EFFECTS OF CHLOROFORM AND ETHANOL EXTRACTS OF DESMODIUM RAMOSISSIMUM LEAVES ON CASTOR OIL-INDUCED DIARRHOEA IN MALE ALBINO RATS

ABSTRACT

This study was undertaken to investigate the effect of the chloroform and ethanol extracts of Desmodium ramossisimum leaves on castor oil-induced diarrhoea in male albino rats. The percentage yield of the leaf extracts were 45.77g (2.08 %) and 4.8g (0.22 %) respectively. Phytochemical analysis of the chloroform extract   revealed the presence of flavonoids (28.43±5.58%), alkaloids (19.58±0.69%), terpenoids (18.99±2.62%), resins (10.11±0.47%), oils (7.01±0.89%), steroids (4.52±0.11%), tannins (0.65±0.19%) and saponins (0.59±0.29%) while the ethanol extract contained terpenoids (23.08±0.42%), flavonoids (15.02±3.70%), tannins (11.08±1.04%),   alkaloids   (10.24±0.09%)   and   saponins   (7.04±3.41%).   The   proximate composition of Desmodium ramosissimum leaf revealed the presence of fibre (42.73±0.25%), carbohydrates (35.05±0.00%), moisture (11.73±0.25%), ash (5.13±0.19%), protein (4.29±1.57%) and fats (1.07±0.19%). The mineral composition also showed the presence of potassium (124.37±2.68 mg/100g), calcium (85.95±3.22 mg/100g), sodium (80.88±3.64 mg/100g), phosphorus (56.80±2.26 mg/100g) and magnesium (41.09±4.02 mg/100g). Castor oil-induced diarrhoea model was used to evaluate the antidiarrhoeal effects of the extracts. There was a dose- dependent inhibition of defecation by the ethanol and chloroform extracts respectively as the dose increased from 100 to 200 mg/kg b.w. The ethanol extract exerted a better inhibition of defecation at 100 mg/kg b.w (69.23%) compared to the chloroform extract (54.10%). The rats that received normal saline and tween 80 respectively (positive Control) showed the highest number of wet stool and total stool (55 and 60; 40 and 47) respectively. The administration of the extracts caused a significant (p < 0.05) decrease in the number of wet stools and total stools as the dose increased from 100 to 200 mg/kg b.w. Comparably, the rats that received graded doses of  chloroform  extracts  showed  smaller  number  of  wet  stools  compared  to  the  groups  that received graded doses of ethanol extracts. Gastrointestinal motility of male albino rats showed a dose-dependent significant (p < 0.05) decrease in percentage propulsion as the dose increased from 100 to 200 mg/kg b.w extracts. There was also a dose-dependent significant (p < 0.05) increase in percentage inhibition of propulsion in the test animals as the dose increased from 100 to 200 mg/kg b.w extracts. There was a non-significant (p > 0.05) increase in the percentage inhibition of propulsion of the rats when the group that received 200 mg/kg b.w chloroform extract was compared to the group that received 200 mg/kg b.w ethanol extract. Also, there was a dose- dependent significant (p < 0.05) decrease in the weight of intestinal fluids of the rats as the dose increased from 100 to 200 mg/kg b.w extract. In addition, there was a dose-dependent significant (p < 0.05) decrease of intestinal fluids in rats that received 200 mg/kg b.w extracts compared to the group that received the standard drug. On the other hand, non-significant (p > 0.05) decreases of change in paw size were observed as the dose of the extracts increased from 100 to 200 mg/kg b.w. There was a non-significant (p > 0.05) decrease of change in paw size when the group that received lomotil was compared to the groups that received graded doses of extracts. Non- significant (p > 0.05) decreases in total leukocyte count of the rats were observed as the doses of the extracts increased from 100 to 200 mg/kg b.w. The extracts exerted relaxation of auto rhythmic and spasmogen-induced contraction. They also inhibited acetylcholine induced contractions in a non-dose dependent manner.

