ASSESSMENT OF THE EFFECTIVENESS OF VACCINE COLD CHAIN SYSTEM IN ILORIN WEST L G A KWARA STATE, NIGERIA

TABLE OF CONTENT

Title

Certification

Dedication

Acknowledgement

Abstract

Table of content

  Chapter one

1.0  Background o f the study

1.1 Statement  problem

1.2 Significant of the study

1.3 Objective of the study

1.4 Specific objective

1.5 Research question

1.6 Scope of the study

1.7 Operational of the study

                               CHAPTER TWO

                             LITERATURE REVIEW

2.1 Introduction and layout of the review

2.1 Definition of cold chain system

2.2 Division of the cold chain system

2.3 Component of the cold chain system

23.1 Vaccines

2.3.1 Personal

2.3.2 Cold chain equipment

2.3.3 Cold chain refrigerator

2.3.4 Cold freezer

2.3.5 Cold box

2.3.6 Vaccine carrier

2.3.7 Ice pack

2.3.8 Form pad

2.3.9 Thermometer

2.3.10 Vehicle

2. 4 Types of vaccine

2.4.1 live attenuated vaccine

2.4.2 Inactivated vaccine

2.4.3 Subunit vaccine

2.4.4 Toxion vaccine

2.4.5 DNA vaccine

2.4.6 Conjugate vaccine

2.4.7 Recombine vaccine

2.4.5 V V M

2.6 Category of vaccine base on sensitivity

1.6.1 Heat sensitive vaccine

1.6.2 Freeze sensitive vaccine

2.6 .3 Sensitive to light

2.7 Vaccine shake test

2.8 Vaccination

2. 9 Immunization program and cold chain system in Nigeria

2.10  Appraisal of the literature review

                   CHAPTER THREE

                   METHODOLOGY

3.0 Introduction

3.1 Area if the study

3.2 Crossectional Research Design

3.3 Study population

3.4 Sample size determination

3.5 Research instrument

3.6 Validation if instrument

3.7 Reliability if instrument

3.8 Inclusion criteria

3.9 Exclusive criteria

3.10 Data collection procedure

3.11 Data analyses procedure

3.12 Ethical consideration

                        CHAPTER FOUR

4.0 Presentation if result and Data Analysis

4.1 Showing the bar chat of the groups of the respondents

4.2 Educational level of the respondents

4.3 Barchart Showing Educational qualification if the respondents

4.4 Working experience if the respondents

 4.5 Cold chain equipment

4.6 Multi bar chart showing the responses on cold chain equipment

4.7 Cold chain storage centre and staff

4.8 Bar chart of cold chain storage centre and staff

4.9 Cold chain vaccine storage and power supply

4.10 Cold chain Equipment management

                CHAPTER FIVE

5.0 Introduction discussion of finding

5.1 Discussion of finding

5.2 Summary if finding

5.3 Limitation of the Study

5.4 Implication for the community health

5.5 Conclusion

5.6 Recommendation

5.7 To the individual community health professional

5.8 To the Government

5.9 Suggestions for the farther Study

ABSTRACT

To ensure the optimal potency of the vaccine storage and handling, need or there is a careful attention adequate electricity power and refrigerator are often lacking in developing countries, where storage handling and heat stability of vaccine are consequently of great concern, where new product have been developing for safe transport and storage while the reliability of vaccine supply has been increased by the introduction of improved management techniques, extensive training ensure that everyone involved in the cold chain system is familiar with all its facet. However, the evaluation in Indian Malaysia Nepal the united republic Tanzania and Tunisia show that these were still weak points in the cold chain system performances and that more attention should be paid to it especially in peripheral facilities the importance of monitoring the cold chain has been given little consideration in temperature countries although adequate refrigerator is often taken for granted, errors in vaccine handling may occur more commonly than is generally assumed.

CHAPTER ONE

BACKGROUND

A cold chain is defined as a temperature control apply chain( l]. cold chain is also  an uninterrupted series of storage and distribution activities which maintain a given temperature range(1).According to WHO cold chain is used to help extend and ensure the shelf life of products  such as fresh agricultural products,, chemicals and pharmaceutical drugs etc. it ensures that there are minimum temperature fluctuations for good in transit from place of production to the point of consumption(1).

Otis regarded as a temperature-controlled supply chain that involves equipment in view of the different temperature needed for different vaccine and medicines. Cold chain is the process that ensure vaccine are stored at recommended temperature range of 2.0 C to 8.0C from the point of manufacturer to the point of administration (immunization Advisory center)put no reported cold chain as the system used to keep and distribute vaccine in perfect condition.

Cold chain in network is regarded as the backbone to ensure that the right quality of vaccine reaches the target population. Manufacturing plant, vaccine distribution and then to provider office (immunization clinic) and end with the administration of the vaccine to the recipient (1).

Vaccine are immunogens consisting of weakened or dead pathogenic cell injected in order to stimulate the production of antibodies it’s use to improve immunity to particular disease(1). The prevention of disease by the immunization is a conventional public health measure is known as today the best disease low-cost community based way of protecting children against the major killer disease over a 2 million death that are preventable through immunization. Each year and worldwide(2).this vaccine preventable disease remain the most common cause of childhood mortality with on estimated 3million death each yea(2). .development of effective vaccine has reduced the incidence of much serious infectious disease, early year immunization services in developing countries prevent about 490.000children from becoming paralyzed by poliomyelitis. Over 3million death are similarly prevented from measles, neonatal tetanus, pertussis (5). The achievement is partly attributable to the training of staff in the proper storage and transport of vaccine and partly to improvement in the cold chain. Immunization to vaccine preventable disease only result when active and affective vaccine can be sustainable by harnessing the essential elements in the cold chain system namely the vaccine, manpower, equipment and transportation. The cold chain refers to the continued of safe handling practice including material equipment and procedure that maintain vaccine within a temperature range from the time they are manufactured to the time they are administered to the person being immunized the cold chain still remains a highly vulnerable element of any immunization program. Both in developing and developed countries. The cold chain management including all of the means use to ensure a constant temperature between +2.c +8.c for that is not heat stable e.g. vaccine (2).

ASSESSMENT OF THE EFFECTIVENESS OF VACCINE COLD CHAIN SYSTEM IN ILORIN WEST L G A KWARA STATE, NIGERIA

THE ROLE OF COMMUNITY HEALTH PRACTITIONERS ON INJECTION SAFETY

ABSTRACT

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of “Safe Injection Global Network (SIGN)” was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.

INTRODUCTION

The WHO(2004) research shows that over 12 billion of injections administered are unsafe injection. Health care workers are exposed to the risk of blood-borne diseases such as HIV, Hepatitis B and C in their daily encounter with infected patients and materials through unsafe injections. Injection is an important health care procedure used worldwide for administration of drugs. Billions of injections are used worldwide for curative care and for immunization. In developing countries, approximately 16 thousand million injections are administered – a rate of 3.4 (range 1.7-11.3) injections per person per year. Majority of the injections are unnecessary and are not used safely. Reuse of injection equipment in the absence of sterilization is common.

TABLE OF CONTENTS

TITLE PAGE                                                                                                             I

ATTESTATION                                                                                                         II        

CERTIFICATION                                                                                                     III

DEDICATION                                                                                                           IV

ACKNOWLEDGEMENT                                                                                         V

ABSTRACT

INTRODUCTION                                                                                VI

TABLE OF CONTENTS                                                                                           VII

CHAPTER ONE: INTRODUCTION                                                                                           

1.1       Background Information                                     1                                                                                

1.2       Statement of the Problem       2                                                                                            

1.3       Justification of the study             3                                                                                            

1.4       Objectives of the Study                     3                                            

CHAPTER TWO: LITERATURE REVIEW                                                     

2.1       Definition of injection, safe injection, unsafe injection 4-7                                    

2.2       Steps of giving safe injection                     8                                                                                             

2.3       Safe Choices matter                              11-12                       

2.4       Interventions and challenges for save injection practice    13

 2.5      Safe disposal of used injections equipments          14      

   2.6       Training community health practitioners on injection safety              14-15        

   2.7 Advocacy for injection safety                                                       16                    2.8 Roles of other health progammes in promoting injection safety   17       

CHAPTER THREE: METHODOLOGY                                                                                       

3.0      METHODOLOGY   18                                                                                                                   

CHAPTER FOUR: DISCUSSION                                                                        

4.0       DISCUSSION   19                                                                                                 

CHAPTER FIVE: CONCLUSIONS                                                                    

5.0       CONCLUSIONS                                                                               20

5.1      RECOMMENDATION   21                                                                            

REFERENCES                                                                                22

CHAPTER ONE

1.1 BACKGROUND

Injection safety, or safe injection practices, is a set of measures taken to perform injections in an optimally safe manner for patients, healthcare personnel, and others. The Standard Precautions section of the 2007 Guideline for Isolation Precautions provides evidence- based recommendations for safe injection practices and reflects the minimum standards that healthcare personnel should follow to prevent transmission of infections in healthcare settings.(Brokensha,1999). Despite these recommendations, outbreaks and patient notifications resulting from healthcare personnel failing to adhere to Standard Precautions and basic infection control practices continue to be reported.(Bhattarai,2000). Unsafe injection practices that have resulted in disease transmission have most commonly included:(Brokensha,1999; Bhattarai,2000).

