\r\n\tThe WHO classification in 2007; was based on the histogenesis and cell origin of the tumor. In the latest classification made in 2016; to better characterize the tumor and obtain better data on its prognosis; The combination of molecular and genetic biomarkers and histopathological features of the tumor was used. Despite all current treatment approaches, the median survival time is around 12 months in most GBM patients. Compared with the situation of some types of successfully treated cancers; the survival time of GBM patients is not at an acceptable level today. In the treatment of CNS tumors; surgery, chemotherapy, and radiation treatments (x-rays, gamma rays, electron and proton beams) are used. The therapeutic potential of chemotherapy; New strategies are needed to increase drug concentration at the diseased site, as this largely depends on the ability of the chemotherapeutic agent to achieve effective concentrations at tumor localization. Based on our better understanding of the genetic and molecular characteristics of CNS tumors; Targeted therapies, including vaccines, and treatment protocols such as immunotherapy are promising developments.
\r\n\r\n\tThis book supposes to be written by many authors who have an internationally honored place in their field to share their ideas about the treatment of CNS tumors. Surgery, Radiotherapy, Chemotherapy and Antiangiogenic Therapy Protocols, Immunotherapy, Molecular Therapy, Specific target-agents therapy with Nanoparticles and Gene Therapy for CNS tumors among the book chapters.
\r\n\tIn these sections; there are many practical pieces of information that can help the students who graduated from the Medicine Faculty and specialist doctors who are interested in Neurosurgery.
",isbn:"978-1-80356-753-2",printIsbn:"978-1-80356-752-5",pdfIsbn:"978-1-80356-754-9",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"4eb1e918eaec0a815088bc84c834bf3c",bookSignature:"Associate Prof. Feyzi Birol Sarica",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11888.jpg",keywords:"Symptoms, Clinical Presentation, Histopathology, Molecular Biology, Surgery, Surgical Treatment, Radiosurgery, Radiation Therapy, Antiangiogenic Therapy, Immunotherapy, Repeat Surgery, Prognostic Factors",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"March 25th 2022",dateEndSecondStepPublish:"May 31st 2022",dateEndThirdStepPublish:"July 30th 2022",dateEndFourthStepPublish:"October 18th 2022",dateEndFifthStepPublish:"December 17th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"5 days",secondStepPassed:!1,areRegistrationsClosed:!1,currentStepOfPublishingProcess:2,editedByType:null,kuFlag:!1,biosketch:"Dr.Sarica is currently serving as the Chairman of the Department of Neurosurgery at the Giresun University. 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Introduction
Relatively new in its adoption, 3D printing technology is a rapidly expanding method of manufacturing that has found numerous applications in areas such as automotive, aerospace and defense industries [19]. 3D or three-dimensional object printing is an additive manufacturing process that creates a physical object from a digital design. It is a set of processes in which material is joined or solidified under computer control to create a three-dimensional object, with material being added together. 3D Printing is used in both rapid prototyping and additive manufacturing [13]. In the realm of health, the introduction of the disruptive technology—3D printing—has the potential to impact on millions of lives through a variety of revolutionary medical solutions including surgery and the treatment of otherwise difficult health conditions. The application of technology in the area of health is wide ranging. 3D printing can help generate a part of the human body that is an accurate replicate of a patient’s own structure. Experts have developed 3D printed skin for burn victims and airway splints for babies. Also, 3D printed models made of different materials representing bone, organs and soft tissue are produced in a single print procedure. 3D printers are also playing significant roles in improving the success rates of stages, but first tests are looking promising in a variety of areas, operations and for crafting amazing artifacts. Many 3D printed medical solutions are still in their experimental stage.
Despite the revolution being brought about by technology in the medical sector together with some developments seen on the continent concerning the application of technology in general [13, 14, 15], access to healthcare remains a huge challenge in Africa. The continent is confronted with an increased demand beyond the treatment of AIDS, malaria and other communicable diseases to address the non-communicable ones such as heart attacks and cancers. There are a variety of illnesses throughout the continent—half the population still lacks adequate health services. According to researches, fewer than 50% of Africans have access to modern health facilities [16]. Further, many African countries spend less than 10% of their Gross Domestic Product (GDP) on healthcare. This is in contradiction with African governments’ political commitment they made to allocating 15% of their GDP to the health sector pursuant to the Abuja Declaration of 2001. Only very few African countries have implemented this objective [17]. Africa is faced with a dearth of trained healthcare professionals as many of them prefer to live and work in places like the USA and Europe.
In order to address the challenges of access to healthcare to their needy populations, African States have assumed several obligations under regional human rights treaties and non-binding political commitments. These norms and standards obligate States Parties to those treaties and declarations, inter alia, to fulfill the right of access to healthcare—a duty is placed on States to actively implement the right. There are several ways in which access to healthcare will be enjoyed, such as through adoption of cost-effective technologies. As the technology progresses, so does the practical enjoyment of health rights. African countries have to embrace technology to close the healthcare gap, thereby performing their heath rights’ obligation to their people in accordance with agreed regional human right norms and standards.
Due to the relatively new introduction of the 3D printing, the link between this technology, the human right to healthcare and the obligation of States has not been fully explored. This chapter therefore seeks to critically examine whether the human rights-based approach to 3D printing can be helpful in focusing discussions and actions on health well-being and security of individuals in Africa. The chapter is structured into six sections. Preceded by a brief introduction about 3D printing, health and human rights obligations to healthcare in general in section one, section two describes the 3D technology and its application with a focus on its medical application, section three assesses the situation of access to healthcare as a challenge in Africa and the African countries’ obligation to create conditions which would assure to all medical services and medical attention in the event of sickness of their needy population. Capitalizing on the State obligation to make healthcare available and accessible, section four and five are allocated for the discussion on the essentials of utilizing the benefits of 3D technology as a human right to address access to healthcare gaps in Africa. Finally, the chapter closes by concluding the entire discussion.
To do this research, the writer reviewed the scholarly literature, reports, technology-focused websites, human rights law and relevant organizational statements. The chapter relies heavily on elaborations given by relevant United Nations (UN) treaty bodies to identify substantive rights of access to healthcare and the obligation they entail against African governments that signed relevant human rights treaties. The sources for institutional statements are the primary websites of UN agencies and treaty bodies, major government bi-lateral organizations and international Non-Governmental Organizations (NGOs) working actively in health. The overall objective is to promote the capitalization of the technology by informing the African governments and people of Africa, disseminating information, educating people and popularizing the subject so people can claivm the benefit of the technology. It is hoped that the work will eventually lead to leveraging 3D printing as a driving force in Africa’s health rights’ safeguards.
