NON-PARAMETRIC ANALYSIS OF DATA ON CHRONIC LIVER CIRRHOSIS (A CASE STUDY OF FEDERAL MEDICAL CENTER BIRNIN KEBBI)


A PROJECT SUBMITTED TO THE DEPARTMENT OF STATISTICS FACULTY OF SCIENCE, KEBBI STATE UNIVERSITY OF SCIENCE AND TECHNOLOGY, ALIERO.
IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF A BACHELOR OF SCIENCE (B.SC HONS) DEGREE IN STATISTICS
Approval
This is to declare that this research carried out by Ismail Abubakar with admission number (1510212036) of mathematics department (statistics unit), is fully adequate in scope and qualify for the award of Degree of Bachelor of Science (B.sc Hon) in statistics. From Kebbi State University of Science and Technology, Aliero.



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(Project supervisor)








-----------------------------------                                                        -----------------------------------
Prof. R.V.K. Singh                                                                                              date
(Head of department)









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External Examiner                                                                                        date

DEDICATION
This project work is dedicated to God Almighty and to his prophet Muhammad (SAW) who has given me the privilege from begging to the end of my programed.




















Acknowledgment
I would like to express my special thanks of gratitude to my lecturer (DR. N.O. Nweze) as well as the head of department (DR. R.V.K. Singh) who gave me the golden opportunity to do this wonderful project on the topic (non-parametric analysis of chronic liver cirrhosis), which also helped me in doing a lot of Research and I came to know about so many new things I am really thankful to them.
Secondly I would also like to thank my parents and friends who helped me a lot in finalizing this project within the limited time frame.
















TABLE OF CONTENT
Title page i
Dedication ii
Acknowledgment iii
Table of contents iv
List of table v
Abstract vii
CHAPTER ONE: INTRODUCTION
1.1 Background of the Study 1
1.2 Statement of the Problem 2
1.3.1 Aim 2
3.1.2 Objective 3
1.4 Significance of the Study 3
1.5 Scope and Limitation 3
1.6 Definition of the basic Terms 4
CHAPTER TWO: LITRATURE REVIEW
2.1 CONCEPTIONAL FRAMEWORK 5
2.2 Chronic Liver Disease 5
2.3 Signs and Symptoms 7
2.4 Causes of CLD 8
2.5 Effect of the Infection 11
2.6 Prevention and Control 11
2.7 Role of W.H.O 12
CHAPTER THREE: RESEARCH METHODOLGY/DATA PRESENTATION
3.1 Research design 13
3.2 Population of the Study 13
3.3 Method of Data Collection 13
3.4 Method of Data Analysis 13
3.5 Testing hypothesis using chi-square Test 13
3.6 Procedure for Testing chi-square 14
3.7 The Kruskal Wallis Test 14
3.8 The Test Statistics for testing Kruskal Wallis Test 15
3.9 Mann whitney U test 16
CHAPTER FOUR: SUMMARY, CONCLUSION AND RECOMMENDATIONS
4.1 Summary 21
4.2 Conclusion 21
    4.3 Recommendations         21
References                 23

LIST OF TABLES
Table 3.1 Represent 2017 male and female and 2018 male and female 17
Table 3.2 Cross tabulation of Gender and Months 17
Table 3.3 Cross Tabulation of gender and years 18
Table 3.4 Mean Ranks of Patients 18
    Table 3.5 Test Statistics of Kruskal Wallis Test     19
    Table 3.6 Mean Ranks of Study Months and Gender      20
Table 3.7 Test Statistics of Mann Whitney Test 20
ABSTRACT
The research investigates the reported cases of  chronic liver diseases patients in specialist hospital, in sokoyo state, using yearly data from 2017 to 2018, the non-parametric test of Chi-square test, Kruskal Wallis test, and Mann whitney u  test were used for the analysis, the result of the analysis revealed that  gender is dependent on months, and gender is independent on years, using chi-square analysis,and it revealed that there is signifance differences between them using Mann whitney u test,  and it also revealed that there is significance differnces among the patients and years using Kruskal Wallis test.


