Determinants of maternal mortality in General hospital Calabar, Cross River State

 

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CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The growing concern on improving reproductive health at the global level  has created a demand for  research  especially in the area of maternal health. Maternal health, which is the physical well being of a woman during pregnancy, childbirth, and postpartum period (WHO, 2011; Fadeyi, 2007), has been a major concern of several international summits and conferences since the late 1980s, which culminated to the Millennium Summit in 2000 (WHO, 2007).

 

It is obvious that maternal mortality is a key constituent of maternal health. The World Health Organization in the international statistical classification of diseases and related health problems (ICD), has defined maternal mortality as the death of a woman while pregnant or within 42 days of a termination of a pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental and incidental causes (WHO 2007; Ogunjuyigbe and Liasu, 2007; Khama, 2006).

 

It is within this conceptual framework that the Millennium Development Goal Target 5A, calls for a reduction in maternal mortality ratio by three-quarters by 2015. At its present rate, however, the world will fall short of the target for maternal mortality reduction because the data so far collated suggest that to reach the target, the global Maternal Mortality Rate (MMR) would have had to be reduced by an average of 5.5% a year between 1990 and 2015.

 

Nigerian constitutes only two percent of the world‟s population, but Nigeria accounts for over 10% of the world maternal deaths, and ranks second globally only to India (Okonofua, 2007; Abdul‟Aziz, 2008). The status of maternal health is poor in Nigeria, defined by maternal mortality of 59,000 per annum due to pregnancy-related causes. This has been identified as the leading cause or determinant of death among women of reproductive age in Nigeria (Idris, 2010).

Although opinion differ on the determinants of maternal mortality, Herfon, (2006), noted  that the cause of maternal mortality is an outcome of nexus interaction of a variety of factors namely: the distant factors (socio-economic, cultural) which include; occupation, income level and illiteracy act through the proximate or intermediate factors (health and reproductive behavior, access to health services) and in turn influence outcome (pregnancy complication mortality).Idris, (2010) further identified other factors responsible for maternal  mortality as socio-cultural factors which include; traditional practices, norms, believes, education and religion.

Several attempts have been made in the past aimed at reducing maternal mortality in Nigeria, such attempts, especially by the Federal and state governments, have generally not proved very successful in achieving the desired results.

 

Some promising results however have recently begun to be recorded through some  policy initiatives by a few state governments. In Cross River state, the state house of assembly approved a bill in 2007, guaranteeing free maternal health services to pregnant women (Shiffman and Okonofua, 2007). The state commissioner of health, who is an obstetrician and gynaecologist, played a central role in its development and adoption.

 

The introduction of the safe motherhood programme in 1995,midwife service scheme (MSS) in (2011) and subsidy reinvestment program (SURE-P) IN 2012 introduced a range of interventions which included antenatal care, labour and delivery care, postnatal care, family planning, prevention and management of unsafe abortions, and health education but still MMR has not been encouraging over the years and improvements are so slow.

 

The former state commissioner of health together with some senior obstetrician and gynaecologist, played central roles in creating this positive environment for maternal health. Hence , today  pregnant women in Cross River now assess free medical services in General hospital, Calabar as part of measures put in place by the state government to reduce maternal mortality rate in the state (Media Global,2010).

 

However, other states like Jigawa, as part of measure in checking maternal mortality,  have provided funds for the upgrading of obstetric care facilities in hospitals, the recruitment of obstetricians and gynaecologists and the provision of ambulances at the local level to transport pregnant women experiencing delivery complications to health facilities. The former executive secretary for primary health care, who subsequently became state commissioner for health, stood behind these initiatives.

 

 

1.2 Statement of the Problem

Maternal mortality is the most important indicator of maternal health and well being in any country (Herfon, 2006). Maternal mortality is a tragedy, many children are rendered  motherless, such children are deprived of maternal care which goes a long way to affect adversely both their physiological and psychological development. The majority of these pitiable situations are due to maternal mortality.