Using the same syringe to administer medication to more than one patient, even if the needle was changed or the injection was administered through an intervening length of intravenous (IV) tubing(Drucker,2001).

Accessing a medication vial or bag with a syringe that has already been used to administer medication to a patient, then reusing contents from that vial or bag for another patient   Using medications packaged as single-dose or single-use for more than one patient  Failing to use aseptic technique when preparing and administering injections  For these reasons, CDC reminds healthcare personnel of thefollowing practices that are critical for patient safety(Reeler,1990):

Never administer medications from the same syringe to more than one patient, even if the needle is

  • changed or you are injecting through an intervening length of IV tubing.
  • Do not enter a medication vial, bag, or bottle with a used syringe or needle.
  • Never use medications packaged as single-dose or single-use for more than one patient. This includes ampoules, bags, and bottles of intravenous solutions.
  • Always use aseptic technique when preparing and administering injections.
THE ROLE OF COMMUNITY HEALTH PRACTITIONERS ON INJECTION SAFETY

DETERMINANTS OF ACUTE MALNUTRITION AMONG UNDER-FIVE YEARS CHILDREN IN ILLELA LOCAL GOVERNMENT SOKOTO STATE, NIGERIA

ABSTRACT

Malnutrition is one of the major causes of mortality and morbidity among under-five children in Sub Saharan Africa. To understand the determinants of malnutrition among under –five children, a study was conducted in Araba and  kalmalo  districts of Illela l/g  to Understand the determinants in these districts

The source of data was household demographic and socio-economic characteristics which included anthropometric data on under five children in Araba and Kalmalodistric.

It was found out that  Children aged 39-59 months were less likely to be underweight than those aged less than  twelve months. Findings also revealed that stunting was more prevalent among children of peasant farmers than the pastoralists. There was however no significant relationship between child wasting and selected child characteristics.

In conclusion, it is worthy to note that the study is essential in pointing out the particular age-groups among under five children as well as the occupations that contribute to malnutrition in  the districts of Araba and  kalmalo. Based on the findings, the study recommends exclusive breast feeding and proper complementary feeding especially among those aged less  than three years. Special arrangement could also be put in place to have children of mothers engaged in cultivation brought regularly for breastfeeding. 

TABLE OF CONTENTS

DECLARATION  …………………………………………………………………………………  i

APPROVAL BY SUPERVISORS  …………………………………………………………  ii

DEDICATION  …………………………………………………………………………………….iii

ACKNOWLEDGEMENTS  ………………………………………………………………….  iv

ABSTRACT  ……………………………………………………………………………………….  v

LIST OF ACRONYMS/ ABBREVIATIONS  …………………………………………  ix

CHAPTER ONE: INTRODUCTION  …………………………………………….  1

1.1 Background to the study  ………………………………………………………………….  1

1.2 Problem Statement  …………………………………………………………………………. 4

1.3 Main objective  ………………………………………………………………………………..6

1.4 Specific objectives  …………………………………………………………………………..6

1.5 Hypotheses  …………………………………………………………………………………….6

1.6 Scope of the study  …………………………………………………………………………….7

1.7 Conceptual frame work  ……………………………………………………………………..7

1.8 Significance of the study  …………………………………………………………………..9

1.9 Structure of the dissertation  ……………………………………………………………..10

CHAPTER TWO:LITERATURE REVIEW  ……………………………………..11

2.1 Introduction  …………………………………………………………………………………11

2.2 Malnutrition among under-five Children  ……………………………………………11

2.3 Child related factors of under five malnutrition …………………………13

2.4 Maternal factors of malnutrition among under-five children .19              

2.5 Summary of the literature review  ……………………………………………………  27

CHAPTER THREE:METHODOLOGY  ………………………………….   28

3.1 Introduction  ………………………………………………………………………………….28

3.2 Study Population  ………………………………………………………………………..  28

3.3 Data Source  ………………………………………………………………………………  28

3.4 Study Variable Specification  ………………………………………………………. 29

3.5 Anthropometric analysis  …………………………………………………………….. 31

3.6  Data analysis  …………………………………………………………………………..  32                                      

3.7 Limitations of the study  ……………………………………………………………..  33

CHAPTER FOUR:MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS …………… 34

4.1 Introduction  ……………………………………………………………………………..  34

4.2 Background characteristics of children and caretakers  …………….34

4.3 Levels of malnutrition among under five children  …………………………  41

4.4 Relationship between child and maternal factors with malnutrition among under-five children  ……………………………………………………… 44

4.5 Determinants of malnutrition among under-five children in Araba and Kalmalo districts.  ……………………………………………………………………………..  51

CHAPTER FIVE:SUMMARY, CONCLUSIONS  AND RECOMMENDATIONS  …………….  55

5.1 Introduction  ………………………………………………………………………………  55

5.2 Summary of findings …………………………………………………………………….63

5.3 Conclusion  ………………………………………………………………………………….63

5.4 Recommendations  ……………………………………………………………………….64

5.5 Areas for further studies ……………………………………………………………….65

REFERENCES  ………………………………………………………………………………  66

APPENDICES  ………………………………………………………………………………  72

APPENDIX I: RESEARCH INSTRUMENT  …………………………………….  76

APPENDIX II: A MAP SHOWING STUDY AREA   

LIST OF TABLES

Table 4.1: Under five Child factors …..34                                                                   

Table 4.2: Maternal factors  of malnutrition among under-five children  ……  38

Table 4.3: Immunization status of under-five children in Araba and kalmalo Districts……………………………………………………………………………….  40

Table 4.4: Levels of malnutrition among under five children in Araba and Kalmalo districts  …………43                                           

Table 4.5: Bivariate associations between child and maternal factors with malnutrition among under-five children  ………………………………………………..44

Table 4.6: Determinants of malnutrition among under five children in Araba andKalmalo   districts  ………………………………………………………  51

LIST OF ACRONYMS/ ABBREVIATIONS

AfrII:   Africa Innovations Institute

BCG:    BacilleCalmette-Guerin

BMI:   Body Mass Index

CDP:   Child Days Plus

DHS:   Demographic and Health Surveys

EPI:   Expanded Programme on Immunization

FAO:   Food and Agricultural Organization

MAAIF:   Ministry of Agriculture, Animal Industry and Fisheries

MoH:   Ministry of Health

NPA:   National Planning Authority

TASO:   The AIDS Support Organization

UNICEF:   United Nations Children’s Fund

WHO:   World Health Organization

CHAPTER ONE

INTRODUCTION                          

1.1 Background to the study

The World Health Organization (2013) estimates that thereare 178 million children that are malnourished across the globe, and at any given moment, 20 million are suffering from the most severe form of malnutrition. Malnutrition contributes to between 3.5 and 5 million annual deaths among under-five children. UNICEF estimates that there are nearly 195 million children suffering from malnutrition across the globe. In 1997, the World Health Organization had observed that 60% of the deaths occurring among all the underfive children in developing countries were attributed to malnutrition (Murray and Lopez., 1997). Most of the damage caused by malnutrition occurs in children before they reach their second birthday, in the time when the quality of a child’s diet has a profound impact on his or her physical and mental development.

It has been estimated by the global burden of disease study that under-five malnutrition alone has caused approximately half (15.9%) of the global loss of Disability Adjusted Life Years (DALYs) that is the sum of years of life lost from premature mortality years lived with disability  adjusted for severity (Faruqueet al., 2008). This consequently affects the intelligence level of children, their behavior and school performance. The impaired mental development is taken as the most serious long-term handicap associated with underfive malnutrition.

Malnutrition among under-five children is one of the most important public health problems in developing countries especially Sub-Saharan Africa (Gulati, 2010) and about 35% of under-five deaths in the world are associated with malnutrition.    An estimated 230 million under-five children are believed to be chronically malnourished in developing countries.

Similarly, about 54% of under-five deaths are believed to be associated with malnutrition in developing countries. In Sub-Saharan Africa, 41%  of under-five children are malnourished and deaths from malnutrition are increasing on daily basis in the region.  Malnutrition continues to be a significant public health problem throughout the low income countries, particularly in Sub-Saharan Africa and South Asia (Kimokoti and Hamer, 2008).

In Uganda, malnutrition remains a serious health and welfare problem affecting the under-five children to whom it contributes significantly to mortality and morbidity.  According to Uganda Demographic and Health Survey of 2006, nearly four in ten Ugandan children under-five years of age (38 percent) are stunted (short for their age), six percent are wasted (thin for their height), and sixteen percent are underweight  (UBOS &Macro International Inc, 2007).