CHAPTER ONE
          INTRODUCTION
1.1 Background of the study
The consequences of liver disease have a worldwide disorder distribution. Often affect individual are not showing any symptoms for a long period of time making it very difficult to generate population who estimate that 30% of 170 million of the world population are chronically infected with hepatitis c virus [HCV]. It was known that liver perform a great function in the body of organism in the event that is was become diseases. It causes many internal disorders prevalence liver diseases infection in the country keep on increasing in resent time. Thus there is need for the statistical analysis for infection. This give rise to the study of the infection.
The effect of the infection can affect so many aspect of social devolvement population rate, economical improvement and some social activities it was reported liver problem include a wide range of diseases and condition that can affect the function of liver. The pattern of liver diseases varies in different geographical location. Like in (U.S) cirrhosis are 12 leading causes of hospitalization death and the prevalence remain stable in U.S between 1998-2008 exception alcoholic fatty liver diseases (NAFALD).
Sub-Sahara African is 0f great interest because it is reported to have the highest prevalence of chronic liver diseases rate 5.3% and concurrent HIV epidemic. While 2.4% south and eastern Africa with lowest estimate 1.6%. Also almost 900 million worldwide are estimate to be infected with hepatitis B virus (HBV). Nigeria is the one of the countries with prevalence of 10-15% across the country both males and females did not rescue. Medical personal, especially surgeon, dentist and nurses are at great risk of infection.
For these, the condition is likely to shower the development of the society and plays a great role increasing mortality rate.
 sokoto state specialist hospital is the one of the centers that handles many cases of chronic liver diseases (C.L.D) most a time the condition result to death of many people. More over this research work will be carried out to look in too deep in determining the factors of chronic liver diseases infection a still intended to find out the possible complication of CLD as well as identification of prevention and control measure of the infection. So also it will help in creating awareness and planning program to reduce or prevent the occurrence of the infection. In a study at university college hospital (U.C.H) Ibadan, Oyo state it discover that liver disease accounted for 12.1% of 45.68 death in the medical ward. Viral hepatitis remains a leading cause of morbidity and mortality affecting of individual organization.
   1.2 Statement of the Problem
It has been observed that the prevalence of chronic liver disease (CLD) is on increase nationwide particularly our great country; Nigeria. This condition is a result of many diseases and causes losses of normal function of liver even to death, and diminishing growth and development of country population.
Despite all effort made by the government and other non-governmental organization such as WHO, UNICEP and C.D.C etc toward preventing and combating the diseases through organizing seminars to the health personnel about the pre-disposing factors and cultural effect afore mention. There is need to give immense contribution in boosting health condition in the society through exposing the problem and providing possible solution behind the effect of liver diseases.

1.3.1 Aim
To conduct a non parametric analysis of data on chronic liver cirrhosi


3.1.2 Objective
The objectives of this research is to access the cross relationship between gender, months and year and also to examine the significance differences among them. This aim can be achieved through the following:
To determine whether gender is dependent on month using chi-square
To determine whether gender are dependent on years  using chi-square
To examine whether there is significant difference between male (2017), male (2018), female (2017) and female (2018) using Kruskal Wallis test.
To check whether there is significance difference between gender and months using Mann Whitney u test.

1.4 Significance of the Study
At the end of the study the decision makers, government and other researchers will benefit       with the report and it also guide in creating awareness to the in-patient attending specialist hospital, sokoto.
Also it will make the public to be known of the consequences of liver diseases infection.
      It will also help physician medical, doctors and health workers in handling the causes of the
      infection. It can also serve as a guide for further research.

1.5    Scope and Limitation                                                                                                                      The scope of the research work is limited only to the admitted patient with liver disease at specialist hospital, sokoto.



1.6     Definition of Terms
Mortality: - is the number of death in population.
Mobility: - is the interest in unpleasant activities.
Sample: - fraction of the population.
HVD: - hepatitis B virus.
HVC: -   hepatitis C virus.
CLD: - Chronic liver disease.


















CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter review literature related to the study under the following subheading:
i. Occurrence of LCD.
ii. Sign and symptoms of CLD.
iii. Causes of liver diseases.
iv. Effect of the infection.
v. Prevention and control of chronic liver diseases.
vi. Role of W.H.O in eradicating the diseases.
2.2 Chronic liver diseases (CLD)
Chronic liver diseases in the clinical context are a disease process of liver that involve a process of progressive destruction and the regeneration of liver parenchyma leading to fibrosis and cirrhosis. According to Abdulfatai (2007), chronic liver disease accounted for tremendous mobility and mortality.
The liver is vital organs that play a major role in human metabolism, because of its peculiar anatomy and physiology. It is extremely susceptible to the influnence of wide variety agent including infection and train.Liver diseases produce a wide range of clinical manifestation jaundice is the main manifestation resulting from damage to the liver itself and form portal hypertension.
In many counties the dominant causes of portal hypertension is hepatic cirrhosis (liver diseases) although the underlying liver disease is always advanced. Liver failure may or may not be presence. (Son, 2008).
During a research Abdulfatai, discover that hepatitis, liver cirrhosis, and primary liver cancer comprise the major causes of mobility and mortality from liver diseases in Nigeria.
The American association for liver diseases study estimated that 25million American experience of liver related diseases each year. Also American liver foundation have an estimate of the infection and found that 20,000 Americans die of chronic liver diseases each year and another 360,000 are hospitalized, Owalabi and ojo (2008), discover in their report that about 300million worldwide are estimated to be infected with hepatitis B virus, Nigeria is one of countries with highest prevalence of 10 – 15% across the country. There is strong relationship between hepatitis B infection and various forms of chronic liver diseases. Hepatitis C is not implicated in pathogenesis of chronic liver diseases in Nigeria but co-existence HBV and HDV infection tends to worsen the causes of HBV.Association liver diseases, hepatitis B infection Hepatitis B virus DNA and liver biopsy are widely unavailable in the country and expensive for the average patient available. Liver diseases can be inherited or occur in response to virus and chemicals some liver problem are temporary and go away on their own. While other liver problem can last for a long period of time and lead to serious complication. (Mayo clinic, 2011)
Patient with drug induced hepato-cellular (liver) jaundice have 11.7% chance of progressing to death or liver transplantation. In a research reported by Alexander and gun I, revealed that all of the estimated 50million new cases of hepatitis B virus infection diagnosed annually. 5-10% 0f adult and up to 90% of infant will became chronically infected 75% of these ware in Asia, where hepatitis B virus is leading causes of hepatitis, cirrhosis and hepoto-cellular carcinoma (HCC). In Indonesia 4.6% of the population was positive for hepatitis B in 1994. They add that the annual probability of developing cirrhosis varies from 0.1% depending on the presence of concomitant infection or drugs.  The annual incidence of hepatitis decompensating in HBV related cirrhosis varies from 2 to 10% and these patient, the 5year survival rate drop dramatically to 14-35%. They also add that the annual risk of developing HCC in – patient with cirrhosis varies between 1 to 6% in a study of 214 CLD
 infected patient with cirrhosis show that HCC developed at the rate of almost 4% year. HCC was the first complication to occur in 27% of 55 patients, often 17%years, HCC developed in 33% of 68 patients. In another cohort of 416 patients with uncomplicated cirrhosis. Hepatitis C virus related cirrhosis, the incident of HCC was 13.4% at 5 years and death rate was 15.3% with the hazard rate of HCC.
 N Goncalo (2017) he studied that outcome and nutritional chronic liver disease patients using anthropometry and subjective global assessment and he concluded that with the experience of the analysis CLD patients, those with advanced liver diseases tends to tends to be more severely malnourished and alcohol may play a very important causative role
 2.4 Sign and symptom
  In an investigation of patient with abnormal function. Test start with a clinical history and physical examination. Non-specific symptom such as fatigue and weakness are common in patient with chronic liver diseases. Infant young children aged less than 10years with newly immune suppressed, adult with newly acquitted hepatitis B infection are usually symptoms and sing might include; malaise, nausea, vomiting, abnormal pain and judies, extra-hepatic manifestation  (like  skin  rashes and arthritis) can also occur.
The case fertility rate after acute hepatitis B is 0.5 – 1% in adult with normal immune status most (95-98%) recover completely from newly acquired.
Many people with chronic hepatitis C (HCV) do not have symptoms and not know they are infected. Symptom of chronic hepatitis C can take up to 30 years to develop when symptoms do appear they often are a sign of advanced liver diseases.
 This symptom can include fever, fatigue loss of appetite, nausea, vomiting, abnormal pain, dark urine, gray colored stool.


