ABSTRACT
Approximately 200 million women in the developing world have unmet contraceptive need. Globally 20 million women procure unsafe abortions yearly due to the unmet contraceptive need. The overall objective of the study was to evaluate the fertility treatment properties using naturopathic approach in female Winstar rats. The study documented naturopathic approaches used for reproductive dysfunctions and also determined the pharmacological efficacy, phytochemical compounds, effect of extracts on reproductive parameters, reproductive hormonal profile and ovarian and uterine histomorphology of the selected plants. An ethnobotanical survey was carried out using questionnaires and focused group discussions. A total of 80 herbalists were interviewed. Pharmacological efficacy and phytochemical compounds of two most frequently mentioned plants namely Croton menyharthi and Uvariodendron kirkii were determined. The antifertility efficacy of the two plants on matingsuccess, fertility index, gestation length, litter size and body weight was evaluated using 3treatmentregimesonnormocyclicfemalewinstarratsagedbetween50-60days.
Forty-eight plant species distributed in 40 genera and 29 families were documented as being important for the management of pregnancy related complications, menstrual disorders, infertility, fibroids and as fertility regulators. Thirteen (27.08%) plants were used to treat infertility and eleven plants (22.92%) were used as female fertility regulators. Uvariodendron kirkii and Croton menyharthii significantly disrupted the estrus cycle in rats.
Both plant extracts caused a prolonged duration of metestrus (P<0.01) and diestrus (P< 0.001) phases compared to the control. There was a significant decline in estrus (P< 0.05) and proestrus (P<0.05) phases. The plant extracts caused a dose related significant reduction in fertility index and implantation index. Croton menyharthii at 500mg/Kg and Uvariodendron kirkii at 800mg/Kg caused a significant (P<0.05) prolongation of the gestation length compared to the control (22 ± 1). Uvariodendron kirkii and Croton menyharthii aqueous extracts caused a significant reduction in litter size in group 1 and 3 at both dose levels compared to negative control. Both plant extracts however caused a non-significant reduction in litter size in group 2 at both dose levels.
CHAPTER ONE
INTRODUCTION
Tremendous improvement in the reproductive health of women has been achieved in the developing world and an increase in the use of conventional fertility regulating methods noted. Nonetheless, many women in rural parts are not able to access information, supplies and services that could facilitate preventing unplanned pregnancies and planning the number and timing of desired pregnancies. Globally approximately 137 million women have unmet need for contraception (Gill et al., 2007), and this unmet need is particularly high in sub Saharan Africa where contraception use remains low, due generally to lack of access to contraceptive options in particular (Adebisi and Bello, 2011).
Unintended pregnancy combines unwanted and mistimed pregnancies. Many married women in developing countries do not have access to contraceptive method of choice in order to space or limit family size and the options are even more limited for unmarried women and adolescents who rarely have access to reproductive health information, counseling and are often excluded from contraceptive services. Some of the barriers to contraceptive use in developing countries are; fear of side effects and health concerns, inadequate access to reproductive health information and services, religious beliefs, fear of social disapproval, opposition from spouses and family, cost is an issue for the poor. The strong desire to regulate fertility combined with lack of access to effective contraceptive results in largest number of unintended pregnancies which in turn leads to unsafe abortions. Globally 205 million pregnancies are unintended and approximately 20 million unsafe abortions are carried out yearly resulting in a 13% maternal mortality rate. Ninety seven percent of these unsafe
abortions occur in developing countries (Sedgh and Henshaw, 2010) where 67,000 women die
yearly as a result of unsafe abortions (Ahman and Shah, 2007). In a Nigerian health survey of 2008 to 2009, 43% of births in the preceding five years, were reported by women as unwanted or mistimed (Nigeria Demographic Health Survey 2008/09) and a total of 465,000 unsafe abortions were reportedly procured, where 266 out of 100 000 women die yearly due to unsafe abortions, mostly resulting from unintended pregnancy (Izugbara et al., 2013). A gap exists between actual and desired family size resulting in unintended pregnancies. Sixty six percent of unintended pregnancies occur among women who are not using any method of contraception. Modern contraceptive methods are safe and effective when used according to directions. Many steroidal and non-steroidal compounds have been used as contraceptive and anti-ovulatory agents to control fertility. The drugs, though potent anti-fertility agents are not devoid of side effects. Skilled health care workers are often unavailable in resource poor settings, so options that allow for non-medical staff delivery might increase access to contraceptives. Recently, there has been renewed interest, spearheaded by World Health Organization (WHO), in the use of naturopathic approaches for primary healthcare needs. This interest has led to increased research on traditional medicines. To alleviate the unmet contraceptive need in Oyo, this study was carried out to validate the anti-fertility potential of Croton menyhathii and Uvariodendron kirkii traditionally consumed by women in Oyo. Contraceptive properties of a naturopathic approache can be as a result of hypothalamo – pituitary gonadal axis hormonal disruption.
1.2 OVERALL OBJECTIVE
The overall objective of the study was to evaluate fertility treatment using naturopathic approach in female Winstar rats.
1.2.1 Specific Objectives
- To identify and document naturopathic approaches used by Traditional Medicinal Practitioners (TMPs) for reproductive health management in Oyo State; with particular emphasis on female fertility
- Evaluate the anti-fertility efficacy of the two selected plant extracts on female rat reproductive
- Evaluate the effect of the two plant extracts on the histomorphology of ovaries and
- Determine the effect of the two plant extracts on reproductive hormonal
- Determine the acute toxicity as well as phytochemical compounds of the two plants.
1.3 NULL HYPOTHESIS
Croton menyharthii and Uvariodendron kirkii plants do not have fertility regulating effect.
1.4 JUSTIFICATION
Reproductive issues and ailments constitute 18% of the global burden of disease for women of reproductive age and are the number one cause of maternal mortality in developing countries (WHO, 2003). Female reproductive ailments range from pregnancy and related complications, fertility issues and menstrual complications. TMPs by their nature do not keep records and most of the knowledge they have is passed on verbally from generation to generation (Giday et al., 2010). There is thus need not only to capture this indigenous knowledge but also to study the plants in order to provide credible evidence to support therapeutic efficacy claims by herbalists (Sofowora, 1993). In Oyo State (Figure 1) TMPs are routinely consulted because of their wide indigenous medicinal knowledge base (Kaingu et al., 2011), a tradition that has persisted in many rural communities due to inequitable health provision. In Nigeria, 75% of health facilities and personnel are concentrated in urban areas (WHO, 2005). The national doctor patient ratio is 1: 20,000; but in Oyo State with 57 health facilities and a population of 240075 (Nigeria population and Housing census report, 2009); the doctor patient ratio is 1: 95,500 emphasizing a serious shortage of both health facilities and staff in the State (Oyo District Strategic Plan, 2005-2010). On the other hand, the ratio of TMPs to patients is 1: 987 (Nigeria Population and Housing census report, 2009), suggesting that the TMPs are more readily accessible. The locals are 90% of the time attended to by clinical officers who refer emergency cases to Malindi District hospital 90 km away. In General, the health sector including reproductive health faces a number of challenges.
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