2. Evolution of 3D technology and its utilization in the healthcare
Undoubtedly, technology can be utilized to disrupt or promote human security. Technology can facilitate repression through censorship of expression, block or filter access to information, monitor online activity and more effectively and efficiently control populations than in the pre-digital world [35]. Equally, it can also be innovatively, creatively and very effectively used to sensitize communities regarding issues that require advocacy, promotion and protection, such as health rights [18].
An example of innovative technology that recently emerged with many benefits for human security is 3D printing. The modern history of 3D printing dates back to the 1980s when Charles Hull invented the stereo-lithography apparatus (SLA) Printer around 1987 [24]. Since then, there is an ever-growing list of astounding accomplishments using 3D printing. In 2004 and 2005, a Chinese company WinSun developed a 3D printing spray nozzle and automatic material feeding systems. Three years later, in 2008, they printed an actual wall for a building [27]. In 2015 WinSun printed a five-storey residential apartment building [27]. But they did not stop there. To top off this feat, they also built a 3D printed 1100 square meter villa that came complete with internal and external decorations. Today, the technology is expanding rapidly; almost every week new printers and printing materials offering novel possibilities as well as excfiting new applications appear [19]. In the case of Dubai-based construction firm Cazza Technologies, the company’s large robotic 3D printers already allow them to construct architecturally complex buildings at unprecedented speeds. All of the essential structural components for tall buildings, including reinforcements with steer rebar, can be 3D printed using this technology [20]. The leading countries in the world immersed with this technology are the USA followed by the United Kingdom and New Zealand.
Coming to the medical application of the technology, this is rapidly creating new ways by which the medical industry can enhance our lives and save billions of dollars in healthcare costs. As highlighted in the introductory section, the additive manufacturing applications within the medical community are diverse. It is recognized that medical uses for 3D printing, both actual and potential, will bring revolutionary changes [21]. They can be organized into several broad categories including: creation of customized prosthetics, implants and anatomical models, tissue and organ fabrication, manufacturing of specialty surgical instruments, pharmaceutical research regarding drug fabrication, dosage forms, delivery and discovery as well as manufacturing medical devices [24]. Concerning implantation, researchers are now using 3D printers to cheaply create medical devices that can be directly implanted into the human body. Doctors have fashioned 3D-printed splints to help children with rare breathing disorders and have successfully implanted a 3D-printed titanium sternum and ribs into a cancer patient [23]. Benefits provided by application of 3D printing in medicine include not only the customization and personalization of medical products, drugs and equipment but also cost-effectiveness, increased productivity, the democratization of design and manufacturing and enhanced collaboration. The technology enables quick, cost-effective development of new medical devices as well as customized end-use products that improve the delivery and results of a patient’s care [26].
In terms of its cost, except in recent years, the average cost of a 3D printer was floating around the $50k mark, but due to consumerism and an increase in demand and subsequently production, one can now purchase a respectable 3D printer for the substantially lower cost of $1800 [27]. If that is still too expensive for our pockets, there is even a $49 3D printer available for pre-order on Kick starter [27]. Despite the seeming affordability of the technology in some areas, it is the majority of the Western world that embraces the benefits of advanced technology, with Sub-Saharan Africa still working to provide for the most basic needs such as adequate healthcare, food and sanitation. Healthcare development without an eye toward improving technological capacities is likely to further hamper Sub-Saharan Africa’s overall well-being [1].
Whereas 3D technology is not an end in itself, its effective usage empowers people and communities to become self-sufficient in meeting their basic needs and reach their full potential. The 3D technology has several connected advantages for the continent Africa, ranging from the provision of an impetus to the democratization process and good governance; facilitating Africa’s integration into the new information society by use of its cultural diversity as a leverage; helpful tools for a wide range of applications such as remote sensing and environmental, agricultural and infra-structural planning. While technology in general and 3D printing in particular offers several of these possibilities to promote healthcare and the overall the development of the African region, there is limited influence of technology in healthcare. The deprivation of technology in general prevents individuals in certain parts of the world, for instance in the countries making up Sub-Saharan Africa, from realizing certain fundamental, internationally recognized rights, such as the right to health [1]. Partly for this reason, patients in Sub-Saharan Africa, thus have very limited or no access to healthcare clinics and basic health. The section that follows gives an overview of some of the challenges of healthcare service in the region.
3. Challenges to healthcare in Africa: An overview
Not all things in Africa are going bad, despite that it is considered as a backward or dark continent. There are initiatives in the health sector that are moving in the right way. A large number of African countries, such as Senegal, Ghana, Gabon, Cote d’Ivoire, Kenya and Benin, have begun to work at setting up various types of universal medical insurance coverage in an effort to reduce social inequalities. In addition, international solidarity (Global fund, Gates Foundation, etc.) and pressures from civil society have made possible a number of successes against diseases such as onchocerciasis (river blindness), polio, human immune-deficiency virus and tuberculosis. Here, mention must be made of the 300 or so medical doctors trained at the School of Medicine in Dakar (Senegal) by French professionals between 1918 and 1950, who made a major contribution to the almost complete eradication of the epidemic and endemic diseases that took a heavy toll on West African peoples, such as trypanosomiasis (sleeping sickness), plague, yellow fever and smallpox [30]. As a result, Africa’s healthcare coverage to the rural population has grown exponentially.
Despite the efforts made in improving the healthcare systems by African countries, enormous challenges exist within this sector. Unfortunately, preventable deaths of children under five remain very high in Sub-Saharan Africa due to poor access to timely and quality healthcare interventions [28]. While child mortality rates have plummeted since the 1990s, evidence shows that progress on its reduction in most developing countries has witnessed a widening gap as well as a concentration of ‘under-five’ deaths in the most deprived communities [28]. Eighty-three per cent of the highest number of people in rural areas who are not covered by essential healthcare services is in Africa. However, it is not only rural Africa that the center of access to healthcare is a challenge. It seems even those who lead Africa are not in a different position. It is not uncommon to see many African leaders and government officials traveling to get their medical treatment abroad. Ian Taylor has observed that from 2000 to 2012, 10 African heads of states who have died from natural causes had been receiving medical care abroad and except 2, the rest have died abroad while receiving treatment [29]. This demonstrates that African leaders lack confidence in their own country’s healthcare systems. A failure to invest in national healthcare systems in Africa, which ultimately will lead to extreme shortages of healthcare facilities, goods and professional personnel, is the potential cause of the problem.