2.5 Causes of CLD
According to (Wikipedia) there are a number of conditions associated with CLD which is extensive and can be categorized in the following ways:                                                                                                         Viral causes (hepatitis A, B and C).
 toxic and drugs causes (alcoholic liver diseases)
   Metabolic causes (non-alcoholic fatty liver diseases)
Auto-immune e.g. chronic hepatitis cirrhosis.
Right heart failure.
   Hepatitis virus
An infective hepatitis is the inflammation of the liver which may be due to viral infection or toxic substance like poison and drugs. As a result of this the liver is unable to store and reconvert already stored glycogen in to glucose (Micah 2008).
Hepatitis referred to as a group of viral infection that effect the liver. In this disorder hepatitis results in damage to live with subsequent cell death. The common types of hepatitis are; hepatitis A virus. Hepatitis B virus which are acute illness and hepatitis C, D and E virus are chronic level of the infection. Viral hepatitis is the leading causes of the liver cancer and almost common reason for liver transplantation. An estimated 4.4 million Americans are living with chronic hepatitis. Most do not know they are infected. Studies shows that the main causes of chronic liver disease are:
Hepatitis A virus (HAV): A disease of liver causes by HAV is spread most by often by the route. They are potential no symptom with this disease likely hood of symptoms increases with age if present symptom include yellow skin or eyes, tiredness, stomach ache lost of apatite or nausea. The Hepatitis A vaccine is prepared from an inactivated HAV viral antigen. The center of diseases control (CDC) recommended that children in state with at least 20 cases out of 100,000 populations receive the vaccination. But the researchers described that this infection is not too common among individual.
Hepatitis B virus (HBV):
 This disease of liver course by HBV is spread through contact with blood of an infected person
or by having sex with an infected person.
It present symptom include yellow skin or eyes, stomach ache, loss of appetite, nausea or joint pain. HBV vaccine is prepared from an inactivated hepatitis B Virus antigen. The HBV vaccine is recommended for all people at risk of contracting the virus and is giving to those at high risk of developing the diseases who do not show evidence of immunity to virus (Sarah, 2003).
Hepatitis B virus infection is a major health burden in the Asia pacific region. The seriousness of chronic liver hepatitis B (CHB) is often realized at late stage. The resultant mobility and mortality from cirrhosis complication is considerable with high human cost. The most effected patient is men aged 40 years or older two decades ago. The prognosis for the 300millions people with chronic hepatitis B virus infection was gloomy will have no effective intervention. 20years on research and development have changed their outlook.  Chronic hepatitis should now be diagnosed early at a symptomatic stage. According to WHO HBV account for 75% of chronic liver diseases and increase mobility and mortality in a population and its prevalence is globally concern.
 Hepatitis C virus (HCV)): HCV is the most common chronic blood borne infection in U.S during 1999, 3111 cases were reported. According to Awolabi (2008) in trying to estimate the absolute and relative effects of hepatitis C infection on liver relation mortality he found that the result show a strong relative but weak absolute effects of HCV on liver related mortality in 10years period poison and binomial model are virtually