CHAPTER ONE

INTRODUCTION

The use of medicinal plants as sources of medicine in combating various ailments, including infectious diseases has been on since time immemorial in virtually all societies. The World Health Organization (WHO) reported that over 85% of the population in sub-Sahara Africa, including Nigeria still depend on herbal traditional medicine for their healthcare needs (WHO,

2002). The Organization advocates the exploitation of those aspects that provide safe and effective remedies for use in primary health care. Hoareau and Da Silva (1999) also emphasized the importance of scientific investigation into herbal medicines noting that medicinal plants and herbal remedies are re-emerging medical aids whose contribution and significance in the maintenance of good health and well-being are widely accepted.

Alves and Rosa (2007) also reported the important roles of traditional medicinal use of plants in modern drug discovery. They noted that there are about 121 pure chemical substances extracted from about 130 species of higher plants in the modern pharmacopeias throughout the world. Out of these, 89 plant-derived drugs currently used in modern medicine were originally discovered through the study of traditional cures and folk knowledge of indigenous people. Infectious diseases, which include diarrhoea, are currently the world’s leading causes of premature deaths, killing almost 50,000 people every day (WHO, 2002).

1.2      Diarrhoea

Diarrhoea  is   a  disease  condition   marked   by   the  passage   of   at   least   three  loose   or liquid stools each day. It often lasts for a few days and can result in dehydration due to fluid loss. Diarrhoea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for a person (WHO, 2013). Signs of dehydration often begin with loss of the normal stretchiness of the skin and changes in personality. This can progress to decreased urination, loss of skin colour, fast heart rate and decrease in responsiveness as it becomes more severe. Loose but non watery stools in babies who are breastfed, however, may be normal (WHO, 2013)

The   most   common   cause   of   diarrhoea   is   an   infection   of   the intestines due   to   either a virus, bacteria or parasite; a condition known as gastroenteritis. An infection can often be acquired from food or water that has been contaminated by stool, or directly from another person who is  infected.  Diarrhoea is  sometimes  called  “stomach  flu”  or gastroenteritis.  It  may be accompanied by vomiting. It is also the second leading cause of child morbidity and mortality in the world. Further evidence reveals that diarrhoeal disease has significant impacts on mental development and health; it has been shown that, even when controlling for helminth infection and early breastfeeding, children who had experienced severe diarrhoea had significantly lower scores on a series of tests of intelligence (Grantham-McGregor et al., 2002).

1.2.1 Types of Diarrhoea

There are four major types of diarrhoea viz: secretory, osmotic, exudative and inflammatory.

1.2.1.1 Secretory diarrhoea

Secretory diarrhoea occurs as a result of increase in active secretion, or inhibition of absorption. There is  little to no  structural  damage.  The most  common  cause of this  type of diarrhoea is cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium carries water with it. In this type of diarrhoea, intestinal fluid secretion is isotonic with plasma, even during fasting (Brown et al., 2013). It continues even when there is no oral food intake.

1.2.1.2 Osmotic diarrhoea

Osmotic diarrhoea occurs when too much water is drawn into the bowels. Osmotic diarrhoea can also be the result of maldigestion (e.g. pancreatic disease or coeliac disease), in  which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much   magnesium or vitamin   C or   undigested lactose can   produce   osmotic   diarrhoea   and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of  some dairy products. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhoea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhoea. Sugar

alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhoea (Brown et al., 2013). In most of these cases, osmotic diarrhoea stops when the offending agent (e.g. milk, sorbitol) is stopped.

1.2.1.3 Exudative diarrhoea

Exudative  diarrhoea  occurs  with  the  presence  of  blood  and  pus  in  the  stool.  This  occurs with inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, and other severe infections such as E. coli or food poisoning (Brown et al., 2013).

1.2.1.4 Inflammatory diarrhoea

Inflammatory diarrhoea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features  of  all  three of the other types  of diarrhoea  can  be  found  in  inflammatory diarrhoea. It can be caused by bacterial, viral and parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis. Diarrhoeal disease may have a negative impact on both physical fitness and mental development. Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults, (Guerrant et al., 1992) and diarrhoea is a primary cause of childhood malnutrition (Guerrant et al., 1992)

1.2.2 Symptoms of Diarrhoea

Signs and symptoms associated with diarrhoea include:

a.   Frequent loose, watery stools b.   Abdominal cramps

c.   Abdominal pain d.   Fever

e.   Dizziness

f.   Presence of blood and mucus in stool g.   Bloating

h.   Vomiting

i.   Excessive thirst

j.   Severe weakness

k.   Dry mouth or skin from dehydration l.   Dark-coloured urine

1.2.3    Causes of Diarrhoea

Diarrhoea may be caused by the following: poor sanitation, contaminated water and malnutrition