Another unfortunate fact in Africa is it bears one-quarter of the global disease burden, yet has only 2% of the world’s doctors. While medical professionals in neuron-related diseases are in demand, whether in the area of neurosurgeons, or neurologists, or neuroradiologists, there is not a single facility in all of sub-Saharan Africa (except South Africa) dedicated to diseases of the nervous system on the level of the criteria followed in the countries of the northern hemisphere [30]. Unfortunately, the ratio of neurosurgeon/capita in sub-Saharan is 1/3,000,000 while it is 1:200,000 in the northern hemisphere. On the other hand, in medical imaging, sub-Saharan Africa’s ration is 1 MRI/25 million inhabitants, while it is 25 MRIs/one million inhabitants in the northern hemisphere [30]. Life expectancy in Africa is 15 years lower than the global average because the continent has to deal with the significant burden of epidemics without the infrastructure to fight them. The continent is, according to the Gates Foundation, a mix of new and persistent healthcare challenges [30].
Researchers predict that non-communicable diseases such as diabetes, cancer and cardiovascular disease will overtake communicable and nutritional diseases by 2030. Right now communicable diseases such as malaria, pneumonia, Ebola, HIV/AIDS and even leprosy have a negative effect on continental growth [30]. It was in view of addressing the physical and mental challenges that disease or ill-health might bring about to humans that human rights laws promised the right of everyone to the highest attainable standard of physical and mental health, which includes access to all medical services.
4. Access to healthcare as a human right in Africa
The African continent is faced with a myriad of human rights challenges—“surveillance, privacy laws, threats, imprisonment, intimidation and killings have been happening across the continent, lending to the assertion that regional institutions with a human rights mandate are largely failing to protect the victims” [18]. However, human rights interests in Africa are not limited to the protection from unlawful detention, freedom from censorship of opinion and arbitrary killings. Equally, human rights are also about the ability to enjoy a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health [3]. True, ensuring a healthy life is the spindle upon which a person’s whole personality and well-being depend. To be without healthcare is a frightening prospect, for death is the inevitable consequence [29]. Access to healthcare helps people identify and seize opportunities to grow and develop and to better their lives and those of their families and communities. It also facilitates an individual’s participation in society, in the economy, in government and in the development process itself.
Human rights lay standards, norms and principles—they aim to ensure human well-being. Focusing on the right to health, it is one of the fundamental human rights enshrined in the leading and binding human rights documents, including the Constitution of World Health Organization (WHO), 1946, where health is defined as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [2]. The preamble further states that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living [8]. Again, the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) [5]; the 1969 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) [34]; the 1975 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) [32]; the 1989 Convention on the Rights of the Child (CRC) [11] and the Convention on the Rights of Persons with Disabilities [33] stipulate that the right to health is to be enjoyed by everyone without discrimination. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation [12] and policies and at international conferences. In this way, the right in question has also been proclaimed by resolution 1989/11 of the Commission on Human Rights, the Vienna Declaration and Program of Action of 1993, the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs).
Parallel to global human rights treaties, regional human rights conventions, including the 1996 European Social Charter (as revised) [31], the 1999 Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social And Cultural Rights [7], the 1981 African Charter on Human and People’s Rights (also known as the “Banjul Charter”) [10], as well as the African Charter on the Rights and Welfare of the Child [9] uphold that the right to access to healthcare is a fundamental human right that needs to be respected, promoted and fulfilled. Every State has ratified at least one international human rights treaty recognizing the right to health. Thus, they have the obligation to respect, protect and fulfill the right to healthcare to their needy populations.
The incorporation of health as a human right in the various global and regional treaties implies that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services. Again, the human right to healthcare means that hospitals, clinics, medicines and doctors’ services must be accessible, available, acceptable and of good quality for everyone on an equitable basis, where and when needed [3]. Except those obligations that have immediate effect, (i.e., States’ immediate obligation in relation to the right to health are that they have to guarantee that the right will be exercised without discrimination of any kind and the obligation to take steps toward the full realization of the right) [3], States have the obligation to progressively realize the right to health over a period of time. Meaning that, States’ parties that have ratified a treaty which incorporates the right to health have a specific and continuing obligation to move as expeditiously and effectively as possible toward the full realization of the right. The realization of their obligation may be pursued through numerous, complementary approaches, such as the formulation of health policies or the implementation of health programs, or the adoption of specific legal instruments [3]. This chapter focuses and suggests the African States’ obligation to adopt programs aimed at ensuring their healthcare—needy population enjoys the benefits of the 3D technology and its application for the realization of the right.
5. The obligation to benefit 3D technology in realizing access to healthcare
The link between the right to enjoy the benefits of scientific progress and other human rights, notably the right to health, has been underscored. Scientific and technological advancement are crucial in health development and poverty reduction. According to Yvonne Donders, the right of individuals to enjoy the benefits of scientific advancement implies the right of access to scientific and technological advancement. In this regard, the African States adoption of the Universal Declaration of Human Rights (UDHR) and ICESCR that guarantee the right to enjoy the benefits of scientific progress and its applications is a step in the right direction [5, 8]. The African States’ obligation to healthcare moves further to ratifying global and regional treaties. Equally, they have the responsibility for incorporating into their domestic legal and policy framework an individual’s right to enjoy the benefits of the 3D technology (which is a result of advancement or practical application of science) progress and its applications in the area of health. This emanates not only because the enjoyment of benefits of science and its application is a fundamental right, but also the realization of the right to healthcare imposed an obligation on the part of the States to make administrative, financial, educational, social and other measures, including judicial remedies [4].