The Nigerian Demographic Health Survey (NDHS).conducted in 2008 showed that the nutritional situation in Nigeria was 14% wasting, 23% underweight, and 41% stunting. Underweight levels increased when compared with the 2003 NDHS. Twenty four out thirt­­y-six state (67%) had more than 2% severe Acute Malnutrition(SAM) level and 19 out 36(53%) had level of Global Acute Malnutrition (GAM) above 10%. The state most affected are in the north-east and north west zone of Nigeria, particularly the Sahel Regionbordering Niger and Chad with stunting level above 50% and wasting levels above 20%.

The Uganda food and nutrition policy focuses on nutrition and childhood development as one of the goals with an aim of improving child health especially among those under-five years.

This policy is being formulated to address nutrition priority problems with assistance from international and local agencies like UNICEF, Save the Children, Plan International and TASO. The 2004/2005 Uganda food and nutrition policy reform focuses on policies and guidelines on anaemia, breastfeeding, HIV/AIDS and a number of other nutrition related disorders prevalent in the country (MoH and MAAIF, 2005).

The Ugandan government has put in place tremendous efforts in reducing the prevalence of malnutrition in the country through effective nutrition programs which act directly on feeding practices. However, the yield would be more significant if the government acted through factors that affect under-five child malnutrition. In addition, addressing the plight of women by strategically targeting their economic, education, and health status can improve nutrition at household level since women are the principle providers and care givers of children at this level.

DETERMINANTS OF ACUTE MALNUTRITION AMONG UNDER-FIVE YEARS CHILDREN IN ILLELA LOCAL GOVERNMENT SOKOTO STATE, NIGERIA

ASSESSMENT OF KNOWLEDGE AND STRATEGIES FOR PREVENTION AND MANAGEMENT OF DIARRHEA DISEASE AMONG UNDER FIVE CHILDREN IN: OKO-ERIN COMMUNITY

CHAPTER ONE

1.1       BACKGROUND OF THE STUDY

Diarrheal disease is highly preventable, yet accounts for nine percent of all deaths among children under age five worldwide [Liu, 2013]. In 2013, this translated into about 580,000 child deaths, or, on average, 1,600 children dying each day due to preventable diarrhea [WHO, 2014].

Diarrhoea is the disturbance of the gastrointestinal tract comprising of changes in intestinal motility and absorption, leading to increase in the volume of stools and in their consistency [Ballabriga, et al 2000]. In diarrhoea, stool contains more water than normal stool and is often called loose or watery stool. In certain cases, they may contain blood in which case the diarrhoea is called dysentery [Obionu, 2007]. Any passage of three or more watery stools within a day [24 hours] is referred to as diarrhoea [Cairncross et al, 2010].

Diarrhoea accounts for high levels of mortality in young children in developing countries like Nigeria, despite worldwide efforts to improve overall child health levels. Each year,third world countries of Asia, Africa and Latin America, record approximately five million deaths of children under five years of age from acute diarrhoea. About 80 per cent of these deaths are in the first two years of life [Lucas & Gilles, 2009]. In the developing world as a whole, about one-third of infant and child deaths are due to diarrhoea and approximately 70 per cent of diarrhoeal deaths are caused by dehydration – the loss of large quantity of water and salts from the body, which needs water to maintain blood volume and other fluids to function properly [Gupta & Mahajan, 2005]. UNICEF [2002] summated that in Nigeria, infant mortality rates are twice as high in rural settings as they are in urban ones due to poor hygiene and poor sanitation. About three million infant births in Nigeria, approximately 170,000 result in deaths that are mainly due to poor knowledge and management practices of childhood diarrhoea. Several factors are likely to contribute to the high rate of diarrhoea morbidity and mortality in children under-five years these include poverty, female illiteracy, poor water supply and sanitation, poor hygiene practices and inadequate health services [Park, 2009]. Malnutrition is another established risk factor for mortality among children with diarrhoea disease. This may be due to inadequate case management. In 2004, WHO and UNICEF issued a joint statement on clinical treatment of acute diarrhea, recommending the use of low-osmolarity oral rehydration salts [ORS], zinc supplementation, increased amounts of appropriate fluids, and continued feeding [WHO; 2014]. Treatment of diarrhea with ORS is a simple, proven, high-impact intervention that can be provided in home settings by caretakers or by health care providers at community and facility levels to prevent dehydration due to diarrhea and decrease related deaths. The first line of management of diarrhoea is therefore, the prevention of dehydration. This can also be achieved at home using Oral Rehydration Therapy [ORT].

The consistency and the volume of stool constitute how to classify diarrhoea. World Health Organization – WHO [2014] classified diarrhoea as acute or persistent based on its duration. An episode of diarrhoea that lasts less than two weeks is acute diarrhoea, while diarrhoea that lasts more than two weeks is persistent. Calogero et al[2000] further classified diarrhoea according to its typology: Secretary Diarrhoea, osmotic diarrhoea and exudative diarrhoea. Secretary diarrhoea results from active process in the intestinal epithelium stimulated by the presence of toxin, chemical or nutritional product in the intestinal linning. Osmotic diarrhoea is caused by the presence in the intestinal linning of osmotically active solutes that are poorly absorbed by the injection of laxatives such as magnesium sulphate or magnesium hydroxide. Exudative diarrhoea is associated with damage to the mucosa lining leading to outpouring of mucus, blood and plasma protein among other substances. However, it is important to note that the classification of diarrhoea does not influence the cause.

Diarrhoea is a symptom of infection caused by a host of bacterial, viral and parasitic organisms most of which can be spread by contaminated water. Diarrhoea in most cases is caused by three major groups of micro-organisms namely; Viruses, bacteria and protozoa or parasites [Lucas & Gilles, 2009]. The main agents of diarrhoea are enteroviruses [e.g. rotavirus, escherichia coli, campylobacter spp, shigella, vibrio cholera, salmonella [non typhoid], entamoeba histolytica, giardia lamblia, cryptosporidium]. These are further grouped in the following ways: Viruses

; Bacteria [e.g. shigella, escherichia coli, vibrio cholerae, salmonella non typhoid, campylobacter spp]. Parasites [e.g. entamoeba histolytica, crytosporidium and giardia lamblia]. All over the world, viruses especially rotavirus has been identified as the major cause of acute diarrhoea in children. Studies in Nigeria also found viruses as the major causes of diarrhoea in 60 per cent of cases with bacteria responsible for about only 3-20 per cent. Most of these pathogens are transmitted by faeco-oral route. Childhood diarrhoea within the context of this study refers to any type of loose, watery stool that occurs more frequently than usual in a child. The various causative agents vary according to the signs and symptoms manifesting from the disease.

The main consequence of diarrhoea are frequent loose or watery stools, the risk of dehydration, damage to intestine [especially when there is bloody diarrhoea] and loss of appetite with or without vomiting. However, Victoria, Bryce, Fountaine and Monasch [2000] asserted that signs of dehydration are not evident until there is acute fluid loss of approximately 4-5 per cent of body weight. The signs and symptoms of dehydration include sunken fontanels, dry mouth and throat, fast and weak pulse, loss of skin elasticity and reduced amount of urine. This loss leads to shock and untimely death of under-five. Werner [2001] noted that dehydration takes its heaviest toll on infants and children under-five. The signs and symptoms according to Longmach, Wilkinson and Rajagopalan [2004] are passage of frequent loose watery stools, abdominal cramps or pain, fever particularly if there is an infectious cause and bleeding. Bacteria and parasites often can produce bloody diarrhoea [dysentary]. In addition, inflammatory bowel disease, polyps and colorectal cancer can cause blood and mucus in the stools, nausea and vomiting may also be present in the case of infection.

1.2       Problem Statement

The diarrhea prevalence rate in Nigeria is 18.8% and is one of the worst in sub-sahara Africa and above the average of 16%. Diarrhoea accounts for over 16% of child death in Nigeria and estimated 150,000 deaths mainly amongst children under five year occur annually due to this disease mainly caused by poor sanitation and hygiene practice. Various literature suggest 2.7%  of prevalence rate in Jos representing north central which include Nasarawa, Benue, Kogi and  Kwara State. (WHO Global Report for research in infection diseases of poverty 2012 Geneva)

In Nigeria diarrhoea is responsible for almost all child’s death in every year, Nigeria was estimated to have a total number of annual child death due to diarrhoea to be 151,700 (WHO, 2009). Diarrhoea was the most commonly reported cause of water borne infection in the North West in Nigeria which include Kano, Jigawa, Katsina, Sokoto, Kebbi, Zamfara and Kaduna with prevalence rate of 10%. (Unicef State of World Children 2013)

According to the manufacture instruction using G zard generation Rida Screen Elisa kit (R Biopharm AG Germany) and demographic data were collected via questionnaire to administered to parent/guardians of the subject and analysis was done using online easy chi-square (P<0.05) statistical package, show the prevalence rate of diarrhoeal in north east state including Borno, Bauchi, Adamawa, Gombe, Taraba and Yobe State is between 6.7% (40/600) and 5.0% (30/600) respectively across the north east region (2013-2014). An hospital base study in Lagos reported a prevalence rate of diarrhoea in South-West region of Nigeria that include Lagos, Oyo, Ondo, Osun, Ogun and Ekiti State was found in 4/50 (8% 2010-2015). (Unicef at glance Nigeria http//www.unicef.org/inferby conty)

Through World Health Organisation (WHO) Research International (2015-2017) at University of Nsukka on prevalence rate of diarrhoea across southeast which include Abia, Anambra, Ebonyi, Imo and Enugu which present with prevalence rate of 57% and the prevalence rate for diarrhoea in South South region of the country which include Akwa Ibom, Cross river, Bayelsa, Rivers and Delta states has prevalent rate of 15.6%. (WHO Geneva report for research on infection of disease of poverty 2012 Geneva). Despite the several studies highlighted above cutting across most or all of the geopolitical zones, diarroeal disease seem yet to be effectively controlled within the Nigerian society.

