves around various holes. These help to guide the flow in a desired direction.
When removing the foams from the frame, the only attachment is a rubber duct for seat ventilation. These two parts, like the upholstery, can be quickly assembled and disassembled without any special tools. The frame contains the attachment for the foams. The backrest is mounted to a plastic plate, where valves for the bolsters and massage bladders are.
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2.4.5 Flexible Aluminium Foil Air Ducting

Figure 2.4.6 Flexible ducting Figure 2.4.7 Flexible Aluminium Ducting Ventilation Vent Tube
To optimize the airflow through the system, a significant factor is to understand the design of the ductwork is shown in Figure 2.4.7 and Figure 2.4.8 Even though the B-side is not strictly pipes, it can be assumed to be so, for engineering purposes. Crucial parts are the outlets, inlets and areas where the flow separates. Most literature focuses on fans with as pushing system. Throughout the system, it is not relevant if the fluid is pushed or pulled through the pipe (Cory, 2005). Included in performance enhancements, one factor is to reduce the noise. This increases the performance without compromising airflow. The noise is not the most essential part for this project, but it cannot be increased. If the noise reaches a lower level the comfort increases. An essential factor is that the noise is directly coupled with duct design. This means that a good duct can improve both airflow, and reduce the noise (Tsai, 1982).

2.4.6 Pneumatic Systems (Pneumatic Seat Control)

Figure 2.4.9 Pneumatic Seat Systems for Maximum Driving Comfort
Pneumatic Seat Systems with many added functions are especially comfortable and offer clear technical advantages. The multi-contour seat function allows vehicle occupants to adapt the contour of the seat to their individual requirements. Via air cells integrated into the backrest and seat cushion the seat adjusts to fit the body. The optional massage function further enhances comfort for vehicle occupants on long journeys by means of alternate inflation and deflation of the air cells. The drive dynamic function automatically adapts the side bolsters of the seat to the current driving situation, ensuring optimum stability for occupants at all times, even when cornering. The advantages of a comfort seat are thus combined with those of a sports car seat (Tsai, 1982).

2.4.7 Seat Foam
The angle of the seat surface is about 17° from the horizontal with an extra slightly softer area to resist forward slipping of the seat bones. The area behind the seat bones has been carefully designed to provide an upward force on the buttock behind the seat bones to provide extra pelvis support, i.e. to resist backward rolling of the pelvis. The example show in Figure 2.4.10.

Figure 2.4.10 Seat foam sectioned down the centre line
Figure 2.4.12 Arduino Uno
2.4.8 Ambient Temperature sensor
The ambient air temperature sensor is located behind the bumper or grill of many vehicles and monitors the air temperature outside of the vehicle. The ambient (ATC) or outside air temperature sensor is an (NTC) negative temperature coefficient sensor that informs the semiautomatic/automatic temperature control system of outside air temperature. The NTC sensor’s resistance decreases as the outside air temperature increases. The computer uses this input, along with other in-car temperature sensors to control temperature and blower speed. When there’s a problem with this sensor, performance will suffer and the compressor’s clutch may not engage.
Ambient air temperature sensor symptoms, like an inoperative clutch or input problems are diagnosed with a scan tool and a multi meter. Use a multi meter and verify manufacturer’s specifications, (~ 220-240 ohms at 70°-80° F), to test this sensor for proper resistance. So, the sensor when it reads 80°F (27°C) or higher, it will allow the operation of the ventilated seats during a remote start. When it reads 50°F (10°C) or lower, the system will allow operation of the heated seat during a remote start (Rosh 2013).

2.5 Type of car seat material
To fabricate a ventilated car seat Nylon Fabric, Faux Vinyl, PCV, Vinyl, Faux Leather, Suede and Brushed Nylon is the common material used. Each material is described briefly in section 2.5.1 to 2.5.7.
2.5.1 Nylon Fabric
Nylon can come of many colour because it has a durable, hard-wearing upholstery fabric. fabrics can also be drawn into most shapes and are readily dyed to colour key with other parts of vehicle interior. Because nylon is weaved, it is harder to tear than some fabrics. It is also very stain resistant, providing you can wash out any spills before the dry. It is also the most popular form of fabric found in most automobiles. It is available in many colours and is the least expensive form of trim for your vehicle (Willis, 2014).
2.5.2 Faux Vinyl
This is actually a vinyl which takes on the characteristics of leather or suede or other types of material. It is hard-wearing and can have the appearance and shine of soft leather or the dullness of fabric trim. Faux vinyl is a mock vinyl which emulates the real article at a fraction of the cost (Willis, 2014).
2.5.3 PCV Leather
Commonly known as soft plastic, this is a vinyl style-material that is pliable and easy to form. It stretches well and is used in lower-end models of cars and vans. It can be coloured or made in black and white, but it is notorious for being sticky to sit on during the summer. Heat has a tendency to make the upholstery sweat and the driver of the vehicle is best advised not to wear shorts in the summer if their vehicle is lined with PVC (Willis, 2014).
2.5.4 Vinyl
Easy to wipe clean, durable and hard wearing, vinyl is another coonly used material in the making of automobile upholstery. It has similar properties to PVC but vinyl can soft, hard, pliable or firm. You might be aware that old LP records were made from vinyl but, because it is used in a different capacity for upholstery, it can be as soft as velvet although it will still make the skin sweat during hot periods of weather (Willis, 2014).
2.5.5 Faux Leather
Faux leather is a very versatile material that can be made to appear like almost anything. People have covered their car seats in fake crocodile skin, fake snake’s skin and even dinosaur prints. It behaves like leather and is easy to wipe clean. Spillages can be quickly dealt with so faux leather doesn’t stain easily and is very durable (Willis, 2014).
2.5.6 Suede
Cloth-based suede fabrics are a nice choice for an automobile interior. Suede is soft to the touch and feels like brushed cotton. This automobile fabric is not used as often because it stains easily and it not as durable for many types of automobile use (Willis, 2014).
2.5.7 Brushed Nylon
Brushed nylon is soft and warm and ideal for an interior seat cover or door trim. It is a thick fabric that is usually just under a ¼ thick when used in vehicles. It seems well and is a firm, durable material which is quite hard to tear (Willis, 2014).

2.6 Type of material duct
Ducts are conduits or passages used in heating, ventilation, and air conditioning (HVAC) to deliver and remove air. The needed airflows include, for example, supply air, return air, and exhaust air. Ducts commonly also deliver ventilation air as part of the supply air. As such, air ducts are one method of ensuring acceptable indoor air quality as well as thermal comfort. Each material is show in section 2.51 to 2.5.4.we decided the flexible duct with aluminium is our material use to connect the airflow to the car seat.
2.6.1 Fabric Hose
This is actually an air distribution device and is not intended as a conduit for conditioned air. The term fabric duct is therefore somehow misleading; fabric air dispersion system would be the more definitive name. However, as it often replaces hard ductwork, it is easy to perceive it simply as a duct. Usually made of polyester material, fabric ducts can provide a more even distribution and blending of the conditioned air in a given space than a conventional duct system. They may also be manufactured with vents or orifices. Fabric duct offers also many benefits such as low cost, lightweight and easy installation, a uniform distribution of air, and a wide spectrum of available colours and sizes.
2.6.2 Metal ducts
Such ducts are made from sheet metal (galvanized or stainless steel, copper, aluminium), cut and shaped to the required geometry for the air distribution system. Since metal is a good thermal conductor, such ducts require thermal insulation, the commonest material for which is glass wool, usually in roll form (known as ‘wraps’ or ‘wrapped insulation’), wrapped around the outer duct wall. Wraps incorporate an aluminium foil facing that acts as a vapour barrier. Insulation can also be installed on the inner wall of the duct (‘duct liners’), as glass wool duct wraps or duct slabs faced with a glass matting or mesh providing acoustic insulation and strengthening the inner face of the duct.
2.6.3 Flexible duct
Flexible ducts these usually consist of two aluminium and polyester concentric tubes. A glass wool layer is inserted between the two tubes as thermal insulation. Their use is generally limited to short lengths, due to high pressure drop-off and the acoustic. The ducts can be deployed in hardly accessible places of the building and when it is difficult to plan how to connect boxes to the suspended ceiling. With 10-metre sections you can save time, as you do not have to work with short sections, and 120cm large cartons make their handling and storage quite easy. With its 25mm thick mineral wool insulation and a perforated tube inside, the duct also serves as a silencer.
2.6.4 Plastic ducts
This category includes ducts made from plastic or foam boards, shaped by cutting and folded to produce the required cross-sectional geometry. Boards are faced usually with an aluminium coating both internally and external. The main drawback of this type of ducting is their fire classification. Even if they comply with local standards, when exposed to fire they often exhibit poor performance in terms of the production of both smoke and flaming droplets.