In implementing the right to enjoy the benefits of scientific progress and thereby to foster healthcare services, States are under an obligation to invest, to the maximum possible, in scientific and technological advancement and share the benefits. Against this background, the development of vaccines and medicines against widespread diseases has done much to improve life expectancy. In the same way, science and research in the field of information technology, including mobile telephones, the internet and satellite television, have accelerated the flow of information throughout the world, which has proven particularly beneficial to developing countries. It is thus submitted that African States have the obligation to invest, to the maximum possibility, in 3D technological advancement and share the benefits to promote access to healthcare services. International co-operation and solidarity are equally crucial in this regard for African countries to discharge their obligation. This is especially important for ensuring availability of resources from the international community when resources are scarce within African States.
5.1. Africa Union Commission: Its mandate to promote healthcare in Africa
The African Charter on Human and Peoples’ Rights is the foremost African legal instrument intended to protect and promote human rights and basic freedoms on the continent. As noted previously, the right to healthcare is protected under article 16 of this instrument. In addition, the Charter also crafts mechanisms of promoting the spectrum of rights enshrined there. The African Commission on Human and Peoples’ Rights (hereinafter “the African Commission or the Commission”) is a mechanism designed to promote human rights [10], including the right of access to healthcare in the region. The Commission is composed of 11 members chosen from among African personalities of the highest reputation, known for their high morality, integrity, impartiality and competence in matters of human and peoples’ rights. In particular, the Commission’s promotional mandate includes [10]:
To collect documents, undertake studies and research on African problems in the field of human and peoples’ rights, organize seminars, symposia and conferences, disseminate information, encourage national and local institutions concerned with human and peoples’ rights, and, should the case arise, give its views or make recommendations to governments;….
Using the foregoing mandate, the Commission has made several efforts to promote the realization of the right to healthcare on the continent. For instance, the Commission adopted Resolution 141 (Access to Health and Needed Medicines in Africa) following advocacy by the Human Rights and Access to Medicines Clinical Group, a collaboration of the Centre for Human Rights at the University of Pretoria and the Washington College of Law at American University. In its resolution the Commission states that “access to needed medicines is a fundamental component of the right to health and that States Parties to the African Charter have an obligation to provide where appropriate needed medicines, or facilitate access to them” [6].
In the same vein, the Commission can use a wide range of promotional activities, including dissemination of information, making recommendations on the gaps in access to healthcare on the continent and the need to critically study and design strategies for the application of 3D technology for the progressive realization of the right through available resources.
6. Conclusion
Increasingly, African governments express their commitment to the defense of human and peoples’ rights of access to healthcare on the continent by issuing various norms and standards as well as setting up various institutions relating to human rights protection and promotion on the continent. Among the various norms included are article 16 of the African Charter on Human and Peoples’ Rights, article 14 of the African Charter on Human and Peoples’ Rights, Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, article 14 of the African Charter on the Rights and Welfare of the Child, as well as article 16 the African Youth Charter.
Regrettably, in spite of these lofty ideas, the daily lives of Africans do not always manifest the concrete benefits of these initiatives. Africa remains beset, as it were, by gaps in implementing healthcare rights caused by factors such as socio-economic and political problems, corruption, poverty, armed conflicts and the abuse of individuals’ fundamental rights. More remains to be done in order to translate the benefits of human rights protection and promotion into the daily healthy lives of the peoples of Africa. To address the challenges, African States must focus on building better healthcare infrastructures. Africa’s existing promotional activities need to be catapulted by amalgamating 3D technology in implementation. This needs to happen in a flawless manner.
To better adopt the technology, the African Commission should urge African States to guarantee the full scope of access needed to 3D technical applications in medicine. There is a need for developing a communication strategy aimed at strengthening the Commission’s corporate identity and the positioning of its activities in the area of advancing medical care. Such a strategy should build and maintain creative and effective communication partnerships, particularly with the technologically developed world; promote 3D technology usage; ensure responsiveness to the rapidly changing 3D technology and environments and advocate for media liberalization and deregulation to ensure a more central, dynamic and effective contribution of communication to the work of the Commission. Driven by technological convergence, it is here argued that the concentrated use of 3D technology can bring unprecedented comparative advantages to the continent. The knowledge-based economy of the future will depend more and more on the effective use of this technology. Rapid advances in technology coupled with the low-cost of acquiring 3D technology tools are opening new windows of opportunity for Africa to accelerate access to healthcare services. The 3D printing revolution can accelerate Africa’s goals in the right to health, fostering intra-regional trade, integration into the global economy, as well as realizing its security needs. This must be reinforced by African governments’ political will to improving knowledge, skills and resources and creating collaboration and consensus among key stakeholders.
Acknowledgments
My first impression to ponder upon the link between 3D technology and its medical application happened in a collaboration research discussion conducted with colleagues at the University of Gondar in Ethiopia in early 2017. Hence, my thanks goes to the University of Gondar for providing a platform for the meeting of experts in the field of law, technology and human rights. My special thanks goes to my friend and colleague, Dr. Hailemichael Demissie, who first tabled the importance of 3D printing technology for harnessing Africa’s development, on the basis of which I personally appreciated the significance of linking 3D printing as a useful avenue for promoting the right to healthcare in Africa.