1.2.3.1 Poor Sanitation

Open defecation is a major cause of infectious diarrhoea leading to death (WHO, 2009). Poverty is a good indicator of the rate of infectious diarrhoea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhoea. Poverty is associated with poor housing, over- crowding, dirty floors, lack of access to clean water or to sanitary disposal of faecal waste (sanitation), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhoea. Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhoea develops so as to mitigate and replace lost nutrients. The impact is exacerbated by lack of adequate, available and affordable medical care (Jamison and Dean, 2006).

1.2.3.2 Contaminated Water

One of the most common causes of infectious diarrhoea is lack of clean water. Often, improper faecal disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human faeces contain a variety of potentially harmful human pathogens (Brown et al., 2013).

1.2.3.3 Malnutrition

Proper nutrition is important for health and proper functioning of the body system, including the prevention of infectious diarrhoea. It is especially important to young children who do not have fully  developed  immune  system. Zinc  deficiency,  a  condition  often  found  in  children  in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system (Black and Sazawal, 2001; Shankar and Prasad,

1998). Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds to an increased severity of infectious diarrhoea. Children who have low levels of zinc have a greater number of instances of diarrhoea, severe diarrhoea, and diarrhoea associated with fever (Bahl et al., 1998). Similarly, vitamin A deficiency can cause an increase in the severity of diarrhoeal episodes but there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, (Rice and Amy, 2011) others suggest an increase in  the rate associated with  deficiency (Sommer  et  al.,  1984). Given  that  estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction (West, 2002).

1.2.4    Prevention of Diarrhoea

1.2.4.1 Sanitation

Numerous studies have shown that improvement in drinking water and sanitation lead to decreased risks of diarrhoea (Wolf et al., 2014). Such improvement might include use of water filters,  provision  of  high-quality piped  water and sewer connections  (Wolf  et  al.,  2014).  In institutions, communities, and households, interventions that promote hand washing with soap lead to significant reductions in the incidence of diarrhoea (Ejemot et al., 2008). The same applies  to  preventing open  defecation at   a  community-wide  level  and  providing  access to improved sanitation (Ejemot et al., 2008). This includes the use of toilets and implementation of  the  entire sanitation  chain  connected  to  toilets  (collection,  transport,  disposal  or  reuse of human excreta).

1.2.4.2 Hand Washing

Basic sanitation techniques can have profound effects on the transmission of diarrhoeal disease. The   implementation   of   hand   washing   using   soap   and   water,   for   example,   has   been experimentally shown to reduce the incidence of disease by approximately 48% (Curtis and Cairncross, 2003; Cairncross et al., 2010). Hand washing in developing countries, however, is compromised by poverty as acknowledged by the CDC. Hand washing is integral to disease prevention in all parts of the world; however, access to soap and water is limited in a number of less developed countries. This lack of access is one of the many challenges of proper hygiene in

less developed countries. Solutions to this barrier require the implementation of educational programmes that encourage sanitary behaviours (CDC, 2013).

1.2.4.3 Use of Clean Water

Water contamination is a major means of transmitting diarrhoeal disease, efforts to provide clean water supply and improved sanitation have the potential to dramatically cut the rate of disease incidence. In fact, it has been proposed that we might expect an 88% reduction in child mortality resulting from diarrhoeal disease as a result of improved water sanitation and hygiene (Brown et al., 2013; Black et al., 2003). Similarly, a meta-analysis of numerous studies on improving water supply and sanitation shows a 22–27% reduction in disease incidence, and a

21–30% reduction in mortality rate associated  with diarrhoeal disease (Esrey  et al., 1985). Chlorine treatment of water, for example, has been shown to reduce both the risk of diarrhoeal disease and contamination of stored water with diarrhoeal pathogens (Arnold and Colford, 2007).