2.7 Decision Matrix for duct
Decision matrix was used to make decision for conceptual design later, a few criteria was included in our decision matrix. These criteria included are insulation, safety, cost, weight, heat resistance, appearance.
Criteria % Fabric hose Flexible duct( aluminium) Plastic duct Metal duct
Insulation 20 2 3 2 1
Safety 20 2 2 3 1
Heat resistance 20 2 3 2 1
Cost 20 2 2 3 1
Weight 10 2 2 3 1
Appearance 10 3 3 1 2
Total 100 13 15 14 10
Table 2.2 Decision Matrix for duct table
1=bad/ high cost /high weight, 2=median, 3= good/low cost/ low weight
Based on the decision matrix table, we can conclude that the aluminium flexible duct has the highest total value among all the material of duct. Fabric hose has a scored 13 while metal duct only scored 10 and the plastic scored 14. Conclusion, the flexible aluminium duct will be choosen in design.?
Chapter 3: Conceptual Design
3.1 Introduction
This chapter comprises of considering factors on conceptual design such as compliance with standard, environmental and sustainability, and ethical consideration. Also, the detailed conceptual for different designs and the decision matrix to select the best conceptual design for our project.
3.2 Compliance with Standard
3.2.1 Comfort
A ventilated car seat able to impact the society by increasing comfort on passengers. The car seat is commonly used during day-to-day driving, hence it is an influential factor on drivers and passengers. Individuals mostly spend long periods of time sitting on the seat in the same position. In addition, the car seat will trapped the hot air while exposing long time under sunlight and thus causing discomfort on users. Besides, the material of car seat does not often meet the thermal comfort needs of users. The main purpose of ventilation car seat is to provide comfortable seat while driving.
In Malaysia, once the driver get into the vehicle after a car parked at outdoors, they will experience thermal discomfort. Temperatue in a closed car after exposed under the sun will increases more than 20°C above the ambient temperature. Therefore, with our product of ventilated car seat, the user could experience thermal comfort. Thermal comfort is defined as the state of mind is expressing satisfaction and comfortable with the surrounding environment (Eduard, 2016).
Individuals can be easily visualize the temperature of the car seat on their smart devices. As the development of wireless technology is improving, the integration of connected cars from impossible become possible. Recently, Apple has launched the car platform as named as “CarPlay”. The driver able to get directions, listen to music, make calls or even send and receive messages that directly shows on car’s built in display (Jihoon, 2016). Thus, the performance of ventilated car seat are enhanced and improve the design and also its features by cooling the temperature of seat that requested from outside the car. With this features, ventilated car seat enable individual to remain comfortable over different range of ambient temperatures of the car seat.
In addition, ventilated car seat able to remove the heat absorption effectively and remain at desired temperature. It allows the user to control the thermal seat with the smart devices and alter the temperature of car seat immediately from outside the car without affecting the thermal environment. Thus, this ventilated car seat able to increase the level of comfort in the most efficient way.
Furthermore, the drivers or passengers able sit on the car seat at comfort temperature without opening the windows when they feel uncomfortably hot while sitting on the seat. As they sit on the car seat after some period, the energy dissipation from the under thighs and lower back will cause the temperature of car seat to increase. With the ventilated car seat, it able to maintain the temperature between the individual and the seat until it reaches thermal equilibrium. Hence, driver and passenger are ensured to be comfort during the distance travelled.
As a conclusion, ventilated car seat will enable the user to have a comfort seat during driving. It able to view and control the temperature of seat from outside the car by just connecting with the smart devices. Not only that, it able to maintain the seat at desired temperature no matter how long the user sit on it. Thus, it will increase and improve the level of comfort easily and effectively (Aniket et al, 2016).
3.2.2 Health
The others impact of ventilated car seat on society such as health issues. It may increase the seated person’s overall thermal comfort and reduce the transfer of heat to the back of driver. The hot air that trap inside the car might affect the health of user and performance of driving. Thus the ventilated car seat is very important and bring a lot of benefits to the vehicle user.
First of all, the car that parked outdoor mostly would absorb the solar radiation from sun and eventually increases the inlet vehicle temperature. Besides, the temperature of pelvis and the back of driver and car passenger also rises once they sit on the car seat that has absorbed the heat trap from surrounding. When the body temperature rises more than the body optimal temperature, it may causes thermal discomfort to an individual. However, if the body temperature continue rises more than 37°C, the individual might experience heat exhaustion and heat stroke and are a part of continuum. Heat exhaustion on individual when his or her temperature reaches in the range of 37°C to 40°C will experience headache, dizziness, malaise, thirsty and weakness. Meanwhile, the core temperature in heat stroke is greater than 40°C and it is a life-threatening illness. When a victim sitting inside a vehicle at high core temperature, the victim will trigger neurological dysfunction, delirium, nausea and coma (Chan, 2015). Hence, with the ventilated car seat, the heat would dissipates faster and would not trap on the car seat. The user would not experience body temperature rises, sweating in order to dissipated heat out from body, increase in heart rate as organ works in order to cool down and lowering core body temperature. At the same time, the performance in driving long journey is not affected and thus bringing thermal comfort for a seated person. Obviously, ventilated car seat would not causing the user to experience heat related illness.
Moreover, the design of the prototype enable to cool the back which are well in contact surface with the seat. In fact, when the user sitting on the seat in the same position more than half an hour in a journey, the seated person might dissipates heat from the back of body to the car seat and thus causing the temperature of the car seat also increases. If the heat does not escape from the car seat, the temperature of the seated person adversely increases and causes thermal discomfort. However, the concept of ventilated car seat may solve this problem of heat flow from the back of the seated person. It able to transfer the heat and cooling the human back at desired temperature. Hence, ventilated car seat able to achieve the concept of body cooling and enhance the thermal comfort in body health.
Furthermore, prolonged periods of sitting may causes postural problems and damage to the potential skin tissue. In order to improve the posture performance, ventilated car seat are designed in a contoured shape which are matching to our shape of vertebra. Good position of sitting would enhanced the postural problems and the comfort of seating is improved. Thus, the pressure that developed from sitting in a long period and the risk of skin damage are reduced. The contoured surface of the ventilated car seat are allowed the air from air conditioning are draws and flow along the contoured shape in order to cool the back of seated person. Thus, heat is no longer trap at the contact surface with the user (Liu, 2017).
As a result, the ventilated car seat interface temperature has played a vital role in the evaluation of comfort perceived by the user. It can enhance thermal comfort, dissipates heat loss, reduce the heat trap on the car seat and reduce overall heat related illness.
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3.2.3 Safety
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3.3 Environmental and Sustainability

Environmental requirements also consider as one of the impact on society. Citizen in Malaysia normally experience thermal discomfort in car due to Malaysia experiences summer in four seasons. Eduard demonstrated that in order to cool the inlet car which is parked under the sun in prolonged period, the driver might turned on the air conditioning in high speed of cool air flow. Apparently, fuel consumption of the car increases and eventually increases the emissions of carbon dioxide to the surrounding and causes pollution in environment (Eduard, 2016).
Meanwhile, the components of the prototype ventilated car seat are selected as material that friendly use and eco-friendly. The ventilated car seat able to cool down the seated person and thus reduce further emissions of carbon dioxide to the environment. Therefore, all the part of ventilated car seat are considering this criterion and further enhanced the performance.
Besides, the consideration for the components of the prototype such as material are selected wisely. This is to ensure that the materials of PU foam, seat cushion and others are well absorb heat from the seated person in order to achieve the thermal comfort. In addition, the material selected for the prototype would not causes toxic to the user and polluted to the environment. The seat cover’s material can be reusable which can be used on other car seat instead of throwing away or dispose straightly. Consequently, it can continues to be a useful and valuable item that able to reduce heat absorption on the car seat when in use. Hence, it can fully utilize the product and reduce amount of waste to the landfills.
Furthermore, the material selected for the prototype is high standard and good quality. The strength of material for the prototype could withstand the stress from any possible occurrence and beyond the elastic limit. This is to ensure our product is durable and reliable. Thus, the product can be used at a certain long lasting period. In consequence, maintenance and extra material used to repair the product can be reduced further, thus reduce harmful effect on the environment.
In conclusion, environmental factor encourage the proper design of ventilated car seat and material are ensured to be selected wisely. This is to achieve the environmental requirement and reduce further pollution to our living.

3.4 Ethical Consideration
The consideration of ethics is concerned and forms the major element in the research. According to Shuriye (2011), ethics is refer to the systematic study of values, standard of conduct, evaluate moral concept and identify between the right and wrong. With the ethics, engineers able to critically understand and reflect the moral issues in engineering practices.
One of the ethical consideration is the research information should be authentic and any misleading information is avoided. The data collection from the resources or participants is accurate and any insufficient data or information is not included in the research. The research is done carefully to ensure the information provided is reliable and any careless errors that may lead to research misconduct. All the information of the research is done with transparency and honesty.
Moreover, the research respondents or research participants are voluntary and had not been subject to any coercion for participation in the research through online surveying method. They are ensured not subjected to any harmful threat when they not willing to participate in surveying. Also, the respondents or participants have the right to withdraw from the research process at any time. Their recorded data will automatically been removed from the analysis once they withdraw from involving in the research.
Furthermore, all the respondents are ensured to be fully informed and understand the implication of their participation in the research. The interpretations of the research that presented should be done honestly and transparency. The research finding are communicated in nontechnical language and in compact narration when face to face interview or through online surveying form. Any possible conflicts of interest in the research have to declare to prevent any possible risk happens on respondents that may affect the study result in the research.
Besides that, the privacy of the respondents or research participants is protected. The responses obtained from the participants without permission will not be disclosed to others publicly. The researcher has the responsibility to protect the respondents and avoid causing any discomfort on them due to their involvement in the research process. Thus, the trustworthy relationship between the respondents and the researcher is built.
Generally, ethical considerations should be aware and concerned when the research is carried out by the researcher. When the ethics is considered, the respondents or participants in the research project is protected. Thus, the research able to be done smoothly and any mistake or misrepresentation of the research is avoided.

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3.5 Sketching
Design A

Design B

Design C

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3.6 Explanation design how ventilated car seats work
Based the all design sketches in Figure 3.5 it shows 3 different design types of ventilated car seats thereby will further elaborate more on these individual design about working principles, pros and cons, and comparison.
3.6.1 Design A
Design A is shown in Figure 3.5.1(a) to 3.5.1(c). This design come with radial fan and thermoelectric device (TED) as it placed on centre of backrest cushion and bottom seats cushion. The extra components used on normal car seats are radial fan, TED, wiring harness, exhaust tube, exhaust tube bezel, bottle of water, power supply and control switch. The working principles to achieve ventilated car seats is to rely radial fan blow air to the TED, then TED produce cold air to vent tube and flow to cushion as it reduces the temperature of cushion. When engine ignite, the power supply generate electricity to Arduino, radial fan, TED, and control switch as it connected to Arduino by programming code and wiring.
Furthermore, in order to allow the car seats to cool efficiently several hole was drilled on the seat cushion to reduce temperature effectively since the air flow is easier to transfer from bottom to top surface. On the other hand, TED will produce cool and hot air at different exhaust port but our intention is to retain cold air and eliminate ambient hot air by using vent tube to exhaust hot air to bottom of the car seats then enter bottle of water to reject hot air and bezel was installed to get nice looking. While backrest cushion will be similar to bottom seats cushion.
Overall, this design has great reduction in temperature due to TED was used with radial fan thus it has greater air flow than axial fan since a radial fan typically has a fan characteristic with a steeper pressure curve. Cons of the air system, for example by heavy user or dirty air ducts resulting in reduced fan performance. Since the radial fan is located in the foot well of a passenger sitting behind the seat, it can be damaged accidentally if its construction is not sufficiently sturdy. This is largely prevented by the robust design and the anchoring to the seat frame.

3.6.2 Design B
Design B is show in Figure 3.5.2(a) to 3.5.2(c) emphasis on modification of material and axial fan. This design is to change material to coconut fibre due to the ability of heat dissipated is great and recyclable material. Besides, axial fan was used while it was bind on centre of seats cushion with the common size of 100mm*100mm and using duct tube to allow air flow to cushion easily. Small hole was drilled on cushion to let the air flow pass through and reduce upper surface of car seats temperature effectively. Furthermore, fan, switch, power supply, and Arduino were connected similar to design A.
For the backrest cushion two axial fan were used yet it placed at above and below of the centre as reference due to the size of backrest cushion is definitely larger than the bottom cushion since axial fan performance is low. Besides that, everything is similar to bottom seats. Benefits of coconut fibre is weak heat absorption and great heat dissipated but it cost more than normal material. Cons of the design B is similar to design A.