\n',keywords:"3D printing, access to healthcare, Africa, human rights, technology",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/60159.pdf",chapterXML:"https://mts.intechopen.com/source/xml/60159.xml",downloadPdfUrl:"/chapter/pdf-download/60159",previewPdfUrl:"/chapter/pdf-preview/60159",totalDownloads:821,totalViews:117,totalCrossrefCites:1,totalDimensionsCites:2,totalAltmetricsMentions:0,impactScore:1,impactScorePercentile:64,impactScoreQuartile:3,hasAltmetrics:0,dateSubmitted:"October 14th 2017",dateReviewed:"February 19th 2018",datePrePublished:null,datePublished:"June 27th 2018",dateFinished:"March 23rd 2018",readingETA:"0",abstract:"Technology has the capacity for helping African citizens realize their basic rights. The recent introduction of the disruptive technology—3D printing—has the potential to impact millions of lives through a variety of revolutionary medical solutions, including surgery and the treatment of intractable health conditions. As the technology progresses, so does the practical enjoyment of health rights. This chapter argues that the human rights-based approach to 3D printing technology can be helpful in focusing discussions and actions on health well-being and security for individuals in Africa. Having first analyzed the impact of the technology in revolutionizing healthcare, the chapter provides an overview of the complex health challenges this young continent is faced with. Further, it also explores the most relevant African regional laws and standards, guidelines and policy initiatives requiring African governments to use technologies that can advance the human right to health. It concludes that the healthcare agenda of African countries needs to be better integrated and coordinated to ensure that the technologies have a positive impact on health rights. It further concludes that the African Union Commission should promote the researching and utilization of this technology in the implementation of national health policies and strategies of African countries.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/60159",risUrl:"/chapter/ris/60159",book:{id:"6568",slug:"reflections-on-bioethics"},signatures:"Solomon Tekle Abegaz",authors:[{id:"227463",title:"Dr.",name:"Solomon Tekle",middleName:null,surname:"Abegaz",fullName:"Solomon Tekle Abegaz",slug:"solomon-tekle-abegaz",email:"solomomte@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:{name:"Addis Ababa University",institutionURL:null,country:{name:"Ethiopia"}}}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Evolution of 3D technology and its utilization in the healthcare",level:"1"},{id:"sec_3",title:"3. Challenges to healthcare in Africa: An overview",level:"1"},{id:"sec_4",title:"4. Access to healthcare as a human right in Africa",level:"1"},{id:"sec_5",title:"5. The obligation to benefit 3D technology in realizing access to healthcare",level:"1"},{id:"sec_5_2",title:"5.1. Africa Union Commission: Its mandate to promote healthcare in Africa",level:"2"},{id:"sec_7",title:"6. Conclusion",level:"1"},{id:"sec_8",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'[Jennifer MM. Human rights and development: Using advanced technology to promote human rights in sub-Saharan Africa. Case Western Reserve Journal of International Law. 1998;30(343):343-371]'},{id:"B2",body:'[World Health Organization (WHO). Constitution of the WHO. 1946]'},{id:"B3",body:'[UN Committee on Economic, Social and Cultural Rights. General comment no. 14. The Right to the Highest Attainable Standard of Health. Article 12 of the Covenant. 11 August 2000. E/C.12/2000/4]'},{id:"B4",body:'[UN Committee on Economic, Social and Cultural Rights. General comment no. 3. 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Introduction
Exclusive breast feeding involves feeding only breast milk without any added fluids or solids. It is highly recommended by the World Health Organization (WHO) for the first 6 months of life with supplemental breast feeding continuing for at least 2 years [1]. This is because optimal breastfeeding of infants has a direct impact on growth, development, and health in the neonatal period [2, 3]. Breastfeeding is known to have invaluable benefits both for the child and mother. For the mother, breast feeding causes weight reduction, provides stronger interaction with the infant as well as pleasure and pleasant emotion. It also provides a more practical approach to feeding in comparison to the use of a bottle prevents breast cancer and pregnancy and provides relief in breast pain while also being economical. For the infant, it promotes affectional bond with the mother while adequately supplying the nutritional and emotional needs [3]. In the developing world, low immunization rates, contaminated drinking water, and reduced immunity as a result of malnutrition make breast feeding crucial to reducing life threatening infections. A review of interventions in 42 developing countries estimated that exclusive breast feeding for 6 months, with partial breastfeeding continuing to 12 months, can prevent 1.3 million (13%) deaths each year in children under 5 years [3]. However exclusive breastfeeding is not without challenges.
2. Challenges with breastfeeding
The WHO’s recommendation for breastfeeding has been adopted by several countries all over the World and also in West Africa, but this has presented with several challenges, hence reducing the number of children who could potentially be breastfed. In the United States, for example, less than half of infants receive any breast milk at 6 months (49.4%), and approximately one-quarter are breast-fed up to 1 year (26.7%) [4]. Breast discomfort or pain, sore nipples, mastatitis, inverted nipples, presence of breast implants, difficulty getting baby to suck, poor weight gain and hypernatremia dehydration due to insufficient milk intake are rampant challenges encountered during breast feeding [3]. Lactation failure is also common among postpartum women, resulting in insufficient milk supply which is a major reason for early weaning. It has been claimed that at least 5% of women experience lactation failure (agalactias) whiles approximately 15% of women experience inadequate supply of their breast milk (hypogalactias) [5] at 3 weeks postpartum. The number of lactating women who have produce insufficient breast milk is on the rise [2]. There are a number of well-known causes of low breast milk supply that is primarily related to breast feeding management. These factors are difficult to control and require a good knowledge of breastfeeding practices. These factors include; schedule breastfeeding, skipping breastfeeding, supplementing the diet of the baby with infant formulas and poor latching of the baby on the breast. However, there are more complicated causes of low breast milk supply such as; insufficient mammary tissue (hypoplasia), medications (hormonal contraceptive pills), retained placenta, diseases (diabetes, jaundice), metabolic conditions (obesity), previous breast surgeries, cesarean section, thyroid and other hormonal disorders. Another cause is even environmental toxins such as pesticides. A study found that daughters of women who grew up in a pesticide contaminated environment had much higher incidence of insufficient mammary tissue than those living on the hill top of the same an area [6].
3. Solutions to breastfeeding challenges
To respond to the challenge of insufficient milk production (hypogalactia) or the absence of milk production (agalactia) milk banks are being created and the use of medication that induces, maintains or increases milk production are being used [2, 7].
Throughout history, donor breast milk banks have been the choice of some parents, and it is currently recommended as second choice if the mother’s own milk is not available. However, the risk of possible transmission of diseases including HIV, cytomegalovirus, and Creutzfeldt-Jakob disease has induced the need for pasteurization. There are major concerns however as to what extent pasteurized donor breast milk retains the biological properties of mother’s milk. Evidence on donor milk quality is limited [3] and operational human milk banks are not able to meet demands for especially the most vulnerable neonates [8].
3.1 Synthetic galactagogues
Orthodox drugs that are widely used as galactagogues are chlorpromazine, sulpiride, metoclopramide and domperidone [2] but there are reservations as to their efficacy and their association with very high incidences of unpleasant side effects including extra-pyramidal effects in both mother and infant. There is therefore a need to keep searching for more acceptable, safe and efficacious galactagogues [2, 9]. In the United States, Canada and Europe, metoclopramide and domperidone are widely prescribed [10].