1.3       Justification

Community-based strategy for prevention and management of diarrhea disease among under five children appeared not to have received adequate research attention. Finding out these, certainly, will represent a positive step forward in the effort to promote the childhood diarrhoea knowledge and management practices. Following from these therefore, one is then inclined to ask, what are the community-based strategy adopted for prevention and management of diarrhea diseases among under five children in Oko-Erin community of Ilorin West local government? How effective are these strategy adopted by the community? What are the factors influencing the strategy towards achieving the desire goal?

  1.       Research Objective

1.4.1    General Objective

To investigate strategies put in place by the community for prevention and management of diarrhoea among under five children.

1.4.2    Specific Objective

  1. To assess the level of knowledge of mothers on diarrhoeal; methods of prevention and treatment.
  2. To assess different indigenous methods or strategies adopted for the prevention and management of diarrhoea in the study area.
  3. To assess the effectiveness of the strategies put in place by the Oko-Erin community towards the management and prevention of diarrhoea among under five children.
  4. To investigate the ability of such strategies to reduce morbidity and mortality due to diarrhoea among under five children in the study area.

1.5       Research Questions

This research work aims at providing answer to the following questions;

  1. What is the level of knowledge of mothers on diarrhoeal; methods of prevention and treatment?
  2. What are different indigenous methods or strategies adopted for the prevention and management of diarrhoea in the study area?
  3. How effective are the strategies put in place by the Oko-Erin community towards the management and prevention of diarrhoea among under five children?
  4. What is the ability of such strategies to reduce morbidity and mortality due to diarrhoea among under five children in the study area?

1.6       Scope of the Study

This study covers the community-based strategies in the prevention and management of diarrhoea among under five in rural Nigeria using the study location as a case study. It therefore, examines various home remedies in the treatment and management of diarrhoea. This study gives attention to mothers and care givers who are directly involved in the subject matter, that is, those whose child or children are within the age bracket of this study and care givers including community health workers/practitioners. Little attention is given to hospital diagnosis and treatment of diarrhoea. The scope of this study is limited to children of under five years of age while the data collection is also limited to Oko-Erin community of Ilorin West local government of Kwara State.

ASSESSMENT OF KNOWLEDGE AND STRATEGIES FOR PREVENTION AND MANAGEMENT OF DIARRHEA DISEASE AMONG UNDER FIVE CHILDREN IN: OKO-ERIN COMMUNITY

THE EFFECT AND IMPACT OF NUTRITION EDUCATION ON THE DIETARY HABITS

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

        Nutrition education is any combination of educational strategies, accompanied by environmental supports, designed to facilitate voluntary adoption of food choices and other food- and nutrition- related behaviour conducive to health and well-being.

        Nutrition education is delivered through multiple venues and involves activities of the individual, community, and policy levels (Jones and Bartletti, 2007).

        This definition has been adopted by the society for nutrition education and behaviour and was authored by Dr. Isobel Contento, a leading authority in nutrition education. The work of nutrition educators takes place in colleges, universities and schools, government agencies, cooperative extension, communications and public relations firms, the food industry, voluntary and service organizations and with other reliable places of nutrition and health education information.

        The American Dietetic Association (ADA) published a position paper regarding the nutritional needs of teenagers. This paper stated that the health of adolescents is dependent on normal dietary intakes and that the provision of foods that contain adequate energy and nutrients was essential for physical, social and cognitive growth and development.

        Adequate nutrient intake during adolescence is very important for many reasons. Adolescence is a particularly unique period of life because it is a time of intense physical, psychological and cognitive development.

        Adolescence is a transition phase to adulthood. The age of adolescence encapsulates a window of time when bodies are metamorphosing and evolving into that of an adult. It is a time when the adolescent tries to establish his own identify yet desperately seeks to be socially accepted by his peers (Lulinski, 2001). During adolescence hormonal changes accelerate growth in height. Growth is faster than at any other time in the individual’s life except the first year (Brasel, 1982). Increased nutritional needs at this juncture relate to the fact that adolescents gain up to 50% of their adult weight, more than 20% of their adult height and 50% of their adult skeletal mass during this period (Brasel, 1982). The adolescent therefore face series of serious nutritional challenges which would impact on this rapid growth spurt as well as their health as adults. However, the adolescent remain a largely neglected, difficult to-measure, hard-to-reach population. Consequently, the needs, particularly those of adolescent girls are often ignored (Kurz and Johnson-Welch, 1994).

        At this developmental stages, protein requirements maximal. Increased physical activity, combined with poor eating habit and other considerations, for example, menstruation, oral contraceptive use and pregnancy contribute to accentuating the potential risk for adolescents of poor nutrition.

1.1 STATEMENT OF PROBLEM

        Poor nutritional choices and practices have been shown to increase during adolescence; the need for nutrition education becomes clear. It is important that health educators look into nutrition education and its impact on the dietary habits of adolescent females. Several studies have been conducted that show how nutrition education impacts the dietary habits of adolescents.

        These studies have reviewed the effect of nutrition education on adolescent athletes and have analyzed how nutrition education impacts snack patterns.

        The main nutritional problems affecting adolescent populations in particular include under-nutrition in terms of stunning and wasting. Others are deficiencies of micronutrients such as iron and vitamin a, obesity and other specific nutrient deficiencies (Kurz and Johnson-Welch, 1994).
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THE EFFECT AND IMPACT OF NUTRITION EDUCATION ON THE DIETARY HABITS

STRATEGY FOR GUARANTEE FOOD SECURITY

CHAPTER ONE

INTRODUTION

1.1    BACKGROUND TO THE STUDY

Since independence in 1960, the Nigerian economy had operated under two major economic philosophies with the turning point being 1986. Prior to 1986, the economy was highly regulated with government taking direct control of the “commanding heights” of the national economy. By the early 1980s, significant distortions were thought to exist in the economy with respect to pricing of tradeable items leading to sub-optimal allocation of resources in the economy. Hence, in 1986 an economic reform programme in the form of a Structural Adjustment Programme (SAP) was embarked upon anchored principally on the deregulation of the economy and liberalization of trade. The targets of these measures were principally the relaxation or abolition of import licensing, tariff structure, price control, foreign exchange control and interest rates control. Reform processes such as those embarked upon in Nigeria in 1986 usually leads to “a complete re-orientation of the economy” (Olashore, 1991) and this was indeed the case in Nigeria where the deregulatory and liberalization philosophy remains the critical basis of economic policy despite the official abandonment of Structural Adjustment Programme in the 1990s. Spurred by globalization, which itself is essentially deregulation on a global level, the Nigerian economy has since remained anchored on free-trade, market mechanism and private sector orientation, the key instruments of the SAP that channeled in the reform of the economic philosophy underlining the Nigerian economy in 1986. Although the shift to economic deregulation and trade liberalization affected many sectors of the economy, its impact on the agricultural economy was one of the most acute and remarkable (Adubi, 1996; Ojo, 1994). The key features of agricultural production and the long tradition of governmental regulation of the sector became radically affected by the deregulation and liberalization philosophy with vital consequences for food security. Following over two decades of deregulatory practices, this research work reviews the strategies for food security in Oredo Locl Government Area of Edo State, Nigeria and the effects of this shift in economic philosophy on one aspect of human well being, namely, food security using trend examination and descriptive methods. The paper compares the food security status of the country before and after the adoption of deregulation as the dominant economic philosophy. It considers the lessons derivable from Nigeria’s experience and proffer suggestions in this regard.