3.6.3 Design C
Design C is show in Figure 3.5.3(a) to 3.5.3(d). This design concept is able to generate two states which is heating and cooling effect as the air flow is from automobiles air conditioning system since the air flowing through dashboard compartment and to the foot compartment are commonly known thus a flexible aluminium duct tube was connected between air conditioning system to lower surface of backrest, and bottom seats cushion. Since air conditioning will produce small amount of water vapour due to sudden vary in temperatures, it will bring harmful effects to cushion thus a sponge was used to absorb water and prevent it damaged the cushion. Since user sit on cushion will apply pressure to sponge leads to water eject from sponge before it dry, so at the lower surface centre part of cushion need to remove it to some thickness in order for sponge to be fitted in.
Furthermore, since using flexible aluminium duct tube hence no worry about the position of duct tube as it can be placed side or middle then meet to centre part of cushion. Moreover, cushion have few small hole (d?15mm) to let the air flow from duct tube to pass through cushion and hit on the seats cover surface then temperature will vary significantly.
The design can be used as automated or manual, if automated ventilated car seats are made, a temperature sensors is required to put into the seat cushion to detect the desired temperature range from user setting through radio system screen as it will send to Powertrain Control Module (PCM) acts as the brains of the car system thus the air conditioning system will flow air to car seats. Moreover, it can be controlled wirelessly by using smartphone with the apps Carplay and before entering the car all it needs is to take out smartphones then the car seats temperature is control at desired temperature. On the other hand, if manual ventilated car seats are made, basically just turn the switch to foot compartment or maybe new compartment as car seats on dashboard then the air conditioning system will flow air to car seats. Therefore, automated and manual is suitable for modern and former automobiles.
Overall, this design is applicable to all country whether you live in hot weather states or cold weather states, heated and cooled seats (or ventilated seats) are perfect for a hot day or a chilly late night. Safety, cheaper, better and comfortable has achieved in this design.
3.7 Decision Matrix
Decision matrix was used to make decision from the 3 conceptual ideas previously, a few criteria are include in our decision matrix. These criteria are comfort, safety, cost, weight, ventilation effect, appearance. Comfort, safety, ventilation effect are given priorities compare to the other criteria.
Criteria % Design A Design B Design C
Comfort 20 3 60 3 60 4 80
Safety 20 2 40 2 40 4 80
Ventilation 20 4 80 3 60 4 80
Cost 20 2 40 3 60 3 60
Weight 10 4 80 4 80 4 80
Appearance 10 4 80 3 60 2 40
Total 380 360 420
Table 3.7 Decision Matrix Table
Based on the decision matrix table, we can conclude that design C has the highest total value among all the designs. Design A scored 380 while Design B only scored 360. In conclusion, Design C was chosen.
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Chapter 4: Final Design

4.1 Introduction
This chapter involves the detailed of

4.2 Final Design (SolidWorks)

Figure 4.2(a): Front view of the design.

Figure 4.2(b): Side view of the design.

Figure 4.2(c): Top view of the design.

Figure 4.2 (d): side view of the inside

Figure 4.2 (e): overview of the final design

In the Sitting Position (Low), four of the rear wheels and two of the front wheels touch the surface of the ground. The seat is sitting………………………………………………….
(explain)
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4.3 Prototype

Chapter 5: Analysis and Discussion
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5.2 Calculation and Results

Chapter 1: Introduction
This research talks about the effect of the store atmosphere on consumer purchasing decisions in Virgin Megastore, because there are many factors that can influence a consumer’s decision in purchasing. The music in the store, the lighting, design of the store, layout of the clothes are all examples of things that can affect the consumer’s purchasing decision. Sometimes, just by looking at the store design from the outside this could make you feel a bit mysterious of how their designs are and it can also make you feel some hatred towards the store or bothered by the design, hence affecting the sales of the shop.
This is going to be an applied research on the effect of Virgin Megastore’s atmosphere on consumer purchase decisions in Egypt and it aims to know more on why and how the store atmosphere can affect the purchasing decisions of consumers by making surveys, online questionnaires, and observing customers entering stores or their expressions towards Virgin Megastore.

1.1: About Virgin Group:
Virgin Group is a family owned growth capital investor, with a globally recognized ; respected brand. Their investment team focuses on their core consumer sectors which are travel ; leisure, telecoms ; media, music ; entertainment, financial services, and health ; wellness. They seek to invest in more opportunities and partner with like-minded investors. They provide value in their investments using 3 ways:
• Sector expertise and track record across 5 core sectors.
• Experience and understanding of consumer behavior, brands, and marketing.
• Strong network of investors, management teams, and alumni.
Virgin Group is an active venture investor that is focused on technology with a portfolio of over 35 companies spanning the consumer internet, fin-tech, and sharing economy sectors. Virgin Group has more than 60 businesses that serve 53 million worldwide customers, who also interact with them on social media, they currently have over 37 million followers on social media.
Virgin Group’s purpose is “Changing Business for Good”. They mean by that statement that they think about the long term effect of the business decisions made today. They aim on having a clearly expressed, fixed, and measurable purpose in every Virgin business which motivates their decisions and boosts their success which results with positive efforts on customers, people, communities, and the environment. As well as, keeping their purpose principles and values stable in all the existing and the new business investments they make. Finally, innovative universal change beyond the Virgin Group through Sir Richard Branson’s profile and support as a global business leader and rising to the challenges.
Virgin Group invests in more than one industry such as:
• Financial Services: (Virgin Money ; Virgin Money Giving)
• Health ; Wellness: (Virgin Active, Virgin Care, Virgin Health Bank, Virgin Pulse, Virgin Pure, ; Virgin Sport)
• Music ; Entertainment: (Virgin Casino, Virgin Games, Virgin Mega Store, Virgin Produced, Virgin Radio International, ; Virgin Records)
• People ; Planet: (Virgin Earth Challenge, Virgin Racing, ; Virgin Start-Up)
• Telecoms ; Media: (Virgin Books, Virgin Connect, Virgin Media, Virgin Business, Virgin Media Ireland, Virgin Mobile in Australia, Canada, USA, France, Latin America, Central ; Eastern Europe and the Middle East ; Africa, and Virgin Red)
• Travel ; Leisure: ( Virgin America, Virgin Atlantic, Virgin Australia, Virgin Balloon Flights, Virgin Experience Days, Virgin Galactic, Virgin Holidays, Virgin Hotels, Virgin Trains, Virgin Wines, Virgin Limited Edition, ; Virgin Racing)

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o About Virgin Megastore:
Virgin Megastore has over 40 stores in the Middle East ; North Africa and it is currently the leading entertainment lifestyle retailer in the MENA region. Virgin Megastore opened its first store in the United Arab Emirates in 2001. It is a one-stop shop for all a person’s entertainment needs. It offers a wide range of lifestyle products and related services.
Virgin Megastore also sells tickets, which is the no. 1 physical and online ticketing platform in the region, which offers its customers entrance to festivals, clubs, sports events, music concerts, theme parks, and theatricals. Furthermore, Virgin Megastore created a new aspect in entertainment marketing and satisfaction to the region’s cultures through events, activities and support of local artists in all the markets it enters.
1.2: Research Importance:
This research is important because it helps understand the factors that affect consumer’s purchasing decisions and helps in examining their attitudes towards those factors.
1.3: Research Objectives:
Furthermore, this research focuses on knowing the factors in Virgin Megastore that affect the consumers’ purchasing decisions, observing the consumers’ impressions and attitude when they enter and exit Virgin Megastore and compare between them, knowing why and how do these factors affect the consumer’s purchasing decisions, to relate between the factors and the 5 senses (Scent, Sight, Hearing, Touch, and Taste).

CHAPTER 1. INTRODUCTION
Background of study
The World Health Organization (WHO) recommendation of safe blood transfusion is provision of compatible blood which is cross matched and had been screened at least for five transfusion transmitted infections (TTIs); human immunodeficiency virus (HIV), hepatitis C (HCV),hepatitis B (HBV), syphilis and malaria parasite (WHO, 2011).

Blood products, such as blood components for both transfusions and plasma derivatives, are essential therapeutics in modern medicine. Red blood cell transfusions are vital in saving lives during emergencies and in other cases where interventions are necessary (Heiden, 2010) For example, blood coagulation factor concentrates dramatically improve the life expectancy and quality of life of hemophilia patients. Until recently, blood products were considered to be purely physiological materials that were not expected to be harmful (Su et al., 2003). However, HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) were found to be associated with blood transfusions in Chinese adults (Shepard et al., 2005; Shang at al., 2007; Shan et al., 2007).

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Transfusion therapy has been the mainstay of several medicosurgical therapeutics since 1930 (Zafar, 2000).
There are 3 types of blood donors: voluntary/unpaid, family/replacement, and paid.2 A voluntary blood donor intentionally donates blood without pursuing any remuneration, whereas are placement donor is requested to do so by the patient or his associates (WHO, 2014). According to World Health Organization (WHO) Global Database on Blood Safety (GDBS) 2008, total around 91.8 million blood donations are collected annually. But, approximately 48% of these emanate from high-income countries, astringent to 15% of earth’s population. Ten nations vouch for 65% of blood collections worldwide ,and India is the third highest bidder in this respect following United States and China (Agravat et al., 2004). With almost 9.8 million units of yearly collections and 84% voluntary donors, India is expected to bang on the WHO target of 100% voluntary donations by 2020, much before due date ( WHO, 2014).

Blood transfusion aggravates the risk of transfusion transmissible infections (TTIs) like hepatitis B (HBV), hepatitis C (HCV), Human Immunode?ciency Virus (HIV), syphilis, and less commonly to malaria, toxoplasmosis, brucellosis, other viral infections (Mollison and Engelfriet, 2005). Early reports of the transfusion-related transmission of syphilis led to the World Health Organization (WHO) recommendations for syphilis testing of blood donors (Takpo et al., 2007 ). These recommendations have been questioned, since many syphilis antibodies among blood donors are the result of previous infections or even unspeci?c reactions. Furthermore, Treponema pallidum does not withstand cold storage (Tagny, 2011). The WHO recommends several syphilis screening tests: the enzyme immunoassay (EIA)and T. pallidum haemagglutination assay (TPHA) as speci?c tests, or the Venereal Disease Reference Labor to y (VDRL) and rapid plasma reagin (RPR) as non specific test (WHO, 2010).

Objectives: The primary objective of this study is to compare laboratory practices for screening blood donors for syphilis and hepatitis B virus at blood transfusion facilities in some private hospital in Port Harcourt, Nigeria with the recommendations of the World Health Organization and the National Blood Transfusion Service, Nigeria (NBTS).
This survey is to compare the current syphilis and Hepatitis B virus screening practices in Nigeria with the recommendations of the WHO and NBSG regarding the use of assays for screening blood donors and their performance. Also the prevalence of syphilis antibodies and Hepatitis B virus in blood donors will be estimated. Additionally, the survey determined whether written SOPs or guidelines were in place for syphilis screening and whether donors with positive syphilis tests were referred for clinical follow-up.

CHAPTER 2. LITERATURE REVIEW.

2.1 HEPATITIS B VIRUS
2.1.1 HEPATITIS B VIRUS INFECTION
Hepatitis B virus (HBV) is a noncytopathic, hepatotropic virus of the Hepadnaviridae family that causes variable degrees of liver disease in humans. Infection with HBV can be either acute or chronic; while adult infections have a relatively low rate of chronicity (around 5%), neonatal infections usually have a high persistence rate (McMahon, 2010).

Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) that affects the liver (WHO,2014). It can cause both acute and chronic infections (WHO,2014). Many people have no symptoms during the initial infection. Some develop a rapid onset of sickness with vomiting, yellowish skin, tiredness, dark urine and abdominal pain. Often these symptoms last a few weeks and rarely does the initial infection result in death (WHO,2014). It may take 30 to 180 days for symptoms to begin (WHO,2014). In those who get infected around the time of birth 90% develop chronic hepatitis B while less than 10% of those infected after the age of five do (CDC,2011). These complications result in the death of 15 to 25% of those with chronic disease (WHO, 2014).
2.1.2 HBV GENOME

The genome organisation of HBV. The genes overlap.

The genome of HBV is made of circular DNA, but it is unusual because the DNA is not fully double-stranded. One end of the full length strand is linked to the viral DNA polymerase. The genome is 3020–3320 nucleotides long (for the full-length strand) and 1700–2800 nucleotides long (for the short length-strand) (Kay and Zoulim, 2007).The negative-sense (non-coding) is complementary to the viral mRNA. The viral DNA is found in the nucleus soon after infection of the cell. The partially double-stranded DNA is rendered fully double-stranded by completion of the (+) sense strand and removal of a protein molecule from the (?) sense strand and a short sequence of RNA from the (+) sense strand. Non-coding bases are removed from the ends of the (?) sense strand and the ends are rejoined. There are four known genes encoded by the genome, called C, X, P, and S. The core protein is coded for by gene C (HBcAg), and its start codon is preceded by an upstream in-frame AUG start codon from which the pre-core protein is produced. HBeAg is produced by proteolytic processing of the pre-core protein. In some rare strains of the virus known as Hepatitis B virus precore mutants, no HBeAg is present (Buti et al.,2005). The DNA polymerase is encoded by gene P. Gene S is the gene that codes for the surface antigen (HBsAg). The HBsAg gene is one long open reading frame but contains three in frame “start” (ATG) codons that divide the gene into three sections, pre-S1, pre-S2, and S. Because of the multiple start codons, polypeptides of three different sizes called large (the order from surface to the inside: pre-S1, pre-S2, and S ), middle (pre-S2, S), and small (S) Glebe and Urban (2007) are produced Beck and Nassal (2007) The function of the protein coded for by gene X is not fully understood but it is associated with the development of liver cancer. It stimulates genes that promote cell growth and inactivates growth regulating molecules (Li et al.,2010).

2.1.3 Structural Protein
2.1.3.1 Hepatitis B surface antigen
Envelope polypeptides are encoded by the combination of the pre S and S gene regions.

The major protein of hepatitis B surface antigen (HBsAg) particles is the smallest gene
product (SHBs). The middle protein (MHBs) contains the pre-S2/S component.

The large surface protein (LHBs) contains pre-S1, pre-S2 and HBsAg, and is
incorporated in intact virus particles (Reifenberg et al., 2006). In viraemic carriers, MHBs
and SHBs products predominate in the liver, whereas in non-viraemic carriers, LHBs
products predominate. LHBs show direct toxic or immunomodulatory effect and
interaction with cytokines (Ayada et al., 2006) which may result in massive
hepatocellular necrosis, regeneration and the eventual development of HCC.

2.1.3.2 Core Proteins
The hepatitis B core antigen (HBcAg) (25 kD) is assembled into the capsid, which is
essential for viral packaging. Its synthesis is restricted to liver tissues, and is an important
target for immune recognition in chronic infection. Soluble Hepatitis B e antigen
(HBeAg) (21kD) peptide is released into the circulation, and is a reliable marker for
actively replicating virus, and hence, for high infectivity (Wu et al., 2007).

Seroconversion from HBeAg to anti-HBe is commonly associated with the clearance of
wild type (wt) HBV and the resolution of acute liver disease.

2.1.4 Nonstructural Proteins
2.1.4.1 HBV Polymerase Enzyme
The HBV polymerase is a 56 to 70kD polypeptide. HBV polymerase has the following
domains; the amino-terminal region; terminal protein (tp) which acts as a prime promoter
for synthesis of the minus strand cDNA, spacer domain, the RNA-dependent DNA
polymerase (reverse transcriptase), and the RNase H domain at the carboxy-terminus. Mutation of polymerase affecting its activity will affect the amount of virus produced, as well as the number of templates available to encode viral proteins (Bajunaid,2013).

2.1.4.2 X-gene
The X gene protein (154 amino acids (aa.)) encoded by the X gene (nt. 1372-1834),
exhibits numerous activities affecting intracellular signal transmission, gene transcription,
cell proliferation, DNA repair, and apoptosis (Francois et al., 2001). HBx trans-activates
and upregulates viral and cellular genes as the transcriptional expression of human
telomerase l; reverse transcriptase (hTERT) (Qu et al., 2005), through activation of
transcription factors, modulation of cell signalling pathways, RNA stabilization, and
alteration of nucleocytoplasmic translocation and inhibition of serine protease activity
(aa. 67-69 and 135-138 (Blackberg and Kidd-Ljunggren; 2003).

2.1.5 GENOTYPES AND SEROTYPES
With about 240 million chronic carriers worldwide and more than 686 000 deaths per year (WHO, 2014), Hepatitis B virus (HBV) infection remains a serious public health problem, particularly in endemic areas including Southeast Asia and Sub-Saharan Africa (WHO, 2015). To date, eight genotypes named A – H are recognized (Norder et al., 2004) and two additional genotypes, I and J, have been proposed (Tran et al., 2008, Tatematsu et al., 2009). HBV genotypes may have distinct geographical distributions. In Africa, especially genotypes A, D and E are prevalent, with genotype E being dominant throughout West Africa (Hübschen et al., 2008, Cooksley, 2010, Kramvis, 2014, Pourkarim et al., 2014, Kramvis, 2016, Hübschen et al., 2011). Several studies have implicated HBV genotypes in disparate disease progression, clinical outcome, therapeutic response and the degree of protection provided by vaccination (Cooksley, 2010, Kramvis, 2014, Pourkarim et al., 2014).

The human HBV is a member of the family Hepadnaviridae and has been classified into 10 genotypes (A-J), which can be further sub-divided into over 40 sub-genotypes (Kay and Zoulim, 2007; Kurbanov et al., 2010; Locarnini et al., 2013). The geographical distribution of genotypes is shown in  HYPERLINK “https://www.sciencedirect.com/science/article/pii/S0168827815000495” l “f0005” Fig. 1 (Locarnini et al., 2013).

Geographical distribution of the HBV genotypes and sub-genotypes. Genotype I and J are not shown as they have not been ratified by the ICTV; genotype I is found in Southern China and Vietnam whilst genotype J was identified from a Japanese World War II person who lived in Borneo (Locarnini et al., 2013).

2.1.6 HBV REPLICATION
During infection, HBV penetrates into the cells after surface binding, then the virus is transported into the nucleus without processing, where replication starts by unwinding circular DNA which is converted into a covalently closed circular DNA (cccDNA) that acts as a template for transcription of HBV pregenomic, and messenger RNAs (Beck and Nassal, 2007). Transcription starts from the core promoter to yield the 3.5 kb pregenomic RNA, which is packaged with polymerase into immature core particles, and then serves as a template for reverse transcription and negative strand DNA synthesis. The incomplete positive strand DNA is then synthesized. The mature core particles are packed into HBsAg and pre-S proteins in the endoplasmic reticulum then are exported from the cell.
2.1.7 IMMUNE RESPONSE TO HBV
The release of HBV DNA from the protective nucleocapsids (NCs) (NC disassembly or uncoating), a prerequisite for CCC DNA formation (Cui et al., 2013), may potentially expose the viral DNA to host DNA sensing mechanisms. Indeed, foreign or mis-localized cellular DNA represents one of the major pathogen-associated molecular patterns (PAMPs) that are recognized by their corresponding cellular receptors or sensors, the pattern recognition receptors (PRRs) (Kawai and Akira, 2010; Paludan and Bowie, 2013). Thus, many DNA viruses are detected by DNA sensors in the host cell cytoplasm (cyclic GMP-AMP synthase or cGAS, and others) (Gao et al.,2013; Sun et al., 2013;Cai et al., 2014), endosomes (Toll like receptor 9 or TLR9 in select immune cells) ((Kawai and Akira, 2010; Paludan and Bowie, 2013), and even in the nucleus (IFN?-inducible protein 16 or IFI16) (Monroe et al.,2014;Kerur et al., 2011). DNA sensors are important 86 innate immune factors in triggering early antiviral defenses such as type I IFN production and in regulating the adaptive immune response to clear viral infections. A major signal transducer in cytosolic DNA sensing is the ER-associated protein, stimulator of interferon genes (STING), which acts downstream of DNA sensors like cGAS, although STING-independent pathways of DNA sensing have also been reported (Paludan and Bowie,2013;Cai et al.,2014; Burdette and Vance 2013). Signaling through STING and downstream effectors such as interferon regulatory factor 3 (IRF3) leads to type I IFN production, which has strong antiviral activities against a variety of viruses through the induction of a large number of interferon stimulated genes (ISGs) (Tanaka and Chen, 2012). If and how HBV is detected by the innate immune system has remained an important yet unresolved issue. In contrast to many other viruses, HBV is generally thought to be a “stealth” virus because it does not induce a type I interferon (IFN) response during natural or experimental infections (Wieland et al., 2014). This is thought to be related to the unique replication cycle of the virus. In particular, the viral DNA is synthesized only after pgRNA packaging into the protective NCs, sequestered away from cytosolic DNA sensors. However, some recent reports have suggested that HBV may be able to trigger the innate immune response under certain conditions in infected hepatocytes or non-parenchymal liver cells such as Kupffer cells, which are not productively infected (Chang et al., 2012; Shlomai et al., 2014). In addition to cytotoxic effector lymphocytes that directly kill infected cells, soluble immune effectors (such as type I and type III IFN, TNF?, IL-6) elicit strong, non cytolytic antiviral effects targeting multiple stages of the HBV replication cycle, including transcriptional and post-transcriptional suppression of viral RNA expression, blocking of nucleocapsid (NC) assembly and destabilization of pre-formed NCs (Weiland et al., 2014; Chang et al., 2012). Intriguingly, as demonstrated in an HBV transgenic mouse model, IFN can also stimulate, rather than suppress, HBV gene expression and replication when viral replication levels are low (Tian et al., 2011), suggesting that HBV may have evolved to co-opt the host antiviral response to enhance its own replication. We recently developed an immortalized mouse hepatocyte cell line, AML12HBV10, which supports high levels of HBV replication in a tetracycline (tet)- regulated manner and is highly responsive to HBV suppressive effects of certain antiviral cytokines like IFN (Xu et al., 2010). Furthermore, we have found that AML12HBV10 cells could support efficient HBV CCC DNA formation, which was likely facilitated by the rapid and efficient uncoating of the viral NCs to expose the genomic DNA for CCC DNA conversion in these cells (Cui et al., 2015). Here, we reported that the increased exposure of RC DNA in AML12HBV10 cells led to the triggering of an innate immune response that was dependent on viral DNA and host DNA sensing and signaling mechanisms and was able to modulate viral gene expression and replication.