 

From recent estimates, the number of deaths each year from  maternal causes worldwide decreased from 536,000 in 2005 to an estimated 358,000 in 2008 and 273,500 in 2011. For every woman that dies, approximately 20 more suffer injuries, infection and disabilities in pregnancy or childbirth (IHME, 2012; UNICEF 2008; WHO, 2007). The situation is even more alarming in Nigeria. For example, in the year 2000, the maternal mortality ratio per 100,000 live births was 800 compared to 540 for Ghana and 240 for South Africa.

 

Consequently, the chance of a Nigerian woman dying from reproductive health disorders and complications was put at 1 in 10 in 2002 (Population Reference Bureau, 2002), 1 in 18 in 2005, and 1 in 23 in 2008, placing the Nigerian woman  at far greater risk than her counterpart in the developed world, where the risk is estimated to be 1 in 17,800 and 1 in 10000 in countries such as the Republic of Ireland and Singapore respectively (World Bank, 2011; UNICEF, 2010; Media Global, 2010; UNICEF, 2008; UNFPA, 2005). Some of the implications of  these estimates are the depletion of the country‟s workforce and the overall stifling of rapid development.

 

 

This study focuses on determinants of maternal mortality in General hospital Calabar, Cross River State. The researcher was motivated to carry out  this study based observation and experience while on clinical posting towards the rate at which pregnant women die during childbirth as a result of post partum hemorrhage or eclampsia. The poser is what are the causes of women death?: thus this question can only be answered when this study is concluded.

 

 

1.3 Purpose of the study

The purpose of the study is to understand the determinants of maternal mortality in General Hospital Calabar, Cross River.

 

 

1.4 Objectives of the study                  

(i)   To assess the influence of poor maternal health care on maternal mortality

(ii)      To identify the influence of education on maternal mortality

(iii)         To determine the influence of occupation on maternal  mortality

 

1.5 Research Questions

In order for the researcher to achieve the objectives of the study, the following research questions were developed to guide the study;

(i)                            To what extent does poor maternal health influence maternal mortality?

(ii)                         How does education factors influence maternal mortality?

(iii)                       Can occupation influence maternal mortality?

 

 

1.6 Research hypothesis

There is no significant relationship between maternal level of education and causes of maternal mortality in General Hospital, Calabar

 

 

1.7     Scope of the study

The study is narrowed to all pregnant women with pregnancy related issues resulting to maternal mortality in General Hospital Calabar.

 

 

1.8       Significance of the study

The findings of this study will help health workers to identify factors responsible for maternal mortality, this will guide them on adopting more effective measures to ensure that women experience uneventful pregnancy, labour and peuperium. It will help women of child bearing age in the prevention of maternal mortality even in future pregnancies by obtaining adequate prenatal care.

 

Similarly, the study will also be of value to government both state and federal, policy makers as well as researchers for further research.

 

1.9     Limitations

The major limitation encountered during this study was the attitude of health record official in providing relevant information for the researcher. Also some retrieval of information was very cumbersome due to the manual nature of keeping information.

 

1.10 Operational definition of terms

Hospital:  Is a place or building where people who are ill/sick or injured are giving medical treatment and care.

Primary Health Care:  Is the medical treatment one received first when sick.

Pregnacy:  Is a period where a woman is having a baby developing inside her.

Maternal Mortality:  Is the death of a woman during or after delivery.

Maternal health: Is the physical well being of a woman during pregnancy, childbirth, and postpartum period

 

 

 

 

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THE EFFECT OF CRUDE OF ALOE BARBADENSIS ON SOME HEMOSTATIC PARAMETERS OF FED ON THERM-OXIDIZED PALM OIL DIETS

 

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TABLE OF CONTENT

CHAPTER ONE

INTRODUCTION AND LITERATURE REVIEW

1.1            Introduction

1.2           Aims and objectives of the study

1.3           Justification of study

1.4           Scope of study

 