In the recent time, there have been a lot of concerns expressed over the looming danger of food crisis in many nations, including Nigeria. The Food and Agricultural Organization, among others have been persistent in expressing these concerns for the global food crisis over the years. According to Food and Agriculture Organization, food security obtains when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life (FAO, 1996).The main goal of food security therefore, is for individuals to be able to obtain adequate food needed at all times, and to be able to utilize the food to meet the body’s needs. Food security is multifaceted. The World Bank (2001) identified three pillars underpinning food security. These are food availability, food accessibility, and food utilization. This means that a nation whose food production level is unable to satisfy these three criteria is said to be food insecure. Supporting this assertion, Maxwell (in Nana- Sinkam 1995:111) stated that a country and its people are food secured when their food system operates in such a way as to remove the fear that there will not be enough to eat. He further stressed that food security requires that the poor and vulnerable have secure access to the food they want. The World Food Summit plan of Action (1996) states that food insecurity occurs when;

People experience a large reduction in their sources of food and are unable to make up the difference through new strategies.
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STRATEGY FOR GUARANTEE FOOD SECURITY

AWARENESS OF GOOD NUTRITION DURING PREGNANCY AMONG WOMEN OF CHILD BEARING AGE

CHAPTER ONE

INTRODUCTION

BACKGROUND TO THE STUDY 

All human beings need a balanced amount of nutrients for proper functioning of the body system. Nutrition is a fundamental pillar of human life, health and development throughout the entire life span (World Bank, 2006). Proper food and good nutrition are essential for survival, physical growth, mental development, performance and productivity, health and wellbeing. However, the nutrition requirement varies with respect to age, gender and during physiological changes such as pregnancy. Pregnancy is such a critical phase in a woman’s life, when the expecting mother needs optimal nutrients of superior qualities to support the developing fetus. Naturally, the urge to eat more is experienced by nearly all pregnant women.

Pregnancy is considered to be a delightful experience for the expectant mother. Evidences manifested that adequate intake of nutrition is a key component for individual’s health and well-being, particularly during pregnancy. It is well documented that inadequate maternal nutrition results in increased risks of short term consequences such as; Intra Uterine Growth Restriction(IUGR), low birth weight, preterm birth, prenatal and infant mortality and morbidity. Moreover, excessive intake of nutrients during pregnancy can lead to some pregnancy complications (such as, preeclampsia and gestational diabetes, macrosomia, distocia and higher prevalence of cesarean section). On the other hand, as the long run outcomes, inadequate intake of nutrients were found to have pathophysiologic or metabolic depict that will appear as disorders of child growth and development as well as adult chronic disease after a long period of quiescence. (Rocco PL, Orbitello B, Perini L, Pera V, Ciano RP,2005)

According to Nagiebs (2003) opined that eating well during pregnancy means do more than simply increase how much the mother eats. The mother must also consider what she eats. The ability of mother to provide nutrients and oxygen for her baby is a critical factor for fetal health and its survival. Failure in supplying the adequate amount of nutrients to meet fetal demand can lead to fetal malnutrition. The fetus responds and adapts to under nutrition but by doing so it permanently alters the structure and function of the body. Maternal over nutrition also has long-lasting and detrimental effects on the health of the offspring.

Naomi M (2010) Malnutrition is one of the most serious health problems affecting children and their mothers in Ethiopia. Undernourished mothers face greater risks during pregnancy and childbirth, and their children set off on a weaker developmental path, both physically and mentally. Undernourished children have lower resistance to infection and are more likely to die from common childhood ailments as diarrheal diseases and respiratory infections. Those who survive may be locked into a vicious cycle of recurring sickness and faltering growth, often with irreversible damage to their cognitive and social development. Malnutrition prevents individuals and even the whole country from achieving full potential, and is closely related with survival, poverty and development. The incidence of dietary inadequacies as a result of dietary habits and patterns in pregnancy is higher during pregnancy than at any other stage of the life cycle. It was shown that, nutrition knowledge was predictive of change in dietary habits and health advices encouraged expectant women to advance their food intake positively.  

Several studies including Villar has indicated that the correlation between poor maternal nutritional status and adverse birth outcomes is complex and are influenced by many biologic, socioeconomic, and demographic factors, which vary widely in different populations. It is therefore, the promotion of women’s health and other preventive health care practice should start before birth, during intrauterine life and extends throughout different phases of their lives in order to sustain their reproductive health in general. The importance of maternal nutrition during pregnancy has long been recognized. The National Academy of Science in America issued a report that reviewed studies of reproductive experience concluded that adequate prenatal nutrition was one of the most important environmental factors affecting the health of pregnant women and their babies. (Villar J, Merialdi M, Abalos E, Carroli G, et al., 2003)
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AWARENESS OF GOOD NUTRITION DURING PREGNANCY AMONG WOMEN OF CHILD BEARING AGE

THE PRODUCTION AND SENSORY EXAMINATION OF BISCUIT USING WHEAT FLOUR, CASSAVA FLOUR (ABACHA FLOOR) & AFRICAN YAM BEAN FLOUR

CHAPTER ONE

INTRODUCTION

Urbanization is charging the food habits and preferences of the populace towards convenient foods, which influence their nutritional intake. Most of the snacks consumed are high in carbohydrate. The use of composite flour has been encouraged since it reduces the importation of wheat.

          Biscuits, which are usually produced from cereal flours (mainly wheat) are consumed extensively all over the world, including the developing counties, where protein and caloric malnutrition is prevalent particularly among women and children. The increasing phenomenon of urbanization coupled with the growing number of working mothers, have contributed greatly to the popularity and increased consumption of snack foods (Singh et al; 1989). However, this increasing importance of snack foods such as biscuit in today’s eating habits has not been fully exploited in the developing countries. This is probably as a result of the prohibitive cost of baked products (Tsen et al; 1973). Since this crops is not currently cultivated in the tropics, there is need to look inwards for local raw materials with optimum nutritive value and good processing characteristics, to substitute wheat in baked products.

          Cassava (Manihot esculenta L) is the staple food of the poorer section of the population of many tropical counties rich in carbohydrate and has minute quantities of protein, vitamins and minerals (Ihekoronye and Ngoddy, 1985) which can result in malnutrition in some areas where it is the main item of diet (Kay, 1987). Although supplementation is necessary, it is not the solution of the elimination of micro nutrient deficiency disorder but rather the simple and most sustainable approach is fortification of staple food with limiting micronutrient (Ihekoronye and Ngoddy, 1985). Therefore the nutritional value of cassava root and its products such as cassava flour can be improved through food composites and fortification with other protein-rich crops with a reasonable amount of fats, vitamins and minerals (Enwere, 1998). One of such crops is the African yam bean.

          The African yam bean known as Odudu, Azama or Okpodudu by the Igbo’s belongs to the family Febaceae, which was formally classified under the sub-family Papillionoides (Anon, 1979). As a legume, it has an excellent supply of B-vitamins (Apata & Ologhobo, 1990). African yam beam will result in a more nutritious diet / snacks.

OBJECTIVES OF THE STUDY

The objective of this study is therefore, to produce biscuit from various blends of wheat flour, cassava flour and African yam bean flour and to determine the sensory properties of the biscuit. Meanwhile, the acceptability of biscuit baked from the flours with a view to increasing the level of the wheat flour, cassava flour and African yam bean composite flour for biscuit production as this will lead to higher utilization of cassava thereby reducing post harvest losses.

SCOPE / LIMITATIONS OF THE STUDY

It is anticipated that in carrying out a study of this nature, there are limitations involved in the study. The writer encouraged a lot of unforeseen problem due to limited time given, the writer was unable to gather enough and sufficient facts which are relevant to the study.

Secondly, there was financial problem. The writer was not able to buy some of the materials like Bakery pastry booklets, get in touch with Bakery industry managers, travel for some researches etc. the polytechnic library was not fully equipped of most relevant materials that would have assisted the writer.
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THE PRODUCTION AND SENSORY EXAMINATION OF BISCUIT USING WHEAT FLOUR, CASSAVA FLOUR (ABACHA FLOOR) & AFRICAN YAM BEAN FLOUR

THE PRODUCTION AND SENSORY EXAMINATION OF BISCUIT USING WHEAT FLOUR, CASSAVA FLOUR (ABACHA FLOOR) & AFRICAN YAM BEAN FLOUR

CHAPTER ONE

INTRODUCTION

Urbanization is charging the food habits and preferences of the populace towards convenient foods, which influence their nutritional intake. Most of the snacks consumed are high in carbohydrate. The use of composite flour has been encouraged since it reduces the importation of wheat.

          Biscuits, which are usually produced from cereal flours (mainly wheat) are consumed extensively all over the world, including the developing counties, where protein and caloric malnutrition is prevalent particularly among women and children. The increasing phenomenon of urbanization coupled with the growing number of working mothers, have contributed greatly to the popularity and increased consumption of snack foods (Singh et al; 1989). However, this increasing importance of snack foods such as biscuit in today’s eating habits has not been fully exploited in the developing countries. This is probably as a result of the prohibitive cost of baked products (Tsen et al; 1973). Since this crops is not currently cultivated in the tropics, there is need to look inwards for local raw materials with optimum nutritive value and good processing characteristics, to substitute wheat in baked products.

          Cassava (Manihot esculenta L) is the staple food of the poorer section of the population of many tropical counties rich in carbohydrate and has minute quantities of protein, vitamins and minerals (Ihekoronye and Ngoddy, 1985) which can result in malnutrition in some areas where it is the main item of diet (Kay, 1987). Although supplementation is necessary, it is not the solution of the elimination of micro nutrient deficiency disorder but rather the simple and most sustainable approach is fortification of staple food with limiting micronutrient (Ihekoronye and Ngoddy, 1985). Therefore the nutritional value of cassava root and its products such as cassava flour can be improved through food composites and fortification with other protein-rich crops with a reasonable amount of fats, vitamins and minerals (Enwere, 1998). One of such crops is the African yam bean.