2.1.8 INFECTIOUS DOSE OF HBV
Recent studies in HBV infected chimpanzees using a wide dose range of a single monoclonal HBV inoculum demonstrated that also the size of the viral inoculum contributes to the outcome of HBV infection (Asabe et al., 2009). As shown in , animals inoculated with 1010, 107 and 104 genome equivalents (GE) of HBV cleared the virus within 8–30 weeks after its first detection, in a virus dose-related fashion similar to what we have previously observed in several other animals that had been inoculated with 108 GE HBV (Thimme et al., 2003). In contrast, both of the animals that were inoculated with 101 GE became chronically infected, one of which (like many chronically infected humans) ultimately cleared the virus in the context of an acute disease flare 42 weeks after first detection, while the other remained heavily infected for at least 55 weeks at which point the study was terminated. This suggests that a virus dose window exists between 104 and 101 GE within which the host-virus dynamics favor persistent infections, while higher doses favor viral clearance. Importantly, viral clearance was heralded by early CD4+ T cell priming either before or at the onset of detectable viral spread, and it coincided with a sharply synchronized influx of HBV-specific CD8+ T cells into the liver and a corresponding increase in intrahepatic CD8 mRNA, serum ALT activity and histological evidence of acute viral hepatitis. Interestingly, the first detectable peripheral CD4 T cell response occurred during or before the phase of detectable viral expansion in the animals that cleared the infection in this study (Asabe et al., 2009). In contrast, the CD4 response was delayed until after the onset of viral expansion in the animals that developed persistent infection at which point the virus had infected 100% of the hepatocytes (Asabe et al., 2009) and there was an uncoordinated influx of HBV-specific CD8+ T cells into the liver and a correspondingly asynchronous increase in intrahepatic CD8 mRNA and serum ALT activity (Asabe et al., 2009).

2.1.9 SIGNS AND SYMPTOMS
2.1.9.1 Extrahepatic manifestations.

Symptoms outside of the liver are present in 1–10% of HBV-infected people and include serum-sickness–like syndrome, acute necrotizing vasculitis ( HYPERLINK “https://en.wikipedia.org/wiki/Polyarteritis_nodosa” o “Polyarteritis nodosa” polyarteritis nodosa), membranous glomerulonephritis, and papular acrodermatitis of childhood ( HYPERLINK “https://en.wikipedia.org/wiki/Gianotti%E2%80%93Crosti_syndrome” o “Gianotti–Crosti syndrome” Gianotti–Crosti syndrome) (Trepo and Guillevin , 2001). The clinical features are fever, skin rash, and polyarteritis. The symptoms often subside shortly after the onset of jaundice but can persist throughout the duration of acute hepatitis B (Liang, 2009). Membranous glomerulonephritis is the most common form (Liang, 2009) Other immune-mediated hematological disorders, such as essential mixed cryoglobulinemia and aplastic anemia have been described as part of the extrahepatic manifestations of HBV infection, but their association is not as well-defined; therefore, they probably should not be considered etiologically linked to HBV (Liang, 2009).

2.1.9.2 Intrahepatic manifestations
Hepatitis B virus can cause a variety of liver diseases including acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma.

Acute infections: After an incubation period of six weeks to six months, this is inversely proportional to the infective dose of the virus. The spectrum of the acute infection varies from mild to severe attacks. Clinically, acute infections manifest by fever, anorexia, nausea, malaise, vomiting, jaundice, dark urine, clay coloured stools, and abdominal pain. 1 to 2 % of acute disease results in fulminant hepatitis, with a case fatality ratio of 63 to 93 % (Bracho et al., 2006). Viraemia may reach up to 1010 virions per ml. HBV replicates in extrahepatic tissues, and particularly in peripheral blood mononuclear cells (PBMCs), which may serve as a reservoir for the maintenance of infection (Mazet-Wagner et al., 2006). Acute exacerbations of infection may develop in chronically infected patients (Kao, 2002).

Chronic Hepatitis B: Chronic infection with hepatitis B virus either may be asymptomatic or may be associated with a chronic inflammation of the liver (chronic hepatitis), leading to cirrhosis over a period of several years. This type of infection dramatically increases the incidence of hepatocellular carcinoma (HCC; liver cancer). Across Europe, hepatitis B and C cause approximately 50% of hepatocellular carcinomas (El-Serag and Rudolph, 2007, El-Serag, 2011) Chronic carriers are encouraged to avoid consuming alcohol as it increases their risk for cirrhosis and liver cancer. Hepatitis B virus has been linked to the development of membranous glomerulonephritis (MGN) (Gan et al., 2005).

Hepatocellular Carcinoma: Hepatocellular carcinoma (HCC) is one of the 10 most common cancers in man. The annual incidence is 250 000 worldwide. Risk factors are; HBV and HCV infections especially those acquired early in life or after prolonged course, cirrhosis, male sex, aflatoxin and smoking, peak incidence in 30-50 year age group. The relative risk of developing HCC is over 200-fold for HBsAg carriers over matched controls. Whilst most HCC arise in cirrhotic liver, this is not always the case (Liu et al., 2006).

2.1.10 TRANSMISSION
Possible forms of transmission include sexual contact, (Fairley and Read, 2012) blood transfusions and transfusion with other human blood products (Buddeberg et al., 2008), re-use of contaminated needles and syringes (Hughes, 2000), and vertical transmission from mother to child (MTCT) during childbirth. Breastfeeding after proper immunoprophylaxis does not appear to contribute to mother-to-child-transmission (MTCT) of HBV (Shi et al., 2011).
2.1.11 DIAGNOSIS OF HBV
2.1.11.1 Serological Tests
Serological tests are the main stay of diagnosing and differentiating the various viruses causing hepatitis, and for blood bank screening, as they are quick, cheap, and detect HBsAg carriers. Acute HBV is characterized by the presence of HBsAg in serum and the development of IgM core antibodies (anti-HBc IgM), which may be the only marker in active hepatitis, and it correlates with inflammatory activity. In the convalescent stage, HBsAg and HBeAg are cleared with the development of anti-HBs, anti-HBe and antiHBc antibodies. Anti-HBs is also elicited by vaccine. In chronic HBV infections, HBsAg generally persists for life. Total anti-HBc tests for both IgM and IgG antibodies to HBV core protein, they indicate current or past infection by HBV respectively. IgM anti-HBc disappears six months after the acute infection. The IgG anti-HBc appears shortly after HBsAg in acute disease and persists for life. Different methods exist for detection of HBsAg as immunodiffusion, reverse passive haemagglutination assays, and the more sensitive enzyme linked immunoassays ELISA and radioimmunoassays with detection limit of = ; 0.1 ng /ml of HBsAg. Ordinary serological tests may not detect mutant HBsAg and would therefore give rise to false negative results. New immunoassays are designed for the detection of hepatitis B surface escape mutants, and are specifically useful in the monitoring of liver transplant recipients on HBIG prophylaxis (Ijaz et al., 2001).

2.1.11.2 Molecular Biology Techniques
Different molecular techniques have been used to detect HBV DNA. HBV DNA is detectable in serum by slot or dot blot hybridization assays (Shao et al., 2007) with detection limit of 1.5 pg per ml (4.0 x105 genomes/ml). PCR detects 103 pg /ml (approximately 100 to 1000 genomes). However, the high sensitivity of PCR is limited by the increased risk of false positive results. Clinical significance of HBV PCR is the same as detection of HBsAg and indicates current HBV infection. HBV DNA monitoring and quantitative PCR are essential in determining the response and follow up of chronic HBV infection to treatment. Nucleic acid sequence analysis is used to identify genetic variants of the virus, and to epidemiologically type nosocomial transmission of HBV (Gunson et al., 2006).

2.1.12 EPIDEMIOLOGY
Approximately 5 % of the world`s population reaching 350 millions, have chronic HBV infection, which is the leading cause of chronic hepatitis, cirrhosis and HCC worldwide. It is estimated that 500, 000- to 1000, 000 persons die annually from HBV related liver disease (Hou et al., 2005). Most infections occur at birth or during early childhood. Infections usually cluster in households of chronically infected patients.

Geographical Distribution
Areas of high endemicity where prevalence is ; 8% are China, Indian subcontinent and Africa. Intermediate endemicity areas show prevalence of 2 to 7 % in North Africa, India and Russia. Low endemicity ; 2 % seen in Western Europe and North America. In areas of high endemicity, the lifetime risk of HBV infection is ; 60 % (Bajunaid, 2013). The main risk factors for HBV progression to HCC include HBeAg positivity and HBV DNA levels. Seminal studies from Taiwan established these associations (Chen et al.,2010). The incidence of HCC was 1169/100,000 person-years for HBsAg and HBeAg-positive persons, 324/100,000 person-years for HBsAg positive, HBeAg-negative and 39/100,000 person-years for those who were HBsAg negative. The Risk Evaluation of Viral Load Elevation and Associated Liver Disease (REVEAL-HBV) study established HBV DNA levels as the main determinant of progression to HCC. However, even HBsAg positive carriers with low levels of HBV DNA and normal ALT had an almost 5-fold greater risk for HCC than HBsAg negative controls (Chen et al., 2010; El-Serag,2012).

In 2004, an estimated 350 million individuals were infected worldwide. National and regional prevalences range from over 10% in Asia to under 0.5% in the United States and Northern Europe. The primary method of transmission reflects the prevalence of chronic HBV infection in a given area. In low prevalence areas such as the continental United States and Western Europe, injection drug abuse and unprotected sex are the primary methods, although other factors may also be important (Redd et al., 2007). In moderate prevalence areas, which include Eastern Europe, Russia, and Japan, where 2–7% of the population is chronically infected, the disease is predominantly spread among children. In high-prevalence areas such as China and South East Asia, transmission during childbirth is most common, although in other areas of high endemicity such as Africa, transmission during childhood is a significant factor (Alter, 2003) The prevalence of chronic HBV infection in areas of high endemicity is at least 8% with 10–15% prevalence in Africa/Far East (Komas et al., 2013). As of 2010, China has 120 million infected people, followed by India and Indonesia with 40 million and 12 million, respectively. According to World Health Organization (WHO), an estimated 600,000 people die every year related to the infection.In the United States about 19,000 new cases occurred in 2011 down nearly 90% from 1990 (Schillie et al., 2013),
2.2 SYPHILIS
2.2. 1 SYPHILIS INFECTION
Transfusion-transmitted syphilis, which is caused by Treponema pallidum subspecies pallidum, is one of the oldest recognized infectious risks of blood transfusion (Gardella et al.,2002).

Syphilis is a sexually transmitted infection caused by the bacterium HYPERLINK “https://en.wikipedia.org/wiki/Treponema_pallidum” o “Treponema pallidum”Treponema pallidum subspecies pallidum (CDC, 2015 a). The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary) (CDC,2015b). The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration) but there may be multiple sores (CDC,2015b). In secondary syphilis a diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet (CDC,2015b). There may also be sores in the mouth or vagina (CDC,2015b). In latent syphilis, which can last for years, there are few or no symptoms (CDC,2015b). In tertiary syphilis there are  HYPERLINK “https://en.wikipedia.org/wiki/Gumma_(pathology)” o “Gumma (pathology)” gummas (soft non-cancerous growths), neurological, or heart symptoms (Kent and Romanelli, 2008). Syphilis has been known as “the great imitator” as it may cause symptoms similar to many other diseases (CDC,2015b; Kent and Romanelli, 2008).