CHAPTER TWO

2.0           Literature review

2.1           Photochemistry of aloe Vera

2.2.1                General uses of aloe Vera

2.2.2        Theraperetic  (medicinal) uses of aloe Vera

2.2.3        Anti-inflammatory effects of aloe Vera

2.2.4        Laxative effects of aloe Vera

2.2.5        Anti-cancer properties of aloe Vera

2.2.6         Gastroprotective properties of aloe Vera

2.2.7        Anti viral effects of aloe Vera

2.2.8         Wound healing properties of aloe Vera

2.2.9        Aloe Vera gels effects on the immune system

2.2.10      Effects of aloe Vera on burns

2.2.11       Hypoglycemic effects of aloe Vera

2.2.12       Aloe Vera in veterinary medicine

2. 3         Other effects of aloe Vera

2. 3.1        Mechanism of action of aloe Vera

2.3.2        Mechanism of anti inflammatory action of aloe Vera.

2.3.3        Mechanism of laxative/ cathartic action of aloe Vera.

2.3.4        Mechanism of wound healing action of aloe Vera

2..3.5        Side effects, contrain dication and toxicity of aloe Vera.

2.4           Homeostasis

2. 4.1       Steps of mechanism

2.4.2                Blood clotting factors

2.4.3                Sequence of clotting mechanism

2.4.4                Bleeding  time

2.4.5                Clotting time

2.4.6                Prothrombin time

2.4.7                Homeostasis disorders / treatment

2.5           The oil palm tree

2.5.1        Thermoxidized  palm oil

2.5.2        Effects of thermoxidized  palm oil on health

 

 

 

CHAPTER THREE

3.0           Materials and methods

3.1            Materials

3.1.1        Experimental animals

3.1.2        Experimental gel

3.1.3         Thermoxidized palm oil

3.2            Methods

3.2.1        Experimental procedure

3.2.2        Preparation of Experimental animal for the determination of homeostatic parameters

3.2.3        Determination of bleeding time by Duke’s Method

3.3.3        Determination of Clotting time

3.3.4        Determine of Prothrombin time

3.3.5        Determine of Platelet count

3.4           Precautions

3.5           Statistical Analysis

 

 

 

 

 

CHAPTER FOUR

4.0      Result

4.1    Comparison of mean food intake in control, thermoxidized palm oil (T.P.O) and T.P.O + aloe vera fed groups

4.2   Comparison of mean water intake in control, thermoxidized palm oil (T.P.O) and T.P.O + aloe vera fed groups.

4.3   Comparison of mean body weights of control, thermoxidized palm oil (T. P. O) and T.P.O aloe vera fed groups.

4.4   Comparison of bleeding time in control, thermoxidized palm oil (T.P.O) and T.P.O + aloe vera extract fed groups.

4.5       Comparison  of clotting time in control, thermoxidized palm oil (T.P.O) and T.P.O + aloe vera extract fed groups.

4.6       Comparison of prothrombin time in control, thermoxidized palm oil (T.P.O) and T.P.O + aloe vera extract fed groups.

4.7       Comparison of platelet count in control, thermoxidized palm oil (T.P.O) and T.P.O + aloe vera extract fed groups.

 

 CHAPTER FIVE

4.0           Discussion and conclusion

4.1           Discussion

4.2           Conclusion

 

 

 

 

 

CHAPTER ONE

INTRODUCTION AND LITERATURE REVIEW

 1.0    Introduction

Aloe barbadensis or aloe Vera is a succulent plant from the family “Liliaceae”, it originated in the African content. The genus has many common names and is often referred to as aloe vera, lily of the desert, burn plant, the plant of immortality, first aim plant, wand of heaven and medicinal plant. The name is derived from the Arabic word “Alloeh” meaning “shining bitter substance”. The Genus contains at least 324 species of herbs, shrubs and ;s (cross white and cross white, 1984).

 

Aloe vera is a perennial with 15-30 fleshy leave up to 0.5m long and 8-Pcrn across the base. Saw like teeth mark the margins- of leaves (Grindlay and Reynolds, 1986). Aloe vera plants withstand high  temperatures   and   long  periods drought, due to their ability to store water in their succulent leaves.

 

However, freezing temperatures can damage or kill the plant. Medically and non- medically, aloe vera has been used for several thousands of years in different cultures from ancient Egypt to Greece, Rome to China, India and Africa (crosswhite and crosswhite, 1984; Grindlay and Reynolds, 1986).