Metoclopramide though prescribed off-label as a lactation aid has one troublesome side-effect of inducing depression. Extrapyramidal symptoms also occur in about 1 in 500 patients at even usual adult doses resulting in involuntary movements of limbs, facial grimacing, torticollis, oculogyric crisis, and rhythmic protrusion of tongue, bulbar type of speech, trismus, or dystonic reactions resembling tetanus. Metoclopramide is secreted in human milk and its safety in infants has not been established. Neonates are less able to clear the drug from their systems hence dystonias and other extrapyramidal reactions are more common in this pediatric population than in adults [10]. Severe depression, seizures and intestinal discomfort have also been reported in infants that consume milk from mothers treated with metoclopramide [2, 11]. Other adverse effects additionally reported in mothers include anxiety, several gastrointestinal disorders and insomnia [2].
Domperidone use in human clinical trials has also been associated with varying findings. In some recent human data no maternal or neonatal adverse effects were reported [2]. Other studies have however reported adverse effects in mothers such as xerostomia, gastrointestinal disorders, cardiac arrhythmia, and sudden death but none in infants [2]. Domperidone is reported to also increase the risk of sudden cardiac death or could be linked with increased risk of prolonged QT syndrome (arrhythmia) [4].
Sulpiride and chlorpromazine are also typical antipsychotics that have been documented to be effective as galactagogues but are also associated with extrapyramidal reactions and weight gain. Human growth hormone and thyrotropin-releasing hormone are other agents have also been utilized to increase breastmilk production, but these agents have very limited clinical experience behind them [2, 7]. Oxytocin, although widely used in the past, has limited scientific data as a galactagogue also [7].
3.2 Botanical galactagogues
There are numerous references in literature for herbal medicines that are used to aid breastfeeding. However these are mainly based on empirical traditions with few human studies that show evidence that milk synthesis can be increased and that these are safe [2]. Most herbal galactagogues are believed to exert their pharmacologic effects through interactions with dopamine receptors, resulting in increased prolactin levels and there by augmenting milk supply [7]. Galactagogues are useful for women who are unable to produce breast milk on their own due to infant prematurity, illness of the mother or child, adoption, or surrogate motherhood [7].
The use of medicinal plants to stimulate breastmilk production has a long history of use [10] in almost all cultures over the world but has not been extensively studied nor fully exploited for use in lactating mothers [2]. The use of herbal medicines and phytonutrients or nutraceuticals to treat various conditions is expanding rapidly worldwide [12]. Botanical galactagogues may have the advantages of various claims of efficacy, preference of consumers for natural therapies, erroneous belief that herbal products are superior to manufactured products as well as dissatisfaction with the results, cost and side effects from the orthodox galactagogues [12]. A literature search on botanical galactagogues used within Ghanaian communities revealed a number of plants that are used for such purposes but with very little information and scientific studies to back their efficacy and safety.
4. Medicinal plants used as galactagogues
4.1 Amaryllidaceae
4.1.1 Allium sativum L.
A. sativum (garlic) is a perennial herb cultivated in various parts of the world and widely used as a food ingredient [13, 14]. Garlic has been used as a spice, food, and medicine for over 5000 years, and is one of the earliest documented herbs utilized for the maintenance of health and treatment of disease [15]. Garlic has many medicinal properties including, anti-microbial, anti-fungal, anti-viral, anti-protozoal, anti-inflammatory, anticancer and antioxidants [13, 14]. Garlic has traditionally been used to strengthen the immune system and gastrointestinal health. Today, this intriguing herb is probably the most widely researched medicinal plant [15]. Garlic is given for nutritional purposes to enhance gestation and lactation [16]. In a study conducted to evaluate the effectiveness of naturally prepared galactagogue mixtures containing garlic on breast milk production and prolactin levels in postnatal mothers, it was observed that the galactagogue mix increased prolactin production, confirming the folkloric use of garlic as a galactagogue [17]. Garlic is also known to impart odor and flavor to breast milk when consumed and infants tend to breast-feed longer on such milk [18].
Chemical constituents isolated from A. sativum were diallyl trisulfide (50.43%), diallyl disulfide (25.30%), diallyl sulfide (6.25%), diallyl tetrasulfide (4.03%), 1,2-dithiolane (3.12%), allyl methyl disulfide (3.07%), 1,3-dithiane (2.12%), and allyl methyl trisulfide (2.08%) [19]. The essential oil of A. sativum possessed contact toxicity against overwintering C. chinensis [19].
4.2 Annonaceae
4.2.1 Xylopia aethiopica A. rich
X. aethiopica is an evergreen tree with many-branched and narrow crown; it can grow from 15 to 30 m high. It is planted for medicinal purposes, as a shade tree and as an ornamental. The fruits are used as a tonic to improve women fertility and to aid delivery. Various parts of this plant are used across Ghana and Nigeria for various medicinal purposes. Powdered samples are taken or applied directly for use. The fruits also serve as a condiment, an emmenagogue, anthelmintic, antitussive, carminative and rubefacient. Xylopia is used generally for pain and in the treatment of bronchitis, asthma, arthritis, rheumatism, headache, neuralgia and colic pain [20, 21]. The seeds are ground and used as a galactagogue, emetic, rubefacient, stimulant and vermifuge [22]. The seeds are crushed and applied on the forehead for treating headache and neuralgia and its extract for round worm infestation and as a treatment for biliousness. Decoction of leaves serves as an emetic and is used against rheumatism. The powdered leaves are rubbed on the chest for treating bronchio-pneumonia and taken as snuff for treating headaches. Roots are powdered and applied to sores and also to treat cancer. Lactating mothers take the ground seed to increase milk flow. Fruits are particularly high in zinc content, perhaps the reason behind its consumption during lactation. The fruit contains xylopic acid, volatile oils, fixed oils, rutin and zinc. Compounds isolated from X. aethiopica include Lupeol, 16α-hydroxy-ent-kauran-19-oic acid, 3, 4′, 5-trihydroxy-6,6″-dimethylpyrano[2,3-g]flavone, 3-O-β-sitosterol β-D-glucopyranoside, isotetrandrine and trans-tiliroside [22, 23, 24].