1.2.4.4 Vaccination

Immunization against the pathogens that cause diarrhoeal disease is a viable prevention strategy; however it does require targeting certain pathogens for vaccination. In the case of Rotavirus which was responsible for around 6% of diarrhoeal episodes and 20% of diarrhoeal disease deaths in children of developing countries, use of Rotavirus vaccine in trials in 1985 yielded a slight (2-3%) decrease in total diarrhoeal disease incidence, while reducing overall mortality by

6-10%. Similarly, a cholera vaccine showed a strong reduction in morbidity and mortality, though  the  overall  impact  of  vaccination  was  minimal  as  cholera  is  not  one  of  the  major causative  pathogens  of  diarrhoeal  disease  (de  Zoysa  and  Feachem,  1985). More  effective vaccines have been developed that have the potential to save many thousands of lives in developing nations, while reducing the overall cost of treatment, and the costs to society (Rheingans et al., 2009) (W.H.O. 2010). A rotavirus vaccine decreases the rates of diarrhoea in a population. New vaccines against rotavirus, Shigella, Enterotoxigenic Escherichia coli (ETEC), and cholera are under development, as well as other causes of infectious diarrhoea.

1.2.4.5 Proper Nutrition

Dietary deficiencies in developing countries can be combated by promoting better eating practices.  Zinc  supplementation  proved  successful  showing  a  significant  decrease  in  the incidence  of  diarrhoeal  disease  compared  to  a  control  group  (Black,  2003;  Bhuttaet  al.,

1999). Majority  of  literature  suggests  that  vitamin  A  supplementation  is  advantageous  in reducing  disease  incidence  (Mayo-Wilson  et  al.,  2011). Development  of  a  supplementation strategy should take into consideration the fact that vitamin A supplementation was less effective in reducing diarrhoea incidence when compared to vitamin A and zinc supplementation, and that the latter strategy was estimated to be significantly more cost effective (Chagan et al., 2013).

1.2.4.6 Breastfeeding

Breastfeeding practices have been shown to have a dramatic effect on the incidence of diarrhoeal disease in poor populations. Studies across a number of developing nations have shown that those who receive exclusive breastfeeding during their first 6 months of life are better protected against infection with diarrhoeal diseases (WHO, 2000). Exclusive breastfeeding is currently recommended during, at least, the first six months of an infant’s life by the WHO (Sguassero, 2013).

1.2.5 Medications

There are several classes of medications available to control loose stools. These compounds have a  variety  of  mechanisms  of  action:  alteration  of  intestinal  motility  (opiates),  antibiotics, absorption of toxins or fluid (kaolin-pectin, fibre and activated charcoal) and alteration of secretion (bismuth subsalicylate). They have the potential to modify the amount of fluid loss and the duration of diarrhoea, but some are of no proven benefit and may be toxic (Chan, 2008).

1.2.5.1 Opiates

The term opiate is used to describe drugs derived from opium (juice collected from the unripe seed capsule of Papaver somniferum L. also known as opium puppy). Opioids exert their pharmacological  actions  by  binding  to  specific  cellular  receptors.  These  receptor  subtypes include µ,  and .

In addition to their well-known effect regulating pain transmission in the brain, opioid receptors are also widely distributed in the peripheral nervous system and the gastrointestinal tract (in the myenteric plexus and intestines) (Chan, 2008). The commonly prescribed opioids can be classified into three major groups based primarily on their chemical structures.

a)  The piperidine and phenylpiperidine group of opioid receptor agonists includes fentanyl, diphenoxylate and atropine (lomotil) and loperamide (imodium). These compounds are synthetic analogues and structurally very different from morphine.

b)  The morphine-like derivatives include the natural alkaloids- morphine, codine and semi- synthetic derivatives such as hydrocodone, oxycodone, hydromorphone and heroin.

c)  The third group is the diphenylheptylamine class of agents. They include methadone and prophoxyphene. These synthetic compounds have longer pharmacological action than morphine (Chan, 2008).

Most opioid alkaloids have several physiological effects on the gastrointestinal tract. These effects include decreasing intestinal motility, increased transit time and inhibition of endogenous secretions. Therefore, many of these drugs can be used to manage excessive stool. The two compounds with the most extensive experience in the management of diarrhoea are loperamide (Imodium and diphenoxylate (Lomotil).