 

In the first century, C.E, the Greek physician, Dioscorides used aloe Vera for mouth infections, sores, wounds and as purgatives. Egyptians, Assyrians and Mediterranean peoples used the latex primarily and the gel as a purgative. The plant was used by the Arabs, Spaniards, ancient Greeks and persians and is still in use by hunters in Africa to reduce perspiration and body scent.

 

In 500 B.C, Egyptians recorded the use of aloe vera in treating burns, parasites and infections. The plant was called. the plant of immortality” by the Egyptians because it can live and even bloom without soil and was given as an offering at the funerals of pharaohs.

 

It was also used in the baths of the Egyptian queens Nefertiti and Cleopatra to keep their skin soft and young (Pamplona Roger, 2001). Today, Egyptians still hang an aloe vera plant over the door of a house   to   provide   a   long   and   fruitful   life   for   its occupants.  In    India,   the   plant  is   used   as   cathartic, anthelminthic,   emmenagogue   and   stomachic.   Aloe  vera latex was used before 1930s in the united states as laxatives ton, 1961; crosswhite and crosswhite, 1984; Grindlay and Reynolds, 1986; Evens 1996).

 

 

1.2Aims and objective s of the study

The aim of this study is to ascertain the effect of crude of aloe barbadensis (aloe vera ) on some hemostatic parameters of fed on thermoxidized palm oil diets. The objective is to ascertain   if   aloe   vera  has any  effect  on  hemostatic derangements that may result from thermoxidized palm oil diet.

 

1.3     Justification of study

It has been known that aloe vera has anti-inflammatory, laxalive,   anti-hypertensive, anticancer, hypoglycaemic fects etc but not much work has been done on its effects on Hemostasis, especially in rats placed on a diet mixedwith thermoxidized palm oil. This research work is therefore aimed at elucidating its effect on Hemostatic parameters ofrats fed on thermoxidized palm oil diets.

 

1.4   SCOPE OF THE STUDY

The scope of the study involves measuring bleeding time, clotting time, prothrombin time and platelet count in 5 albino wistar rats fed with pellet mixed with thermoxidised palm oil and also 5 albino wistar rat fed with the same mixed pellet and in addition 0.1ml/100g body weight  of refined aloe vera gel orally administered for four weeks (28 days)and comparing the results with control group (5 albino wistar rats) fed only on normal pellet for same period.

 

 

 

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GENETIC AND MORPHOLOGICAL DIVERSITY IN Monodora myristica(GAERTN.) DUNAL IN EASTERN NIGERIA

 

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CHAPTER 1

INTRODUCTION                                                                                                     

1.1 BACKGROUND INFORMATION

Monodoramyristica (Gaertn.)Dunal.,also known as African nutmeg or calabash nutmeg, is a tropical tree of the family Annonaceae (Custard-apple family).  Its seeds are widely used as an inexpensive nutmeg substitute becauseof the similarity between the two in odour and taste. Nowadays, however, it is less common outside its region of production(Celtnet recipes, 2011)

 

The genus Monodora contains approximately 15 to 20 species includingMonodora borealis, Monodoraclaessensii andMonodoragrandiflora.Monodoramyristica is easily recognizable by its very long and pendulous pedicels, an undulate upper bract, a large globose fruit with a black and smooth but finely ribbed surface (Burkill, 1985).

 

The Calabash nutmeg tree is native to tropical West Africa, where it grows naturally in evergreen forests from Liberia to Nigeria and Cameroon. It is also native to Angola,Uganda and West Kenya (Weiss, 2002). Due to the slave trade in the 18th century, the tree was introduced to the Caribbean islands where it was established and became known as Jamaican nutmeg (Barwick 2004). In 1897, it was introduced to Bogor Botanical Garden, Indonesia, where the trees flowered on a regular basis but no fruit could yet be collected (Weiss, 2002).