Syphilis is most commonly spread through sexual activity (CDC,2015b). It may also be transmitted from mother to baby during pregnancy or at birth, resulting in congenital syphilis (CDC,2015b; Woods, 2009). Other human diseases caused by related Treponema pallidum subspecies include yaws (subspecies pertenue),  HYPERLINK “https://en.wikipedia.org/wiki/Pinta_(disease)” o “Pinta (disease)” pinta (subspecies carateum), and HYPERLINK “https://en.wikipedia.org/wiki/Nonvenereal_endemic_syphilis” o “Nonvenereal endemic syphilis”bejel (subspecies endemicum) (Kent and Romanelli, 2008). Diagnosis is usually made by using blood tests; the bacteria can also be detected using dark field microscopy (CDC,2015b). The Center for Disease Control recommends all pregnant women be tested (CDC,2015b).

2.2.2 SIGNS AND SYPMTOMS
Syphilis can present in one of four different stages: primary, secondary, latent, and tertiary, (Kent and Romanelli, 2008) and may also occur congenitally (Stamm,2010). It was referred to as “the great imitator” by Sir William Osler due to its varied presentations (White, 2000).

Primary stage
Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person (CDC, 2006). Approximately 3 to 90 days after the initial exposure (average 21 days) a skin lesion, called a HYPERLINK “https://en.wikipedia.org/wiki/Chancre” o “Chancre”chancre, appears at the point of contact. This is classically (40% of the time) a single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders 0.3–3.0 cm in size (Kent and Romanelli, 2008) The lesion may take on almost any form. In the classic form, it evolves from a  HYPERLINK “https://en.wikipedia.org/wiki/Macule” o “Macule” macule to a papule and finally to an erosion or ulcer (Eccleston et al., 2008). Occasionally, multiple lesions may be present (~40%) (Kent and Romanelli, 2008) with multiple lesions more common when coinfected with HIV. Lesions may be painful or tender (30%), and they may occur in places other than the genitals (2–7%). The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally relatively commonly in men who have sex with men (34%) (Eccleston et al., 2008). Lymph node enlargement frequently (80%) occurs around the area of infection, (Kent and Romanelli, 2008) occurring seven to 10 days after chancre formation (Eccleston et al., 2008). The lesion may persist for three to six weeks without treatment (Kent and Romanelli, 2008).
Secondary stage
Secondary syphilis occurs approximately four to ten weeks after the primary infection (Kent and Romanelli, 2008). While secondary disease is known for the many different ways it can manifest, symptoms most commonly involve the skin, mucous membranes, and lymph nodes (Mullooly and Higgins, 2010). There may be a symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles (Dylewski and Duong,2007). The rash may become  HYPERLINK “https://en.wikipedia.org/wiki/Maculopapular” o “Maculopapular” maculopapular or  HYPERLINK “https://en.wikipedia.org/wiki/Abscess” o “Abscess” pustular. It may form flat, broad, whitish, wart-like lesions known as  HYPERLINK “https://en.wikipedia.org/wiki/Condyloma_latum” o “Condyloma latum” condyloma latum on mucous membranes. All of these lesions harbor bacteria and are infectious. Other symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache.5 Rare manifestations include liver inflammation, kidney disease, joint inflammation,  HYPERLINK “https://en.wikipedia.org/wiki/Periostitis” o “Periostitis” periostitis, inflammation of the optic nerve,  HYPERLINK “https://en.wikipedia.org/wiki/Uveitis” o “Uveitis” uveitis, and interstitial keratitis (Bhatti, 2007). The acute symptoms usually resolve after three to six weeks; (Bhatti, 2007).  about 25% of people may present with a recurrence of secondary symptoms. Many people who present with secondary syphilis (40–85% of women, 20–65% of men) do not report previously having had the classic chancre of primary syphilis (Mullooly and Higgins, 2010).
Latent stage
Latent syphilis is defined as having serologic proof of infection without symptoms of disease (White, 2000). It is further described as either early (less than 1 year after secondary syphilis) or late (more than 1 year after secondary syphilis) in the United States (Bhatti, 2007). The United Kingdom uses a cut-off of two years for early and late latent syphilis (Eccleston et al., 2008). Early latent syphilis may have a relapse of symptoms. Late latent syphilis is asymptomatic, and not as contagious as early latent syphilis (Bhatti, 2007).

Tertiary stage
Tertiary syphilis may occur approximately 3 to 15 years after the initial infection, and may be divided into three different forms: gummatous syphilis (15%), late  HYPERLINK “https://en.wikipedia.org/wiki/Neurosyphilis” o “Neurosyphilis” neurosyphilis (6.5%), and cardiovascular syphilis (10%) (Bhatti, 2007). Without treatment, a third of infected people develop tertiary disease (Bhatti, 2007). People with tertiary syphilis are not infectious (Kent and Romanelli, 2008).
Gummatous syphilis or late benign syphilis usually occurs 1 to 46 years after the initial infection, with an average of 15 years. This stage is characterized by the formation of chronic  HYPERLINK “https://en.wikipedia.org/wiki/Gumma_(pathology)” o “Gumma (pathology)” gummas, which are soft, tumor-like balls of inflammation which may vary considerably in size. They typically affect the skin, bone, and liver, but can occur anywhere (Kent and Romanelli, 2008). Neurosyphilis refers to an infection involving the central nervous system. It may occur early, being either asymptomatic or in the form of syphilitic meningitis, or late as meningovascular syphilis, general paresis, or  HYPERLINK “https://en.wikipedia.org/wiki/Tabes_dorsalis” o “Tabes dorsalis” tabes dorsalis, which is associated with poor balance and lightning pains in the lower extremities. Late neurosyphilis typically occurs 4 to 25 years after the initial infection. Meningovascular syphilis typically presents with apathy and seizure, and general paresis with dementia and  HYPERLINK “https://en.wikipedia.org/wiki/Tabes_dorsalis” o “Tabes dorsalis” tabes dorsalis (Kent and Romanelli, 2008).  Also, there may be Argyll Robertson pupils, which are bilateral small pupils that constrict when the person focuses on near objects but do not constrict when exposed to bright light.

Cardiovascular syphilis usually occurs 10–30 years after the initial infection. The most common complication is syphilitic aortitis, which may result in aneurysm formation (Kent and Romanelli, 2008).
Congenital syphilis
Congenital syphilis is that which is transmitted during pregnancy or during birth. Two-thirds of syphilitic infants are born without symptoms. Common symptoms that develop over the first couple of years of life include enlargement of the liver and spleen (70%), rash (70%), fever (40%), neurosyphilis (20%), and lung inflammation (20%). If untreated, late congenital syphilis may occur in 40%, including saddle nose deformation,  HYPERLINK “https://en.wikipedia.org/wiki/Higoumenakis_sign” o “Higoumenakis sign” Higoumenakis sign, saber shin, or  HYPERLINK “https://en.wikipedia.org/wiki/Clutton%27s_joints” o “Clutton’s joints” Clutton’s joints among others (Woods, 2009).Infection during pregnancy is also associated with miscarriage (Cunningham et al.,2013).

2.2.3 AETIOLOGY
Treponema pallidum subspecies pallidum is a spiral-shaped, Gram-negative, highly mobile bacterium (Eccleston et al., 2008). Three other human diseases are caused by related Treponema pallidum subspecies, including yaws (subspecies pertenue), pinta (subspecies carateum) and  HYPERLINK “https://en.wikipedia.org/wiki/Nonvenereal_endemic_syphilis” o “Nonvenereal endemic syphilis” bejel (subspecies endemicum). (Kent and Romanelli, 2008). Unlike subtype pallidum, they do not cause neurological disease (Woods, 2009). Humans are the only known natural reservoir for subspecies pallidum (Stamm, 2010) It is unable to survive more than a few days without a host. This is due to its small genome (1.14   HYPERLINK “https://en.wikipedia.org/wiki/Base_pair” o “Base pair” Mbp) failing to encode the metabolic pathways necessary to make most of its macronutrients. It has a slow doubling time of greater than 30 hours (Eccleston et al., 2008).
2.2.4 TRAMSMISSION
Syphilis is transmitted primarily by sexual contact or during pregnancy from a mother to her fetus; the spirochete is able to pass through intact mucous membranes or compromised skin (Stamm, 2010). It is thus transmissible by kissing near a lesion, as well as oral, vaginal, and anal sex (Kent and Romanelli, 2008). Approximately 30% to 60% of those exposed to primary or secondary syphilis will get the disease (Bhatti, 2007). Its infectivity is exemplified by the fact that an individual inoculated with only 57 organisms has a 50% chance of being infected (Eccleston et al., 2008). Most (60%) of new cases in the United States occur in men who have sex with men. Syphilis can be transmitted by blood products, but the risk is low due to blood testing in many countries. The risk of transmission from sharing needles appears limited (Kent and Romanelli, 2008). It is not generally possible to contract syphilis through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing (CDC, 2010).

2.2.5 DIAGNOSIS
Early reports of the transfusion-related transmission of syphilis led to the World Health Organization (WHO) recommendations for syphilis testing of blood donors (Takpo et al., 2007). These recommendations have been questioned, since many syphilis antibodies among blood donors are the result of previous infections or even unspecific reactions. Furthermore, Treponema pallidum does not withstand cold storage (Tagny, 2011). However, as not all blood components can be assumed to be kept cold for a sufficient amount of time, if at all, and as syphilis may also serve as a potential surrogate marker for high risk behaviour in relation to HIV infection, syphilis screening continues to be a requirement in many countries. The WHO recommends several syphilis screening tests: the enzyme immunoassay (EIA) and T. pallidum haemagglutination assay (TPHA) as specific tests, or the Venereal Disease Reference Laboratory (VDRL) and rapid plasma reagin (RPR) as non-specific screening tests (WHO,2010).Following a documented case of transfusion-transmitted syphilis in Ghana in 2011, (Owusu et al.,2011). The techniques used for syphilis screening are different from one country to another: the VDRL or RPR alone for some, and the VDRL and TPHA for others (Takpo et al.,2007). Tests and algorithms should be selected so that they correspond with the prevalence of the disease and match the technical expertise of the personnel and the availability of reagents and equipment (Tagny, 2009). The selection criteria for a screening strategy must include simple techniques, reliability, sustainability, and cost-effectiveness. Although they are not recommended for blood banks in Africa, rapid test techniques may be preferred because of their affordability, user-friendliness, the availability of test materials, and good sensitivity and specificity; furthermore they do not require sophisticated laboratory materials (Tagny, 2009).