Equivalent but the choice of sum mazing measure of effects may have different impact on death policy.
HVC infection continues to occur among chronic hem dialysis patient. Epidemiologic substantial differences in recommended infection control practice as well as a failure to vaccinate hem dialysis patient against hepatitis B. the practice apparently are not being fully implemented because staff members;
Are not aware of the practice and their importance.
They are confused regarding differences between standard precautions recommended for all health are setting and the additional precaution necessary in the hem dialysis setting.
They believed that the HBV vaccine is in effective for preventing infection in chronic hem dialysis.
      Transmission of HCV
Hepatitis C is usually spread when blood from an infected person with HCV enters the body of someone who do not infected. This can happen in multiple ways.
Before wide spread screening of the blood supply began on 1992, hepatitis C was spread through blood transfusion and organ transplant. People with clotting problem who too blood products prior to 1987 were also exposed to hepatitis C. sharing needle or other equipment to inject drugs is very efficient way to transmit the virus, people have also become infected with the hepatitis C virus from body piercing or tattoos that were getting in prisons, at home or other unlicensed facilities.
Chronic liver diseases is not spread by casual contact,  kissing, hugging, sneezing, coughing, breast feeding, or sharing food and eating utensils or glasses but it can be sexually transmitted babies born to mother with the infection can get infection during child birth. Some people do not know how or when they became infected.
   Liver cirrhosis
Cirrhosis is a serious liver diseases in which the damaged Liver cells become replaced by death or useless fibrous tissue. As a result of this liver feels very firm and irregular cirrhosis may be caused by excessive drinking of Alcohol over a long period of time or by hepatitis. (Michel, 2008)
Excess alcohol consumption can worsen the causes and outcome of chronic liver diseases. It is important to distinguish between alcohol abuses which must be treated on its merit and the effect of alcohol use on progression, severity and treatment of chronic liver diseases by 71% in male and 4% in female. Over the study period; this increase was largely due to alcoholic liver diseases.
2.6 Effects of the infection
Severally system made up the body of organism particularly human each performing a specific function body system use some organs to operate effectively liver is the one of the vital organs in the living organism that perform critical function. Thus liver diseases impair that function as well as causing the following abnormally:
 Lead to loss of appetite.
Causes severe headache and nausea.
Result to generate weakness of the body.
Result the ability to digest fats oil properly.
Account for mobility and mortality.
2.7 Prevention and Control
An understanding of diseases control help set the stage for understanding of diseases eradication and elimination. Diseases control refer to the reduction of disease incidence

Prevalence morbidity or mortality to a locally acceptable level as result of deliberately effort continued intervention measure is required to maintain the reduction. (WHO, 1999)
Prevention of this infection may be primarily or secondary such as the education. Enforcing rule on adequate screening of all blood donors and their need to take precaution it prevents spread in laboratory and hospital. (IFEMED, 2013)
Some of the suggested prevention measures of chronic liver disease by Thomas (2012) include;
Avoidance of alcohol of all types.
Receive vaccination against hepatitis A & B if not already
immune (your doctor can check blood to determine)
Consumption of low fat diet because it’s good for your liver as well as your heart.
Once cirrhosis develops yearly screening should be done to follow your risk of bleeding with upper endoscopy and for the early detection of liver cancer with ultra sound. Surgery, liver transplant, regular administration of drug can be to control progression of liver diseases.
2.8 Role of W.H.O
World health organization (WHO) is the directing and co-coordinating authority for health within the united nation system. It’s responsible for providing leadership on global health matters, shaping the health research agenda setting norms and standard articulating evidence based policy option providing technical support to countries and monitoring and assessing health trend.
In 28th century, health is shared responsibility involving equitable access to essential care and collective defense against transnational threats.