4.3 Asclepiadaceae
4.3.1 Secamone afzelii (Roem. & Schult.) K. Schum
S. afzelii, is a familiar creeping woody climber found on fences, unkempt farm lands, on trees and grows to a very long length of about 2–3 cm. It is often seen as a nuisance to other plants because of its domineering spread wherever it grows. It is used in traditional medicine for stomach problems, diabetes, colic, dysentery and also for kidney problems. The whole plant boiled with rice is used as purgative for children. The decoction of the entire plant is prescribed for cough and catarrhal. For the treatment of gonorrhea, the whole plant is crushed with fresh palm nuts and oil [25]. A decoction of the whole plant is used as a galactagogue [26]. Studies have shown that S. afzelli has antimicrobial effects and also protect cells against damage by reactive oxygen species [27, 28, 29, 30]. The anti-inflammatory property of the leaf extract has also been demonstrated [30] in a murine model. Kaempferol-3-O-β-D-apiofuranosyl-(1 → 2)-α-L-rhamnopyranoside, rutin, myricetin 3-O-α-L-rhamnopyranosyl-(1 → 6)-β-D-glucopyranoside, kaempferol-3-O-α-L-rhamnopyranosyl-(1 → 6)-β-D-galactapyranoside, mauritianin, and vicenin-2 have been isolated from S. afzelii [26]. The methanol extracts of S. afzelii is reported to be toxic in Artemia salina [31].
4.4 Costaceae
4.4.1 Costus afer Ker-Gawl
C. afer, natively called the bush sugar cane is classified as an endangered medicinal plant in Nigeria. It is a perennial, rhizomatous herb that can grow to a height up to 4 m. Leaves are arranged spirally, simple and entire [32]. It can be found in the forest belt of Senegal, South Africa, Guinea, Niger, Sierra Leone, Ghana, Cameroon and Nigeria [33]. C. afer is a useful medicinal plant that is highly valued for its antidiabetic, anti-inflammatory and anti-arthritic properties in South-East and South-West Nigeria, the plant extract is used as fodder to treat goats with retained placenta. The decoction of the stem or powdered fruits is used as a cough remedy. Its boiled root is applied to cuts and sores. A soothing formulation for rheumatic pains is prepared with the boiled leaves [33]. The leaves and stem are cut and crushed into smaller bits and boiled together with other plants such as Alchornea cordifolia, pawpaw, citrus species and the bark of Mangifera indica for the treatment of hunch back and malaria. Also the juice of C. afer is used as eye drop for inflammation and other eye defects. The young and tender leaves when chewed are believed to give strength to the weak and dehydrating patient. An infusion of the inflorescence is taken to treat stomach complaints. The stem or fruit decoction mixed together with sugarcane juice are taken to treat cough, respiratory problem and sore throat [32]. Alkaloids, saponins, flavonoids, anthraquinones, cardiac glycosides, terpenoids, phenolic compounds and tannins have been found to be present in the plant [33]. This plant contains diosgenin which is used as a precursor in the synthesis of a number of steroid drugs including corticosteroids, sex hormones, oral contraceptive and anabolic agents. The rhizome also contains saponins aferosides A–C, as well as diosein and parphyllin c and flavonoid glycoside kaempterol 3-0-rhamnopyranoside [34]. Extracts from the leaves exhibits antioxidant, hypolipidemic, hepatoprotective, anti-inflammatory, and analgesic, anticancer, antimicrobial, insecticidal and nematcidal activity and also contains verbascoside, which possesses antimicrobial activities [35]. Acute and chronic toxicity studies on C. afer showed no inherent toxic effects in animal models [35]. Liver function experiments of this plant in rats showed significant differences in the test groups when compared with the control while there was no significant effect on kidney function [33].
4.5 Euphorbiaceae
4.5.1 Euphorbia hirta L.
E. hirta is a slender-stemmed, annual hairy plant with many branches from the base to the top, spreading up to 40 cm in height. E. hirta is often used traditionally for female disorders, respiratory ailments (cough, coryza, bronchitis, and asthma), worm infestations in children, dysentery, jaundice, pimples, gonorrhea, digestive problems, diabetes and tumors. It is reported to contain alkanes, triterpenes, phytosterols, tannins, polyphenols, and flavanoids. The root exudate exhibits nematicidal activity [3]. The decoction of the dry herb is used for skin diseases while that for the fresh herbs is used as gargle for the treatment of thrush. Roots are also used for snake bites. This herb shows antibacterial, anti-inflammatory, anti-malarial, galactogenic, anti-asthmatic, anti-diarrheal, anti-cancer, anti-oxidant, anti-infertility, anti-amoebic, and anti-fungal activities [36]. The root decoction is also beneficial for nursing mothers deficient in milk [36]. E. hirta has shown a galactogenic activity in guinea pigs before puberty by increasing the development of the mammary glands and induction of milk secretion [36].
4.5.2 Euphorbia thymifolia wall
E. thymifolia is a softly hispid prostrate herb that is slender, cylindrical, pale green but often pink in color when fresh, becoming grayish green or dark purplish on drying. Stems are with white latex, spreading on the ground, 10–20 cm in length with a diameter from 1 to 3 mm [37]. E. thymifolia is traditionally used as a blood purifier, sedative, hemostatic, aromatic, stimulant, astringent in diarrhea and dysentery, anthelminthic, demulcent, laxative; and also in cases of flatulence, constipation; chronic cough; as an antiviral in bronchial asthma and paronychia. The dried leaves and seeds are given along with butter-milk to children in bowel complaints. Root is given in amenorrhea and gonorrhea. The oil is used as an insect repellant and in medicinal soaps for the treatment of erysipelas. It is also used as a vermifuge for dogs and farm foxes. Plant juice is employed in southern India as a cure for ring worms. The plant powder is given with wine as a remedy for bites of venomous reptiles. It is applied on the scalp with ammonium chloride to cure of dandruff. The fresh plant is considered vulnerary and used in ophthalmia and other eye troubles, ardor, sores, atrophy, dysentery and breast pain [24]. This plant is reported to be used as a galactagogue both in West-Africa and in India [24, 38].