Direct testing
Dark ground microscopy of serous fluid from a chancre may be used to make an immediate diagnosis. Hospitals do not always have equipment or experienced staff members, and testing must be done within 10 minutes of acquiring the sample. Sensitivity has been reported to be nearly 80%; therefore the test can only be used to confirm a diagnosis, but not to rule one out. Two other tests can be carried out on a sample from the chancre: direct fluorescent antibody testing and nucleic acid amplification tests. Direct fluorescent testing uses antibodies tagged with  HYPERLINK “https://en.wikipedia.org/wiki/Fluorescein” o “Fluorescein” fluorescein, which attach to specific syphilis proteins, while nucleic acid amplification uses techniques, such as the polymerase chain reaction, to detect the presence of specific syphilis genes. These tests are not as time-sensitive, as they do not require living bacteria to make the diagnosis (Eccleston et al., 2008).

2.2.6 PREVENTIVE MEASURES
Vaccine
As of 2018, there is no vaccine effective for prevention (Stamm, 2010). Several vaccines based on treponemal proteins reduce lesion development in an animal model and research continues (Cameron and Lukehart, 2014).

Sex
Condom use reduces the likelihood of transmission during sex, but does not completely eliminate the risk. (Cameron and Lukehart, 2014). The Centers for Disease Control and Prevention (CDC) states, “Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected. However, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom.” (CDC, 2010). Abstinence from intimate physical contact with an infected person is effective at reducing the transmission of syphilis. The CDC states, “The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.” (CDC, 2010).
Congenital disease
Congenital syphilis in the newborn can be prevented by screening mothers during early pregnancy and treating those who are infected (Schmid, 2004). If they are positive, it is recommend their partners also be treated. (Hawkes et al., 2011). Congenital syphilis is still common in the developing world, as many women do not receive antenatal care at all, and the antenatal care others receive does not include screening. It still occasionally occurs in the developed world, as those most likely to acquire syphilis (through drug use, etc.) are least likely to receive care during pregnancy (Schmid, 2004). Several measures to increase access to testing appear effective at reducing rates of congenital syphilis in low- to middle-income countries (Hawkes et al., 2011). Point-of-care testing to detect syphilis appeared to be good although more research is needed to assess its effectiveness and into improving outcomes in mothers and babies (Shahrook et al.,2014).
2.2.7 EPIDEMIOLOGY
Syphilis is still a public health problem in the world. The World Health Organization estimated that approximately 12 million new cases are reported each year in the world with more than 90 percent from developing countries (Centers for Disease Control CDC, 2007; World Health Organization WHO, 2001). Moreover, syphilis has acquired a higher potential of morbidity and mortality with the increasing prevalence of HIV infection. If syphilis is rare in developed countries, it is much more common in developing countries where prevalence can reach 25% amongst blood donors (Tagny & al., 2009, 2010).The infection is transmitted from person to person through contact with a syphilis ulcer (during vaginal, anal, or oral sex). An infected mother can infect her fetus via the placenta. Furthermore, intravenous drug addicts or other infected person can transmit syphilis through infected blood products i.e. through blood transfusion or use of infected needles for example (Workowski & Berman, 2006).

2.3 BLOOD TRANSFUSION
Blood transfusion is a life saving intervention that is essential in the management and care of patients. In 2005, all member states of WHO signed a document that commits them to the provision of safe and adequate blood and blood products to patients (WHO, 2010). This concern stems from the fact that there is a wide spectrum of blood borne infections which can be transmitted through the blood of apparently healthy and asymptomatic blood donors. These transfusion transmissible infectious agents include hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency viruses (HIV-1/2), human T-cell lymphotropic viruses (HTLV-I/II), Cytomegalovirus (CMV), Parvovirus B19, West Nile Virus (WNV), Dengue virus, trypanosomiasis, Syphilis and malaria (Allain et al.,2009). This scenario is worsened by the method of replacement of blood either by family members or paid donors as against WHO recommended voluntary donors (WHO, 2010). Regular voluntary, unpaid blood donors are the safest group of donors as the prevalence of blood borne infections is lowest among these donors (WHO, 2010).

2.3.1 CLASSIFICATION OF BLOOD DONORS IN NIGERIA.
There are 3 main classifications of blood donors in Nigeria; the voluntary (non remunerated) donors, family (replacement) donors (FDs) and commercial (paid) donors (Ahmed et al., 2007). The voluntary donors are the altruistic individuals who donate blood with the sole aim of saving a life, without regard to any form of inducement. They are usually mobilized through the mass media or blood donation drives to schools, churches and mosques. An earlier study had hypothesized that the dearth of voluntary donors in Nigeria and Sub-Saharan Africa is probably associated with the fact that the mentality of altruism (regarding blood donation) is not yet generally accepted in the typical African culture, compared to what is obtainable in the most developed countries (Osaro and Charles, 2011). The family (replacement) donors include those that donate for a hospitalized family member, friend, or associate and is largely nonremunerated, depending entirely on the good will of friends and family members. Osaro et al. had concluded that the continued importance of family donors in Sub-Saharan Africa could be linked to the fact that it may actually cost less to procure and is also well adapted to the extended family support system of many Nigerian and African communities (Osaro and Charles, 2011). However, FDs may be under pressure to donate blood when their relatives are admitted to hospital and in need of a blood transfusion, even when they know that they are potentially at risk of sexually transmitted diseases as a result of high-risk behaviours. They may be more likely to conceal a relevant medical history and the risky sexual behaviours that predispose them to infections and thus pose a threat to the safety of the blood supply. Despite this, family donations remain dominant in the African continent because family and community ties are often considerably stronger than in other types of society; making the gift of blood is a natural contribution to relieve sufferers in hospitals (Ne’bie’ et al., 2007). Additionally, potential donors may be less willing to donate to someone not known to them. The WHO states that blood from VNRDs who give blood out of altruism is the safest source of blood (Takpo et al.,2007). Persistent blood shortages coupled with increased poverty in Nigeria (and most African countries) created another population of donors who give blood strictly for financial gratification; these constitute the commercial (paid) donors. These have continued to increase in number and prominence in Nigeria, fuelled by the very huge deficit in blood supply and utilization. Ahmed et al. succinctly captured this phenomenon in a report among blood donors seen at the University of Maiduguri Teaching Hospital, Northeast Nigeria over a 12 years period (Ahmed et al., 2007). They observed a progressive decrease in the percentage of voluntary blood donation, over the study period, from 31% to 5%, against an increase from 20% to 63% in the frequency of commercial blood donation (Ahmed et al., 2007). The above study equally emphasized the wide gap between blood supply and demand in Nigeria by showing that the mean annual increment in the number of blood donations (4%) was well below the mean annual increment in in-patient numbers (11%) (Ahmed et al., 2007).
2.3.2 WORLD HEALTH ORGANISATION (WHO) AND NATIONAL BLOOD TRANSFUSION SERVICE (NBTS) STANDARD OF BLOOD TRANSFUSION IN NIGERIA.

The WHO recommends that each country should decide on the TTIs to be screened for as part of the blood screening programme and develop a screening strategy appropriate to its specific situation, influenced by the incidence and prevalence of infection, the capacity and infrastructure of the blood service, and the costs of screening (WHO, 2009).

WHO recommends that universally, blood for transfusion be screened for HIV, HBV, HCV and Syphilis. In selected countries depending on epidemiological evidence, screening should be done for the following also; malaria, Chagas disease, Human T-cell lymphotropic viruses 1 & 2 and Human Cytomegalovirus (WHO, 2010).
The World Health Organization (WHO) had projected that Sub-Saharan Africa will attain sustainable blood transfusion safety by the year 2012, through the implementation of sets of policies geared toward provision of safe, affordable, and readily available blood units in hospitals to serve the needs of patients. (Tagny et al.,2008). Up till now, however, this goal is far from achieved in Nigeria and a number of other African countries, with attendant negative impact on health indices. Effective healthcare delivery globally is known to be supported by a robust supply of safe blood units which could indeed be lifesaving in a number of clinical scenarios. Correspondingly, from the road traffic accident victim with acute hemorrhage at the emergency room to the obstetric patient with antepartum/postpartum hemorrhage or the under-five child presenting with anemic heart failure, prompt administration of appropriate units of blood could well make the difference between life and avoidable demise. Earlier, extensive inquests into the causes of the high maternal mortality in Nigeria and Sub-Saharan Africa had highlighted the huge contribution of the very ineffective blood transfusion services (Umeora et al., 2005; Bates et al., 2005).

In Nigeria, the national blood transfusion guideline stipulates that donor blood should be screened for specified Transfusion-Transmissible Infections including Human Immunodeficiency Virus (HIV), HBV, HCV and Syphilis (NBTS, 2006). The National Blood Policy Nigeria established a National blood transfusion policy through a published set of guidelines in December 2006. The publication was a fall-out of the baseline survey on blood transfusion practices which was earlier conducted in the country in August 2005. Salient conclusions from the survey included; (NBTS, 2006).

? Only half a million units of blood were collected from both private and public sources in 2004
? At the time of the survey, blood need in Nigeria was estimated to be 1.5 million units
? In the public sector, the donor population was made up of 25% commercial donors and 75% of replacement donors. Voluntary unpaid donors were negligible
? In the private sector, the donor population was made up of 75% commercial donors and 25% of replacement donors. Voluntary unpaid donors were insignificant.

The National blood policy is essentially made up of sets of action plans which are all geared toward the provision of safe, available, and affordable blood donor units, where and when they might be needed in the country. It is structured into blood transfusion services under the following strata;
the national blood transfusion service (NBTS),
the zonal blood service centers,
state and local government areas blood service centers,
the armed forces blood service, and
private and other nongovernmental health establishments ( NBTS, Nigeria,2006). The essence of the above stratification was to ensure universal coverage of the country, right to local government councils.

2.3.3 RISK FACTORS OF BLOOD TRANSFUSION
Factors contributing to transfusion-related transmissions in sub-Saharan Africa include: high rates of transfusion in some groups of patients (particularly women and children); a high prevalence of human immunodeficiency virus (HIV) in the general and blood donor populations; inadequate screening facilities; and lack of infrastructure and capacity to ensure sustainable operations (Holmberg, 2006; Bournouf and Radesevich,2000). Since a person can transmit an infection during its asymptomatic phase, transfusions can contribute to an ever-widening pool of infection in the population. The economic costs of the failure to control the transmission of infection include increased requirement for medical care, higher levels of dependency and the loss of productive labour force, placing heavy burdens on already overstretched health and social services and on the national economy (WHO, 2002; Kitchen and Barbara, 2001). It should, therefore, be mandatory that blood is screened for transfusion-transmissible infectious disease markers such as antibodies to HIV, hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis, and hepatitis B surface antigenaemia (Choudhury and Phadke, 2001;Nwabuisi et al., 2002).