Loperamide

Loperamide  is  a  class  of  benzene  and  substituted  derivatives  of  diphenylmethanes  with molecular formula C29H34C12N2O2. Its IUPAAC nomenclature is 4-[4-(4-chlorophenyl)

-4-  hydroxypiperidin-1-ium-1-yl]-N,  N-dimethyl-2,2-diphenylbutanamide  (Stokbroekx  et  al., 1973).

Mechanism of action of Loperamide as an antidiarrhoeal agent

Loperamide is a synthetic opiate agonist which activates the µ opiate receptors in the myenteric plexus of the large intestine. These receptors which are situated presynaptically on the endings of the parasympathetic cholinergic nerves of the intestinal smooth muscle facilitate smooth muscle contraction. Activation of µ receptors by Loperamide inhibits the release of acetylcholine and thus relaxes smooth muscular tone in the gut wall (Wood and Galligan, 2004). Loperamide also

inhibits the stimulation of secretion of water and electrolytes into the intestinal lumen by parasympathetic activity. As a result, Loperamide reduces daily faecal volume, deceases fluid loss, decreases electrolyte loss, increases stool viscosity and bulk density. It also inhibits calcium channels   and   calmodulin   in   intestinal   smooth   muscle.   This   enhances   phasic   colonic segmentation, inhibits peristalsis and increases intestinal transit time (Chen et al., 2012).

Diphenoxylate

Diphenoxylate is a class of benzene and substituted derivatives of piperidine derivative with molecular formula C30H32C12N2O2. Its IUPAC nomenclature is ethyl 1-(3-cyano-3,3- diphenylpropyl)-4-phenylpiperidine-4-carboxylate (Mallinckrodt MSDS, 2007).

The drug has a molecular weight of 489.05 g/mol, melting point of 428-431.6 F (220-222 C) and vapour pressure of < 0.0000001kPa at 25 C. It has a white crystalline powdery appearance, protein binding of 74-95%. Diphenoxylate has a pH of approximately 3.3, slightly soluble in water (0.08 in 100g of water) but freely soluble in chloroform.

Mechanism of action of diphenoxylate as an antidiarrhoeal agent

Diphenoxylate is an opiate receptor agonist that stimulates receptors in the gastrointestinal tract to decrease peristalsis and constrict the sphincters. It has a direct effect on circular smooth muscle of the bowels. This results in segmentation and prolongation of gastrointestinal transit time. The absorption of this drug is 90%.

1.2.5.2 Antibiotics

This is another group of medication used to combat diarrhoea. Antibiotics eliminate pathogens and limit their carriage and systemic effects. Antibiotics are indicated for infectious diarrhoea but should be used with caution due to the increasing problem with resistant bacteria (Kent and Banks, 2010). The type of antibiotic used will depend on the pathogen. Suggested antimicrobial therapies for the treatment of diarrhoea include erythromycin, clindamycin, tylosin, tetracycline or chloramphenicol. Intestinal bacterial overgrowth is usually due to Escherichia coli or Clostridium spp. (Melin et al., 2004).

1.2.5.3 Absorption of toxins or fluids

These agents work by binding to and neutralizing diarrhoea-causing toxins which are produced by infectious agents. These forms of medications act by preventing the adherence of infectious agents to the walls of the gastrointestinal tract (Kent and Banks, 2010). Classes of adsorbents used in the treatment of diarrhoea include

1.2.5.4 Kaolin-pectin formulations

These are popular for symptomatic therapy of diarrhoea. Kaolin is a form of aluminium silicate

(clay) while pectin is a carbohydrate extracted from the rind of citrus fruits (Dominy et al.,

2004). Although kaolin-pectin acts as a demulcent and adsorbent of toxins from infectious agents it may change the consistence of the faeces. But this neither decreases the fluid/electrolyte loss nor shortens the duration of the illness. Kaolin-pectin products may adsorb other drugs and reduce their bioavalability (Trckova et al., 2009).

1.2.5.5 Activated charcoal

They are derived from wood, peat, coconut or pecan shells. The materials are heated and treated in such a way that many large pores are formed. This in turn increases the internal surface area of the charcoal (Romanos et al. 2012). Activated charcoal is available in a variety of pore sizes. The formulations that are sold for drug and toxicant adsorption typically have pore sizes of 10-20 Å (McGraw-Hill Nurse’s Drug Handbook, 2013).