          The African yam bean known as Odudu, Azama or Okpodudu by the Igbo’s belongs to the family Febaceae, which was formally classified under the sub-family Papillionoides (Anon, 1979). As a legume, it has an excellent supply of B-vitamins (Apata & Ologhobo, 1990). African yam beam will result in a more nutritious diet / snacks.

OBJECTIVES OF THE STUDY

The objective of this study is therefore, to produce biscuit from various blends of wheat flour, cassava flour and African yam bean flour and to determine the sensory properties of the biscuit. Meanwhile, the acceptability of biscuit baked from the flours with a view to increasing the level of the wheat flour, cassava flour and African yam bean composite flour for biscuit production as this will lead to higher utilization of cassava thereby reducing post harvest losses.

SCOPE / LIMITATIONS OF THE STUDY

It is anticipated that in carrying out a study of this nature, there are limitations involved in the study. The writer encouraged a lot of unforeseen problem due to limited time given, the writer was unable to gather enough and sufficient facts which are relevant to the study.

Secondly, there was financial problem. The writer was not able to buy some of the materials like Bakery pastry booklets, get in touch with Bakery industry managers, travel for some researches etc. the polytechnic library was not fully equipped of most relevant materials that would have assisted the writer.
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THE PRODUCTION AND SENSORY EXAMINATION OF BISCUIT USING WHEAT FLOUR, CASSAVA FLOUR (ABACHA FLOOR) & AFRICAN YAM BEAN FLOUR

THE EFFECT AND FUNCTIONAL PROPERTIES OF FLOUR PRODUCED FROM ABACHA (CASSAVA)

ABSTRACT

This study was carried out to determine the functional properties of cassava flour produced using different drying method namely sundried and oven dried. The flours were obtaining from cassava (Manihot Esculent Crantz) by peelings, washing, cooking, slicing or chopping, drying, milling  and sieving. The flours obtained were evaluated for functional properties. The flours samples have functional properties ranging from pH dilution 6.35% to 6.65%, bulk density 0.66g/m to 0.72g/ml, water absorption capacity 3.00 to 5.00ml, oil absorption capacity 1.76% to 0.88%, emulsification capacity 42.64% to 45.26%, gelation capacity point 10m to 15ml, gelation temperature 600 to 700c and 2.29 pas to 2.09pas viscosity measurement. The result of this study showed that the drying methods have effect on functional properties of the two different drying method of cassava flour. 
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THE EFFECT AND FUNCTIONAL PROPERTIES OF FLOUR PRODUCED FROM ABACHA (CASSAVA)

THE IDENTIFICATION AND EXAMINATION OF NEMATODE AFFECTING TOMATOES GROWN IN SOME SELECTED AREA OF RIVER KADUNA

CHAPTER ONE

1.0            INTRODUCTION:

Nematodes are tiny, thread-like worms measuring 0.0 15 inch to 0.187 inch in length. They are either free living parasitic or saprophytic, identified on the basis of shapes, size and special structures. The females become swollen and flask-shaped as a result of accumulation of eggs with the anus virtually terminal in position, while the males are vermiform (Sherf and Macnah, 1986; Chitwood, 1949; Taylor and Sasser, 1978; Idowu, 1979 and Idowu, 1983)

Nematodes are known for causing destructive diseases of crops as they have a wide range of feeding habit, constitute about 80% of all multicellular animals, attacking nearly every crop that is grown in the field and as a result crop yields is greatly affected reducing quantity and quality of crops on field, orchard, home garden and green houses (Mai, 1985; Symth, 1994; Sasser, 1952). Among the favoured host in Nigeria as a whole include tomato, yam, tobacco, papaw, citrus and sweet potato (Sasser, 1954).

1.1      Tomato:

Tomato (Lycopersicum esculentum) belongs to the family Solanaceae and subilass polypetalae of the dicotyledenous group of plants. Tomato is a slight modification of tomato the name used by the Indians of Mexico, who have grown the plant for food since prehistoric times. Other names reported by early European explorers were tomato, tumatle and tomatas, probably variants of Indian words (Wener, 2004).

1.2      Origin:

The precise origin of tomato remains a mystery but there is reason to believe that the original tomato came from Peru called tomato, it was taken to Mexico by migrating Peruvians. It found its way to Italy through the explorations of Christopher Columbus. Tomatoes were taken back to Europe along with silver and gold and they were grown on the continent as a pretty curiosity (Fallagatter, 1999). Though, tomato has become one of the most popular and widely grown vegetables in the world (Chung, 1998), until the 19th century, it was grown chiefly as an ornamental plant for its colourful fruit (Villareal, 1980). This is because it was regarded with suspicion due to the reputation of Solanum-like fruits being poisonous (Philips and Rix, 1993)

1.3      Study Area:

Kaduna is the State capital of Kaduna State in north central Nigeria. The city, located on the Kaduna River, is a trade center and a major transportation hub for the surrounding agricultural areas with its rail and road junction.

The Kaduna River is a tributary of the Niger River which flows for 550 kilometers through Nigeria. It got its name from the crocodiles that lived in the river and surrounding area. Kaduna in the native dialect, Hausa, was the word for “crocodile ’’(http:// maguzawa.dyndns.ws/ Retrieved on 2009-07-09). Activities going on there includes; fishing, packing of sand and farming such as maize, tomato, spinach, cocoa-yam, okro, pepper etc.

1.4      Purpose of the study:

The destruction of plants comes from organisms including nematode and insect pest. However, this study is restricted only to those plant nematodes that affect tomatoes grown in some selected area of River Kaduna. Many plants are damage by plant parasitic nematodes which feeds and multiply in or on root, stem spreading soil borne viruses or facilitate secondary infection by bacteria and algae.

All kind of living organisms are dependent on plants in one way or the other for their food supply. Therefore, controlling nematode that destroy our crops, it is almost important both agriculturally, economically and socially for well being of both living organism. Although important contributions in nematology are coming in from many countries. Like Nigeria, generally expanded it is in view of hope that it help in one way or the other in preventing or controlling plants nematodes, as the knowledge of the nematodes themselves is important toward successful nematode control.

1.5      Aims and objectives:

            –           To isolate and identify nematode

–           To determine the distribution or assessment of nematode populations

            –           Proper suggestion on minimizing infection.
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THE IDENTIFICATION AND EXAMINATION OF NEMATODE AFFECTING TOMATOES GROWN IN SOME SELECTED AREA OF RIVER KADUNATHE IDENTIFICATION AND EXAMINATION OF NEMATODE AFFECTING TOMATOES GROWN IN SOME SELECTED AREA OF RIVER KADUNA

STUDYING AND EXAMINING THE OCCURENCE OF HEAVY METALS IN GILLS,MUSCLES, AND LIVER OF CHRYSICHTHYS NIGRODIGITATUS

CHAPTER ONE

1.1  Introduction

Heavy metals are those metallic elements with high atomic or specific gravity that is at least five times greater than that of water. Several elements have been listed in this group. The presence of heavy metals in the aquatic environment in trace concentrations is important for normal development of the organism (Kori-Siakpere and Ubogu, 2008).

They could be detected in the aqueous medium and in the bottom; some however, are completely deleterious and need to be monitored continuously in the bodies of organisms as they are capable of bioaccumulation, resulting to morbidity and often mortality of organisms  (Ayotunde et. al, 2011, 2012., and Ada, et. al., 2012). Heavy metal human health concern has stimulated a lot of research in this area, some of which include the works of Muchuweti

et. al., (2006), Satarug et. al. (2000) and Adefemi et. al. (2012).

       When metals enter aquatic environment, a great portion settles and is absorbed by the bottom mud (Ayotunde, 2012). They could be recycled by chemical, physical and biological processes such that some quantity remains dissolved in the water column and some part is being absorbed by the inhabitants (Rayms- Keller et. al., 1998 and Kori- Siakpere and Ubogu, 2008). Fishes are at the apex of the food chain and can bio accumulate some of these substances into their tissues (Olaifa et. al., 2004).

       Kori- Siakpere and Ubogu, (2008) observed decreased haematological parameter values and heamodilution in fish exposed to sublethal concentrations of zinc for 15 days. They explained that zinc accumulates in gills of fish and it is an indication of depressive effect on respiration in tissues. It may lead to death due to hypoxia, reduced hatchability of eggs, changes in ventilator heart physiology and general change in fish behaviours such as lack of balance, agitated swimming, air gulping, and death.

       Some heavy metals are not biodegradable and can continue to be accumulated in the tissue of organisms until they reach intolerable levels resulting in morbidity or mortality (Offem and Ayotunde, 2008). Man being higher in the food chain stands the risk of higher bioaccumulation. The dangers of heavy metals have been long noted, but the symptoms are poorly diagnosed and patients could be treated for some other illness thereby aggravating heavy metal pollution problems of man (Kaye et. al., 2002 and Nolan, 2003).