CHAPTER THREE
      RESEARCH METHODOLOGY/DATA PRESENTATION
3.1 Research design
The design that will be used for this study is descriptive study. This design was often use for the purpose of achieving any of the following explanatory investigation or analysis among others.                                     
3.2 Population of the study
The population of the study consists of all admitted patient Infected with chronic liver diseases at specialist hospital, sokoto.
3.3 Method of data collection
The method that will be used in collection data in this study is documenting method (secondary data). It will be from the past record of chronic liver diseases cases at specialist hospital sokoto.
3.4    Method of data analysis
The following statistical tools will be used to analyze the data that will be collected base on research question; the observed values are those we gather ourselves. The expected values are the frequencies expected base on our null hypothesis. We total the rows and columns as indicated. It’s a good idea, to make sure that the row total equal the column total and chi-square test for suitable comparison.
3.5 Testing hypothesis using chi-square test
The chi-square test is always testing what scientists call null hypothesis, which states that there is no significant difference between the expected and observed result.
That is chi-square is the sum of the squared difference between observed (o) and the expected (e) data (or the deviation, d) divided by the expected data in all possible categories.


3.6   Procedures for testing hypothesis using chi-square test 
The chi-square test includes the same five basis step, given again below.
Making Assumptions.
Stating the research and null hypothesis and selecting Alpha.
Selecting the sampling distribution and specifying the test statistic.
Computing the test statistic.
Making a decision and interpreting the result.
     Let’s take a closer look at the chi-square test.
The formula for calculating chi-square test is as follow: 
X2 =              (3.4)
Where
Oij = the observed frequency
Eij = the expected frequency
r   = the number of rows
c = the number of columns
= The level of significance selected
Eij = (ith row marginal total  jth column marginal total)/grand total                 
(1)

3.7 The kruskal-wallis test
It was used tests whether two or more independent samples come from identical populations. For example, you may want to know whether the median of malaria incidences are the same among children.
The Kruskal-Wallis test is a nonparametric alternative to a one-way ANOVA. The test does not require the data to be normal, but instead uses the rank of the data values rather than the actual data values for the analysis.

Assumptions
There are at least three (3) independent samples, all of which are randomly selected.
I  each sample has at least five (5) observations, otherwise use special tables of critical values for exact distribution of H under null-hypothesis (H0).
II There is no requirement that the populations have a normal distribution or any other particular distribution.

Procedure for calculating test statistic hypothesis
Combine all samples in to one sample and assign a rank to each sample value.
For each sample, find the sum of the ranks and the sample size.
Calculate the test statistics H as below
3.8 The test statistic for testing kruskal wallis
 – 3(N+1) (3.1)
H = 3(N+1) (3.2)
Where N = n1+n2+  +nk = total number of observations in the sample.
K = number of samples.
ni = number of observations in sample i.
  Ri = sum of ranks for sample i.

3.9 Mann-whitney u test
Is a nonparametric hypothesis test to determine whether two populations have the same population median (h), It tests the null hypothesis that the two population medians are equal   (H0: h1 = h2). The alternative hypothesis can be left-tailed (h1< h2), right-tailed (h1> h2), or two-tailed (h1 ≠ h2). The Mann-Whitney test does not require the data to come from normally distributed populations, but it does make the following assumptions:
I. the populations of interest have the same shape
II. The populations are independent
Test statistics
Where: U = n₁n₂ +  – R   (3.7 Notation
n1 = size of sample 1
n2 = size of sample 2
R1 = sum of rank for sample 1
R2 = sum of rank for sample 2
R = same as R1




Presentation and analysis of data
Table 3.1 Represent 2017 male and female and 2018 male and female

2017
2018

Month
Male
Female
Male
Female

Jan
17
                             11
23
10

Feb
12
16
60
15

Mar
16
3
38
8

Apr
18
21
16
10

May
17
5
17
12

Jun
23
7
15
8

Jul
22
2
23
24

Aug
             26
5
30
10

Sep
24
19
38
13

Oct
11
6
34
12

Nov
10
12
31
13

Dec
14
2
30
10


Table 3.2 cross tabulation of gender and months

Value
Degree of freedom
P-value

Pearson Chi-square
23.890
            11
  0.13

Likelihood ratio
24.335
            11
  0.11

No. of valid cases
819




The result obtained in table above, with the result of chi-square = 23.890 and degree of freedom = 11 and p-value =0.13. The result shows us that our null-hypothesis is rejected, since our p-value>0.05, then we conclude that gender is dependent on months.
Table 3.3 Cross tabulation of gender and years