2.3.4 PREVALENCE OF HEPATITIS VIRUS AND SYPHILIS AMONG BLOOD DONORS.

Hepatitis B and other Hepatitis virus among blood donors
In Federal Medical Centre, Umuahia, screening is carried out for HIV, HBV, HCV and syphilis. Human immune deficiency virus, HBV and HCV are of particular concern because of their prolonged infectivity, carrier state and the fact that they also cause various debilitating disorders which may eventually be fatal (Wallace, 2008). Though these viruses can also be transmitted through other means, infectivity estimates for the transfusion of infected blood products are much higher (92%) than for other modes of transmission owing to the much larger viral dose per exposure than for other routes (Baggaley et al., 2006). It is also important to discourage and as much as possible eliminate commercial and replacement blood donation by relations of the person as such persons have been shown to be likely to test positive for blood transmitted infections (Eldryd et al., 2004). Although blood transfusion contributes relatively little to the overall HIV and other pathogen transmission, prevention of infection through blood transfusion is a priority for ethical reasons. Apart from this, whatever quantity of the pathogen that is present in blood for transfusion is most likely to be transmitted to the recipient as the blood will act as a direct vehicle. The median overall risks of becoming infected with HIV, HBV, and HCV from a blood transfusion in sub-Saharan Africa were 1, 4.3, and 2.5 infections per 1000 units, respectively (Jayaraman et al., 2010). While in the developed countries the estimate is 1/2 600 000 for HIV, 1/6 500 000 for HCV, 1/1 700 000 for HBV (Traineau et al., 2009).
According to the World Health Organization (WHO), each year about 340 million new infections are due to sexually transmitted diseases such as chlamydia, gonorrhea, syphilis and Trichomonas (WHO, 2001). Syphilis remains a major public health problem in sub-Saharan Africa, including Burkina Faso. It is diagnosed routinely in all blood donors using non-treponemal and treponemal tests such as Rapid Plasma Reagin test (RPR) and T. pallidum haemagglutination Test (TPHA) (Wiwanitkit, 2002).

Syphilis among blood donors
Blood donors with high-risk sexual behaviour and other risk factors may be infected by syphilis and compromise the safety of blood used for transfusion. The medical selection of the blood donors consists of information of the donor, the finding of the risk factors in the behaviours and the medical history using a questionnaire, the physical examination in order to find clinical signs of the infection. Donor deferral follows identification of any risk. Medical selection is crucial because it could permit to defer more than half of infected donors, especially the ones in the early period of infection here laboratory tests are not efficient (de Almeida Neto & al, 2007; Tagny, 2009). In some European countries, the prevalence of T. pallidum infection in the general population and thus in blood donors has been increasing since last two decades. An increase in syphilis infections has been associated to the high incidence of HIV. Moreover, an infected blood donor with syphilis is more than 5 times more likely to be HIV-positive. However, the prevalence of syphilis is still very low in developed countries and the very rare cases of recipient contamination raised the question of whether syphilis screening was still necessary for blood donors. In developing countries, the prevalence of positive serologic tests for syphilis can reach 25%. The prevalence is however very variable from one area to another and from a country to another. In such settings, the poor quality of laboratory screening due to the lack of equipment, training personnel, reagents and standard procedures highlights the need of the systematic and better screening for syphilis to help ensure a safer blood supply. Very little systematic information is available on the profile of positive blood donors including differences between donors with recent versus past infection. The exclusion of donors with past and treated infection is still a matter of discussion. Abusive exclusion reduces the blood supply and could be problematic in developing countries. However, past history of syphilis may be high-risk sexual behaviour associated to transmitted transfusion infection such as syphilis itself and HIV. The transfusion risk of syphilis is closely related to risk factors in the blood donor, in particular the sexual behaviours, the disease being primarily transmitted by sexual route. The rates of infection are highest amongst homosexual (gay) men – or men who have sex with men (VallMayans & al, 2006). Recent syphilis infections have been shown to be associated with younger age, male-male sex, two or more sex partners, past syphilis treatment, past syphilis history, HIV seropositivity. Risk factors usually associated with transfusion transmitted syphillis also include more than one sexual partner, prostitution, bisexuality ( men having sex with both men and women), intravenous drug use, and skin scarification (tattoing,blood rituals). In developing countries, most blood donors infected are first-time donors. The prevalence of syphilis is one of the highest amongst the TTI screened in developing countries. The problem of this disease, first of all, is its high prevalence in blood donors in various areas of Africa. The recent prevalence were 3.7 % in Congo (Batina & al 2007), 7.9 % in Ghana (Adjei & al., 2003; Ampofo & al., 2002) and 9.1 % in Cameroon (Mbanya & al., 2003; Tagny & al., 2009). It is just as high in females as in males, in the different age groups and in voluntary donor as well as family donors. The family blood donation and remunerated blood donation, mostly found in developing countries is statiscally associated with higher prevalence of the disease (Batina & al., 2007; Tagny & al., 2010). The donors who have been positive for syphilis during the previous donation are less likely to donate again, whereas donors who were negative for the presence of syphilis in the past would be more likely to donate again. In countries, which use a medical questionnaire for selection of blood donor, there are usually questions related to infection with syphilis. These questions concentrate particularly on sexual behavior (a number of sexual partners, use of condoms, past history of sexually transmitted diseases) and sometimes on specific symptoms observed during clinical examination. However, medical selection remains ineffective for several reasons: – Difficulty of understanding the questions due to the level of education (ignorance of the transmissible infections by blood transfusion) (Nébié & al., 2007; Agbovi & al., 2006), linguistic and cultural (taboos) barriers; – Discrete expression of the disease in its primary phase. The syphilitic rosella is not clearly visible on dark skin. – Suppression of clinical signs and symptoms by the various antibiotics following self – medication (ampicilline, penicillin). Thus, the biological screening of this disease remains essential to defer blood donors at risk. Identified safe donors must be retained in the pool of repeated donors and frequently informed and educated to avoid risky behaviours (Claude, 2011).

2.3.5 SYPHILIS AND SCREENINGOF BLOOD DONATION.

At the beginning of the 20th century newer tests were developed. Present-day, several labs tests, treponemic or not treponemic exist, among which rapid tests, immunological tests, and genomic (Young & al., 2000). Neither there is a specific type of method absolutely indicated, nor is there any confirmatory algorithm for testing based on the different assays available. In fact, the laboratory assessment of syphilis is generally based on the detection of antibodies against T. pallidum antigens in blood by the use of either specific or nonspecific reagents. The detection of genomic particle are more specific but not affordable for most of laboratories (Marfin & al., 2001; Orton & al. 2002). The detection of specific Treponema antigens is possible using methods as passive agglutination, as T. pallidum hemagglutination (TPHA) assay or the T. pallidum particle agglutination (TPPA) assay, indirect immunofluorescence as the fluorescent treponemal antibody absorbed (FTA-ABS) assay or enzyme immunoassay (EIA) for the detection of specific IgG and IgM or total Ig. Non-treponemal methods are based on non-treponemal lipid antigens (cardiolipin), using frequently the flocculation technique. Of these, the Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR) tests are the most commonly used. These tests are cheap, fast and more sensitive (Montoya & al. 2006; WHO, 2006). They are able to identify the contaminated blood donors few days before the treponemal test and thus useful for acute infection. However, VDRL and RPR cannot be automated and are time-consuming if used for large scale testing. Moreover, they produce more false positive results. These tests are routinely used to screen blood donors. False positives on the rapid tests can be seen in viral infections such as hepatitis, tuberculosis, malaria, or varicella. Thus, non-treponemal tests should be followed up when possible by a treponemal test. The treponemal tests are based on monoclonal antibodies and immunofluorescence; they are more specific and more expensive. The tests based on enzyme-linked immunoassays are the more specific and are usually used to confirm the results of simpler screening tests for syphilis. According to the guidelines published by the U.S. Centers for Disease Control and Prevention, the diagnosis of syphilis should be based on the results of at least two tests: one treponemal and the other non treponemal (CDC, 2006; CDC, 2004 ). According to WHO, blood banks may choose Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), or enzyme immunoassay (EIA). VDRL and RPR are sensitive for recent syphilis infection, but not for past infection. Screening should be performed using a highly sensitive and specific test for treponemal antibodies: either TPHA or enzyme immunoassay. In populations where there is a high incidence of syphilis, screening should be performed using a non-treponemal assay: VDRL or RPR. EIA can detect past or recent infection, but may result in rejecting non-infectious blood with distant past infection (Cole & al., 2007). However, one should remember that the reliability of the screening and the diagnosis include the performances as well as the quality assessment notably the use of standard operating procedures, norms, training of the personnel and management of quality. The screening for syphilis is frequently carried out on the African blood donor, and national policies often include the disease in the list of ITT to be screened at the time of blood donation. More than 90 % of blood collected in Africa in the year 2004 was screened for syphilis (Tapko & al., 2005). The techniques used for screening are different from one country to another: VDRL or RPR alone for some, VDRL + TPHA for others (Tagny, 2009). Developing countries are characterized by a difficult epidemiologic, sociological and economic environment which limits the implementation of a high quality of blood safety. Thus, this context requires that tests and algorithms should be selected so that they correspond with the high prevalence of the disease, limited technical know-how of the personnel and limited availability of reagents and equipments. The selection criteria of screening strategy must include simple techniques, reliability, sustainability and cost effectiveness. Regular supply of electricity, freezer and ELISA kits is mostly found in big cities and barely available in small towns. Several blood banks use rapid test technique as it does not required sophisticated lab materials (Tagny & al., 2009). Screening strategies must also take into account the training of technicians, guarantee their capacity to carry out the test and provide reliable results (Claude, 2011).

CHAPTER 3: MATERIALS AND METHODS
3.1. Study design and setting
The data of blood donor recorded from January 2017 to April 2018 and Bio-data and positivity of the diseases will be collected at the blood bank of the Meridian Hospitals. Situated at 21 Igbokwe str D/Line. Port Harcourt. Rivers State. Nigeria. This hospital also has as its objective the management of the numerous accidents along the Aba road which is major highway and other surrounding roads due to the reckless driving of taxi drives, management which often requires blood transfusions.

3.2. Study population
Donors were either volunteers, or relatives or friends of patients who came to replace blood used or expected to be used by patients. Voluntary donors either belonged to an association of blood donors or came individually on their own account to donate blood.
3.3 Sample collection
Blood samples will be aseptically collected from each subject by venipuncture in 5-ml red-top vacutainers (Becton Dickinson, NJ, USA) and allowed to clot naturally at room temperature. Serum specimens will be separated by centrifugation at 3000 g for 5 min and will be used for the analyses.

3.4 Hepatitis B surface antigenemiaHBV was detected using a one-step immunoassay-based DIASpot HBsAg test kit (DIASpot Diagnostics, USA) for qualitative detection of hepatitis B surface antigen (HBsAg) in serum. This test has a relative sensitivity and speci?city of 99% and 97.0%, respectively. Followed with and HBsAg ELISA rapid kit.

3.5. Syphilis serology
Syphilis will be diagnosed using the Venereal Disease Research Laboratory (VDRL) test (Omega Diagnostic, UK) and the Treponema pallidum hemagglutination assay (TPHA) test (Omega Diagnostic, UK). Active syphilis will be diagnosed if an individual’s blood tested positive with both tests. All samples positive for one test and negative for the other will be excluded from the analysis.

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