       There is an increasing concern regarding the roles and fates of trace metals in Nigerian environment. Much of this concern arises from the low level of available information on the concentrations of these metals within the environment. The contamination of sea foods by trace metals is a potential problem to man. Aquatic organisms accumulate metals to concentrations many times higher than present in water.

       The potentially toxic are lead, zinc, nickel, chromium, arsenic, selenium, vanadium, beryllium and barium. Natural and anthropogenic activities result in gaseous emissions and waste water discharge into air, water and land. When  substances in the emissions and effluent discharges in the environment are in very minute amounts or in low  concentrations, are not toxic to plants and animals and have short residence time in the environment, they are described as contaminants’ (Odiete, 1999).

       Bioconcentration is the net accumulation of a substance from water into an aquatic organism resulting from the simultaneous uptake and elimination of the substance. Fish and bivalve molluscs are used in bioaccumulation tests because they are higher tropic level organisms and are usually eaten by man. Tissues such as liver, kidney, muscle, viscera and whole organisms are analyzed to determine the concentration of the metals (Dublin-Green, 1994).

       Heavy metals are commonly found in natural waters and some are essential to living organisms, yet they may become highly toxic when present in high concentrations. These metals also gain access into ecosystem through anthropogenic sources and yet distributed in water body, suspended solids and sediments during the course of their mobility. The rate of bioaccumulation of heavy metals in aquatic organisms depends on the ability of the organisms to digest the metals and the concentration of such metal in the river. (Kukusetging, Ochiai and Cornel 2006). Aquatic organisms (including fish) bioaccumulate trace metals in considerable amounts and stay over a long period. Fishes have been recognized as a good accumulator of organic and inorganic pollutions. Age of fish, liquid content in the tissue and mode of feeding are significant factors that affect the accumulation of heavy metals in fishes. They are finally transferred to other animals including humans through the food chain. Odoemelam et al., 1989, revealed high concentrations of heavy metals such as Cd, Pb, Cu, Ni, Zn, Mn, Mg, and Co in some rivers within proximity of some industrial cities in Nigeria. The discharge of industrial wastes containing toxic heavy metals into water bodies may have significant effects on fish and other aquatic organisms, which may endager public health through consumption of contaminated sea food and irrigated food crops, Nwaedozie 2000 reported that zinc contamination affects the hepatic distribution of other trace metals in fish.

       Environmental pollution is a worldwide problem, heavy metals belonging to the most important group of  pollutants. The growth of industries has led to increased emission of pollution into the ecosystem. Southern Caspian sea coast is one of the most important aqua system and the Eastern south of Caspian, which receive effluent discharge from heavily industrialized and highly populated settlement. Heavy metal can also occur naturally in the ecosystem with large variation in concentration (Phipps, 1991).
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STUDYING AND EXAMINING THE OCCURENCE OF HEAVY METALS IN GILLS,MUSCLES, AND LIVER OF CHRYSICHTHYS NIGRODIGITATUS

DIAGNOSIS AND TREATMENT OF SURGICAL WOUND INFECTIONS

Abstract

Surgical wound infections constitute a major fraction of nosocomial infections and occur within 30 days of procedure or within one year if implant is in place. Surgical wound infections have been classified based on wound location and degree of microbial contamination. Causative agents of surgical wound infections and the routes by which they access surgical incision sites have been recognized. The risk factors of surgical wound infections; patient characteristics and operative characteristics and management of these factors have been identified. Despite knowledge of the factors that influence surgical wound infections and means to prevent and/or control them, surgical patients still get infections. Diagnosis and treatment of surgical wound infections are appropriately undertaken to reduce economic costs and morbidity rate. Different surveillance methods have been adopted to reduce surgical wound infections rate.

CHAPTER ONE

INTRODUCTION

Before the mid-19th century, surgical patients commonly developed postoperative “irritative fever” followed by purulent discharge from their incision, overwhelming sepsis and often death. It was not until the late 1860s, after Joseph Lister introduced the principles of antisepsis that postoperative infection morbidity decreased substantially.

       Among surgical patients, surgical wound infections are the most common nosocomial infections. Surgical wound infections occur within 30 days of procedure or within one year if implant is in place and has been classified into three according to wound location and into four according to degree of microbial contamination. Risk factors and management techniques have been identified. The pathogens isolated from surgical wound infections differ depending on the underlying problem, location and type of surgical procedure.

       Surgical wound infections should be diagnosed and treated appropriately, to return patients home early and reduce morbidity. Surveillance of surgical wound infections with appropriate feedback would be desirable to reduce surgical wound infections rate.
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DIAGNOSIS AND TREATMENT OF SURGICAL WOUND INFECTIONS

EXAMINING THE TREATMENT OF DISEASES CAUSED BY MICRO-ORGANISMS BASED IN THE NATURAL PRODUCTS

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUNG OF STUDY

1.1.1 Phyllantus

This is a genus of the family Euphorbiaceae. It was first identified in Central and Southern India in 18th century. It is called carry me seed, stone-breaker, wind breaker, gulf leaf flower or gala of wind, (Bharatiya 1992).

There are over 300 genera with over 5,000 species in the Euphorbiaceae world wide. The Phyllantus is one of the genus that falls under this enormous family. Phyllantus has about 750-800 species, found in tropical and subtropical regions. Green medicine is safe and more dependable than the costly synthetic drugs, many of which have adverse side effects (Joseph and Raj, 2010). The use of medicinal plants by man for the treatment of diseases has been in practice for a very long time. Screening of compounds obtained from plants for their pharmacological activity has resulted in the isolation of innumerable therapeutic agents.

       Over 50% of all modern chemical drugs are of natural plant product origin and is essential in drug development programs of the pharmaceutical industry (Burton et. al 1983).

1.1.2      Phyllantus amarus (P. amarus)

       P. amarus is an erect annual herb of not more than one and half feet tall and has small leaves and yellow flowers. It is a broad medicinal plant that has received world-wide recognition (Srividiya and Perival, 1995).

       In herbal medicine,        P. amarus has reportedly been used to treat jaundice, diabetes, otitis, diarrhea, swelling, skin ulcer, gastrointestinal disturbances and blocks DNA polymerase in the case of hepatitis B virus during reproduction, (Oluwafemi, and Debiri, 2008).

       In Nigeria, it is called “Oyomokeisoamankedem” in Efik, “Iyin Olobe” in Yoruba and “Ebebenizo” in Bini (Etta, 2008). In traditional medicine, it is used for its hepatoprotective, anti-diabetic, antihypertensive, analgesic, anti-inflammatory and anti- microbial properties (Adeneye et al; 2006). The plant is also used in the treatment  of stomach disorders, skin diseases and cold (Kokwaro, 1976; Iwu, 1993). It has anti-diarrhoea effect (Odetola  and Akojenu, 2000). Its anti-viral activity against hepatitis B virus has been established (Thyagarajan et al; 1988, Wang et al; 1995), anti- carcinogenic (Joy and Kuttan, 1998), anti mutagenic activities (Joy and Kuttan, 1998), antiplasmodial (Soh et al. 2009).

       Plants contain numerous constituents, some tend to possess some level of toxicity. Cases of this toxicity in plants have been reported (Santox et al; 1995, Shaw et al; 1997, Kaplowitz, 1997).   P. amarus has been classified among plants with a low potential for toxicity, with an LD50 averaging 2000mg/kg 1day (Krithika and Verma, 2009).
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EXAMINING THE TREATMENT OF DISEASES CAUSED BY MICRO-ORGANISMS BASED IN THE NATURAL PRODUCTS

DETERMINANTS OF MATERNAL MORTALITY IN GENERAL HOSPITAL CALABAR, CROSS RIVER STATE

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.
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DETERMINANTS OF MATERNAL MORTALITY IN GENERAL HOSPITAL CALABAR, CROSS RIVER STATE

DETERMINANTS OF MATERNAL MORTALITY IN GENERAL HOSPITAL CALABAR, CROSS RIVER STATE

POOR SANITATION PRACTICE ON PUBLIC HEALTH

EFFECT OF POOR SANITATION PRACTICE ON PUBLIC HEALTH

CHAPTER ONE

INTRODUCTION AND BACKGROUND TO THE STUDY

1.1 Introduction

Efforts to assuage poverty cannot be complete if access to good water and sanitation systems are not part. In the 2000, 189 nations adopted the United Nations Millennium Declaration, and from that, the Millennium Development Goals were made. Goal 4, which aims at reducing child mortality by two thirds for children under five, is the focus of this study. Clean water and sanitation considerably lessen water-related diseases which kill thousands of children every day (UN, 2006). According to the World Health Organisation (WHO), 1.1 billion people lacked access to an enhanced water supply in 2002, and 2.3 billion people got ill from diseases caused by unhygienic water. Each year 1.8 million people die from diarrhoea diseases, and 90% of these deaths are of children under five years (WHO, 2004).

. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in the state. Data obtained from the Public and Environmental Health Department of the Ministry of Health (M.O.H., 2008) showed that the top ten most prevalent diseases in the state include malaria, acute respiratory infections, skin diseases and diarrhoea. The others are acute eye infection, rheumatism, dental carries, hypertension, pregnancy related complications and home/occupational accidents. A lot more illnesses occur but on a lower scale and these include intestinal worm attacks, coughs and typhoid fever. A complete data on the top ten diseases prevalent in the state is attached as Appendix E. Table 1.1 is a selection of the illnesses that directly result from poor quality water and sanitation practices in the Bayelsa.

Table 1.1: HIGHLY PREVALENT DISEASES THAT DIRECTLY RESULTS FROM

POOR WATER AND SANITATION PRACTICE

Diseases Prevalence rate per 1,000 population

 

2006 2007 2008
Malaria 350 320 300
Infant  Diarrhoea 30 30 30
Acute respiratory infection 60 60 60
Dental Carries 10 20 10

Source: Regional Directorate of the Ministry of Health, 2008

The number of malaria cases decreased from 350 in 2006 to 300 cases per 1000 population in 2008. Despite the decrease, the values involved are still quite high as compared to values available from neighbouring Bayelsa Amenfi East State for the same period (compare Appendix F and Appendix G). The incidence of diarrhoea among infants and acute respiratory infection remained 30 and 60 cases per 1,000 populations respectively. This can be attributed to several reasons, including population growth, lack of continuous services and inadequate functioning of facilities. In fact, according to the WHO(2004), an estimated 90% of all incidence of diarrhoea among infants can be blamed on inadequate sanitation and unclean water. For example, in a study of 11 countries in Sub-Saharan Africa, only between 35-80% of water systems were operational in the rural areas (Sutton, 2004). Another survey in South Africa recognised that over 70% of the boreholes in the Eastern Cape were not working (Mackintosh and Colvin, 2003). Further examples of sanitation systems in bad condition have also been acknowledged in rural Nigeria, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers , 2007). In the Bayelsa approximately there are 224 public toilets, 560 hand-dug wells, 1,255 public standpipes and 3 well-managed waste disposal sites. According to the 2006 projection, the population of the state was expected to reach 295,753 by the end of the year 2009 (WWDA, 2006).

Development partners in the past have concentrated their efforts on facilities provision only. These facilities are prerequisites for the attainment of good sanitation practice but they have not looked well at the possible causes of the persistence of disease transmission despite the effort they are making. Relationships between household’s sociocultural demographic factors and people’s behaviour with respect to the practice of hygiene could prove an essential lead to the solution of the problem. The fact is, merely providing a water closet does not guarantee that it could be adopted by the people and used well to reduce disease transmission. Epidemiological investigations have revealed that even in dearth supply of latrines, diarrhoeal morbidity can be reduced with the implementation of improved hygiene behaviours (IRC, 2001: Morgan, 1990). Access to waste disposal systems, their regular, consistent and hygienic use and adoption of other hygienic behavioural practices that block the transmission of diseases are the most important factors. In quite a lot of studies from different countries, the advancement of personal and domestic hygiene accounted for a decline in diarrhoeal morbidity (Henry and Rahim, 1990).For example, a literature meta-analysis by Curtis and Cairncross (2003) based on data from Burkina Faso found that the single hygiene practice of hand washing with soap is able to reduce diarrhoea incidence by over 40% and intestinal infections (cholera, dysentery, hospitalized diarrhoeas due to other causes) by over 50%. The World Bank (2003) identifies the demographic characteristics of the household including education of members, occupation, size and composition as factors influencing the willingness of the household to use an improved water supply and sanitation system. Education, especially for females results in well spaced child birth and greater ability of parents to give better health care. This in turn contributes to reduced mortality rates among children under 5years (Grant, 1995).

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EFFECT OF POOR SANITATION PRACTICE ON PUBLIC HEALTH

EFFECT OF POOR SANITATION PRACTICE ON PUBLIC HEALTH

EFFECT OF POOR SANITATION PRACTICE ON PUBLIC HEALTH

INTRODUCTION AND BACKGROUND TO THE STUDY

1.1 Introduction

POOR SANITATION PRACTICE

Efforts to assuage poverty cannot be complete if access to good water and sanitation systems are not part. In the 2000, 189 nations adopted the United Nations Millennium Declaration, and from that, the Millennium Development Goals were made. Goal 4, which aims at reducing child mortality by  two thirds for children under five, is the focus of this study. Clean water and sanitation considerably lessen water-related diseases which kill thousands of children every day (UN, 2006). According to the World Health Organization (WHO), 1.1 billion people lacked access to an enhanced water supply in 2002, and 2.3 billion people got ill from diseases caused by unhygienic water. Each year 1.8 million people die from diarrhoea diseases, and 90% of these deaths are of children under five years (WHO, 2004).

. Despite efforts by the development partners, water supply and sanitation related diseases are highly prevalent in the state. Data obtained from the Public and Environmental Health Department of the Ministry of Health (M.O.H., 2008) showed that the top ten most prevalent diseases in the state include malaria, acute respiratory infections, skin diseases and diarrhoea. The others are acute eye infection, rheumatism, dental carries, hypertension, pregnancy related complications and home/occupational accidents. A lot more illnesses occur but on a lower scale and these include intestinal worm attacks, coughs and typhoid fever. A complete data on the top ten diseases prevalent in the state is attached as Appendix E. Table 1.1 is a selection of the illnesses that directly result from poor quality water and sanitation practices in the Bayelsa. POOR SANITATION PRACTICE

Table 1.1: HIGHLY PREVALENT DISEASES THAT DIRECTLY RESULTS FROM

POOR WATER AND SANITATION PRACTICE

Diseases Prevalence rate per 1,000 population

 

2006 2007 2008
Malaria 350 320 300
Infant  Diarrhoea 30 30 30
Acute respiratory infection 60 60 60
Dental Carries 10 20 10

Source: Regional Directorate of the Ministry of Health, 2008

The number of malaria cases decreased from 350 in 2006 to 300 cases per 1000 population in 2008. Despite the decrease, the values involved are still quite high as compared to values available from neighbouring Bayelsa Amenfi East State for the same period (compare Appendix F and Appendix G). The incidence of diarrhoea among infants and acute respiratory infection remained 30 and 60 cases per 1,000 populations respectively. This can be attributed to several reasons, including population growth, lack of continuous services and inadequate functioning of facilities. In fact, according to the WHO(2004), an estimated 90% of all incidence of diarrhoea among infants can be blamed on inadequate sanitation and unclean water. For example, in a study of 11 countries in Sub-Saharan Africa, only between 35-80% of water systems were operational in the rural areas (Sutton, 2004). Another survey in South Africa recognised that over 70% of the boreholes in the Eastern Cape were not working (Mackintosh and Colvin, 2003). Further examples of sanitation systems in bad condition have also been acknowledged in rural Nigeria, where nearly 40% of latrines put up due to the support of a sanitation program were uncompleted or not used (Rodgers , 2007). In the Bayelsa approximately there are 224 public toilets, 560 hand-dug wells, 1,255 public standpipes and 3 well-managed waste disposal sites. According to the 2006 projection, the population of the state was expected to reach 295,753 by the end of the year 2009 (WWDA, 2006). POOR SANITATION PRACTICE

Development partners in the past have concentrated their efforts on facilities provision only. These facilities are prerequisites for the attainment of good sanitation practice but they have not looked well at the possible causes of the persistence of disease transmission despite the effort they are making. Relationships between household’s sociocultural demographic factors and people’s behaviour with respect to the practice of hygiene could prove an essential lead to the solution of the problem. The fact is, merely providing a water closet does not guarantee that it could be adopted by the people and used well to reduce disease transmission. Epidemiological investigations have revealed that even in dearth supply of latrines, diarrhoeal morbidity can be reduced with the implementation of improved hygiene behaviours (IRC, 2001: Morgan, 1990).

Access to waste disposal systems, their regular, consistent and hygienic use and adoption of other hygienic behavioural practices that block the transmission of diseases are the most important factors. In quite a lot of studies from different countries, the advancement of personal and domestic hygiene accounted for a decline in diarrhoeal morbidity (Henry and Rahim, 1990).For example, a literature meta-analysis by Curtis and Cairncross (2003) based on data from Burkina Faso found that the single hygiene practice of hand washing with soap is able to reduce diarrhoea incidence by over 40% and intestinal infections (cholera, dysentery, hospitalized diarrhoeas due to other causes) by over 50%. The World Bank (2003) identifies the demographic characteristics of the household including education of members, occupation, size and composition as factors influencing the willingness of the household to use an improved water supply and sanitation system. Education, especially for females results in well spaced child birth and greater ability of parents to give better health care. This in turn contributes to reduced mortality rates among children under 5years (Grant, 1995).  POOR SANITATION PRACTICE

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EFFECT OF POOR SANITATION PRACTICE ON PUBLIC HEALTH