Value
Degree of freedom
P-value

Pearson Chi-square
819.000
            1
  0.000

Likelihood ratio
1014.263
            1
  0.000

No. of valid cases
819




The result obtained in table above, with the result of chi-square = 819.000 and degree of freedom = 1 and p-value =0.000 the result shows us that our null-hypothesis is accepted, since our p-value<0.05, then we conclude that gender is independent on years.
Table 3.4 mean ranks of patients

   Male-2017

            28.38


    Male-2018

           39.21


     Female-2017

             13.00


     Female-2018

             17.42


The result above shows us the result that the mean rank of the distribution of the patients differs


Table 3.5 Test statistics of kruskal wallis test

                    N

            12

           
             Chi-square
 
            25.403

     
         Degree of freedom

            3

       
               P-value

            0.000


The above table provide the test statistics (χ2) (chi-square ) value, degree of freedom(df) and significance level ( P-value ) which is all we need to report the result of the kruskal wallis  test. We can see that from our ranks there is statistically significance differences between the related groups
The above table shows the kruskal wallis test for chronic liver disease cases of both male and female, both in-patient and out-patient which are described as K independent samples above. Where sample 1 represent Male-2017, Sample 2 represent Female-2017, Sample 3 represent Male-2018 and Sample 4 represent female-2018
From the result, p-value is (0.000) and our α-level is (0.05) 
Therefore, since p-value < α-level then there is evidence to reject the Ho and conclude that there is significant difference between all the cases of chronic liver disease patients.




Table 3.6 Mean ranks of study months and gender
Gender
N
Mean
Sum of ranks

Male
24
            20.69
  496.50

Female
24
            28.31
    679.50


The result above shows us the result that the mean rank of the distribution of months and gender for people with CLD.
Table 3.7 Test statistics of mann whitney test

             Mann whitney u

            196.500

           
             Wilcoxon w
 
            496.500

     
         P-value

            0.59


From the above result, there is no evidence to reject the null hypothesis, since the p-value (0.59) is less great alpha value (0.05). Therefore we conclude that there is no significant difference between genders in term of months.







CHAPTER FOUR
SUMMARY, CONCLUSION AND RECOMMENDATION
 4.1   Summary
Based on this research work, it was categorized and conducted into five chapters, chapter one described the background of the study, statement of the problems, aim and objectives scope and definition of some terms. Chapter two describes the contribution of some past researchers that review the literature toward achieving a great objective. The third chapter discussed about the method of analyzing of non-parametric tests such as chi-square, Mann Whitney u test and kruskal wallis. Chapter four carried out the analysis using the statistical tool called spss (statistical package for social sciences) for all the analysis. Chapter five describes the summary, conclusion and recommendations. 
4.2 Conclusion
This research work (project) is concluded based on the analysis made, using some nonparametric tests. The chi-square result shows us that gender is independent on year, and gender is dependent on months, and the result of Mann whitney u test shows that there is significance difference between the patients and months, while the Kruskal Wallis test shows us that there is significance difference among the patients and their gender.

4.3   Recommendation
It is recommended that government should provide enough health and vaccination center against hepatitis B, also awareness of the effected and causes of chronic liver diseases should be encouraged and free medical services should be created for the effected people with CLD.
Government go Increase efforts to prevent new HBV infection are urgently need in Nigeria
Federal government should accurately estimate the HBV prevalence for the country and the prevalence for specific sub-groups
Government should continue helping the patients with hepatitis virus
The patients with the virus should be taking their drugs regularly for them to improve their healthy living
Public awareness should be made to people on the causes of chronic liver disease




REFERENCE
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