 

 

1.2 GENETIC DIVERSITY IN PLANTS

Genetic diversity refers to any variation in the nucleotides, genes, chromosomes, or whole genomes of organisms. At its most elementary level, it is represented by differences in the sequences of nucleotides (adenine, cytosine, guanine, and thymine) that form the DNA within the cells of the organism. Nucleotide variation is measured for discrete sections of the chromosomes, called genes. Thus, each gene comprises a hereditary section of DNA that occupies a specific place of the chromosome, and controls a particular characteristic of an organism (Harrison et al, 2004).

 

Diversity enhances the chances of populations’ adaptation to changing environments. With more variation, it is more likely that some individuals in a population will possess variations of alleles that are suited for the environment. Such individuals are more likely to survive to produce offspring bearing that allele. The population can thus continue for more generations because of the success of these individuals (NBII, 2011).

 

Most organisms are diploid, having two sets of chromosomes, and therefore two copies (called alleles) of each gene. However, some organisms can be haploid, triploid, tetraploid or more (having one, three, four or more sets of chromosomes respectively) (Harrison, et al, 2004). Within any single organism, there may be variation between the two (or more) alleles for each gene.

 

This variation or polymorphism is introduced either through mutation of one of the alleles, or as a result of reproduction processes,especially if there has been migration or hybridization of organisms, so that the parents may come from different populations and gene pools. Harmless mutations and sexual recombination may allow the evolution of new characteristics which increases diversity(Andayani,et al.,2001).

 

Each allele codes for the production of amino acids that string together to form proteins. Thus differences in the nucleotide sequences of alleles result in the production of slightly different strings of amino acids or variant forms of the proteins.These proteins code for the development of the anatomical and physiological characteristics of the organism, which are also responsible for determining aspects of the behavior of the organism (Harrison, et al, 2004).

 

Plant diversity is part of the biological diversity and contributes towards achieving food security, poverty alleviation, environmental protection and sustainable development(Frankel 1984).

 

It is being eroded rapidly in important spice plants and other crops mainly because of replacement of traditional landraces by modern, high yielding cultivars, natural catastrophes (droughts, floods, fire hazards, etc.), as well as large scale destruction and modification of natural habitats harboring wild species(Frankel 1984, Bramel-cox and Chritnick, 1998).M. myristica population is threatened by urbanization which damages its natural habitat, and leads to the cutting of most of the trees without replanting.

 

Additionally, the plant is listed under Kew’s difficult seeds due to its inability to easily grow outside its natural habitat(Burkill, 1985). Genetic variation in traditional landraces and wild species is essential to combat pests and diseases and to produce cultivars better adapted to constantly changing environments(FAO, 1994).

 

Molecular tools such as have been found to be more useful and accurate in the study of inter-species and intra-species genetic diversity in several plants. Randomly amplified polymorphic DNA (RAPD) markers have been successfully employed for determination of intraspecies genetic diversity in several plants. These include Phaseolus vulgaris (Razviet al., 2013),Ocimumspp (Sairkaret al., 2012), Chrysanthemum (Martin et al., 2002), Annonacrassiflora( Cotaet al.,2011), Prosopis ( Goswami and Ranade, 1999), date palm (Corniquel and Mercier, 1994), papaya (Stiles et al., 1993), poplars (Bradshaw, et al., 1994) and amaranths (Ranade, et al. 1997). No such attempt has so far been reported for Monodoramyristica

 

1.3 RATIONALE

M. myristica is largely harvested from the wild and greatly affected by wild fires, urbanization, reckless and uncontrolled felling of trees for timber and firewood without replanting. There is need, therefore, to initiate breeding programs for this orphan crop by first documenting available genetic and phenotypic variations in this crop. The present report was done with this in mind, and should provide the much needed baseline for further studies.

 

 

1.4 OBJECTIVES

The general aim of the project was to characterize accessions of African nutmeg inSouth eastern Nigeria and estimate the range and distribution of genetic diversity.

The major objectives of this work were:

v  To determine the level of genetic diversity among 21 accessions of Monodoramyristica using RAPD technique

v  To compare morphological and yield related traits among the accessions using analysis of variance tests

v  To confirm the efficiency of RAPD technique in genetic diversity studies of this important plant.

v  To identify traits contributing significantly to variation in this species.

 

 

 

 

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