1.2.6 Alternative Therapies for Diarrhoea

Zinc supplementation benefits children with diarrhoea, but only in infants over six months old. This supports the World Health Organization guidelines for zinc, but not in the very young (Lazzerini and Ronfani, 2013).

1.2.7 Management of Diarrhoea

Management of diarrhoea is supportive until the mucosa heals. This  support includes fluid therapy and nutrition with the objectives of preventing dehydration, rehydrating a dehydrated patient and preventing nutritional damage by feeding during and after diarrhoea. Management aims to improve and maintain hydration status (Bliss et al., 2006).

1.2.7.1 Rehydration

The major concern with diarrhoea is dehydration, regardless of the cause of the diarrhoea. Oral rehydration is an important aspect in the prevention of dehydration (Kent and Banks, 2010). Oral rehydration therapy (ORT) is the administration of appropriate solutions (oral rehydration solutions) by mouth to prevent or correct diarrhoeal dehydration.  This can be accomplished by the intake of commercially prepared fluids that contain specific quantities of electrolytes and glucose (Burpee and Duggan, 2008). A person with diarrhoea needs to eat to maintain adequate caloric intake as well as meeting the needs of fluid increase (Burpee and Duggan, 2008; Farthing et al., 2012).

In a healthy person, the small intestines absorb water and electrolytes from the digestive tract so that these nutrient-rich fluids may be transported to other parts of the body through the bloodstream. A person suffering from diarrhoea has irritated intestinal mucosa-causing an excessive amount of water and electrolytes to be secreted rather than absorbed. But when the ORS reaches the small intestines, the sodium and glucose in the mixture are transported together across the lining of the intestines. The sodium which is now in higher concentration in the intestines promotes water absorption back into the body from the gut (Burpee and Duggan,

2008).

1.2.7.2 Correction of underlying causes

Especially in chronic diarrhoea, a thorough history and physical examination by a qualified practitioner should be done to determine the cause of the loose stools. If the cause is found to be a medication, the offending medication should be stopped if possible and another substituted if needed (Zarowitz, 2009). If the underlying problem is found to be intolerance to a particular food, such as lactose or one of the other sugars known to promote osmotic diarrhoea, the diet should be changed to exclude or limit the food (Bliss et al., 2006).

1.2.7.3 Dietary measures

Persons, especially children, suffering from diarrhoea show deficiencies in vitamins and trace elements. Zinc and vitamin A are especially relevant in diarrhoea. Zinc has important roles in immunity and wound healing while vitamin A participates in the maintenance of epithelium.

Zinc  supplementation  of  children  who  are  malnourished  reduces  the  incidence,  frequency, severity and persistence of diarrhoea (Rahman et al., 2001; Strand et al., 2002). For certain types of diarrhoea, other dietary measures include adding fibre (soluble and insoluble) to control stool consistency (Bliss et al., 2006), limiting or eliminating the amount of spices that make foods hot and increasing fluid intake in general.

1.3       Desmodium ramosissimum

1.3.1    Description of Desmodium ramosissimum

The plant, Desmodium ramosissimum, is a leguminous plant that belongs to the genus Desmodium. The name is derived from two Greek words “demos” and “hode” which means “bond” or “chain” and “like” respectively in reference to the resemblance of the jointed seed pods to links of a chain (Trout, 1997). Desmodium is a genus in the flowering plant family, Fabacae and is commonly called tick-trefoil, tick clovers, hitch hikers or beggar lice because the seed attaches easily to the clothes and furs of humans and animals and it uses this as a means of dispersion (Wikipedia.org/wiki/Desmodium, 2015). They are erect, slender, perennial herb, 0.3- 2 m tall. The leaves are 3-foliate with their leaflets narrowly oblong-elliptic, 0.7-8 cm long, hairless above, appressed hairy beneath and reticulate venation visible on both surfaces (Andrews, 2001). Its petiole is 8-15 mm long, hairy and persistent. The flowers of the plant are standard mauve, red or rose coloured. Its fruit, 7-25cm long, has sticky yellowish brown bean- like pod which serves as its mode of dispersal by man and other animals. The plant is found in forest clearings, roadsides and grassy swards widespread across the region from Senegal to Nigeria and over tropical Africa to Madagascar and the Macarenes.

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