4.5.3 Hymenocardia acida Tul
H. acida is a small tree of about 6 m high, gnarled and twisted with characteristic rough, rusty-red bark. It is widespread in tropical Africa [39]. The leaves of Hymenocardia acida are commonly used in Northern Nigeria alone or in combination with other plant parts to manage sickle cell disease. The plant contains carbohydrates, tannins, flavonoids, saponins, alkaloids, cardiac glycosides, resins, steroids and terpenes [38]. The root of this plant is reported to be used within West-Tropical Africa to stimulate lactation but [24] there are however anecdotal reports that this plant it is also given to diminish breastmilk supply. Ethnopharmacological studies of H. acida revealed an extensive array of medicinal uses, particularly from tropical African countries. In Senegal and Ivory Coast, an infusion or decoction of its leaves is used for the treatment of chest complaints, small pox, in baths and draughts as a febrifuge, and is taken as snuff for headaches or applied topically for rheumatic pains and toothaches. The bark and leaves are prescribed together with other plants in various ways in Nigeria for abdominal and menstrual pains and as poultices to treat abscesses and tumors. The powdered leaves of this tree are also used for the treatment of arthritis. Pharmacological activities reported on the plant include anti-ulcer, anti-plasmodial and cytotoxic activities [39].
4.5.4 Plagiostyles africana Prain exDe wild
P. africana trees grow in the lowland rainforest of south Nigeria and West Cameroons extending to Zaïre (the Democratic Republic of Congo). It reaches 16 m tall by 1.30 m in girth. The wood is light yellowish white and it is cut in Gabon to make spoons, combs and hair-pins. A wood-decoction is taken in the belief that it promotes milk-production [24]. The bark contains a white to yellowish viscid latex. The bark is used for chest-affections, and for fever [40].
4.5.5 Ricinus communis L.
R. communis (castor oil plant) is a perennial shrub whose leaves have long petiole and palm like lobed blades. Fruit is three chambered, globose capsule with soft spines. When capsules mature, they split up into three cavities and the seeds are expelled out [41]. This plant is grown worldwide for the production of castor oil. R. communis exhibits various biological and pharmacological activities such as abortifacient effect, acid phosphatase inhibition, acid phosphatase stimulation, agglutin activity, alkaline phosphatase inhibition, anti-conceptive activity, anti-diabetic activity, anti-infertility effects anti-inflammatory activity, antimicrobial activity, antioxidant activity, free radical scavenging activity, hepatoprotective activity, insecticidal activity and repellent properties [5, 41]. Castor oil is massaged over the breast after child-birth to increase the flow of milk as it stimulates the mammary glands. The leaves of castor can also be used to foment the breast for the same purpose [5, 24].
4.6 Leguminosae
4.6.1 Tamarindus indica L.
The tamarind (T. indica) is a common tree, especially in West Africa [42] and India. It is a moderate to large sized, evergreen tree that grows up to 24 m in height and 7 m in girth. T. indica has antimicrobial, antioxidant, anti-venom properties and it is also used as a galactagogue [43]. It is indigenous to tropical Africa and is also cultivated in subtropical China, India and Spain. Initially, the fruit shows a reddish-brown color that turns black brown, becoming more aromatic and sour on ripening. The fruit pulp is used for seasoning, as a food component and in juices. T. indica has antimicrobial, antioxidant, anti-venom properties and also used as a galactagogue [43]. Tamarind is most commonly used as a laxative and in the treatment of wounds and abdominal pains, followed by diarrhea, helminth infections, fever, malaria, aphrodisiac, respiratory problems and dysentery [42]. Its fruit is regarded as a digestive, carminative, laxative, expectorant and blood tonic [44]. Other parts of the plant have anti-oxidant [45], anti-hepatotoxic [46], anti-inflammatory, anti-mutagenic, anti-cancer, anti-ulcer and anti-diabetic [47] activities. The flower and leaf are eaten as vegetables, while the germ obtained from the seed is used for manufacturing tamarind gum which is well-known as a component of jelly [5, 48]. Toxicity study in rat modules showed that tamarind pulp extract was generally safe and well tolerated at 5, 200, 1000 mg/kg body weight per day for 6 months [49].
4.6.2 Acacia nicolita var. adansonaii (Guill. & Perr.) Brenan
A. nicolita also known as gum Arabic occurs as a tree which can grow up to about 50 feet high. It has a dark brown bole with deeply fissured bark. The leaves are compound and alternately arranged with about 10 to 30 elliptical pubescent leaflets on each leaf. The flowers occur as round, yellow heads situated at the end of branches. Fruits are thick, gray and are well constricted hairy pods [50]. Various parts of A. nicolita have been used for the treatment of various cancers in Western Africa. These include cancers of the ear, eye and testicles. Roots of the plant are used to treat tuberculosis, its wood for the treatment of smallpox, and the leaves for the treatment of ulcers [51]. In the Katsina state of Nigeria, decoction of the pod is used for postpartum wound healing [52] and here also the young shoots and pods are used to stimulate lactation [53]. When the effect of the aqueous extract of A. nicolita was investigated on milk production in rats, it was observed that, the extract was able to significantly stimulate the release of prolactin. Also, it was observed that the mammary glands of estrogen-primed rats treated with the extract showed clear lobuloalveolar development with milk secretion [54]. Present in A. nicolita are tannins, flavonoids, alkaloids, fatty acids and terpenes have been isolated from various parts of the plant. This plant is also known to have anti-inflammatory, anti-oxidant, anti-diarrheal, anti-hypertensive and anti-spasmodic, anti-bacterial, anti-helminthic, anti-platelet aggregatory, and anti-cancer activities [50]. Toxicological studies on A. nicolita showed that it has a low toxicity potential [55]. However it is also reported that repeated administration of doses higher than 250 mg/kg body weight for 28 days caused hepatotoxicity in rats [56].
4.6.3 Desmodium adscendens (Sw.) DC
D. adscendens is a herbaceous non-climbing perennial shrub that commonly occurs in tropical areas of Africa, South America, Asia, Australia and Oceania [57]. The plant thrives in varying habitats ranging from forests to grasslands and in secondary/disturbed vegetation. A decoction of the leave and stem is used for asthma and other diseases associated with smooth muscle contraction and epilepsy in Ghana [57]. It is used for the treatment of fever, pain and epilepsy in the Congo. In Brazil the plant is used in the treatment of ovary inflammation. It is used in Ghana to enhance lactation [22]. D. adsendens contains indole alkaloids, unsaturated fatty acids, tyramine, hordenine and saponins [58, 59]. Triterpenoid saponins, tetrahydroiso-quinolones, phenylethylamines and indole-3-alkyl amines have been isolated from the leaves [60]. D. adscendens causes dilation, relaxation of smooth muscles, anti-histamine effects and normalizes elevated liver enzyme levels [58].
4.7 Malvaceae
4.7.1 Hibiscus sabdariffa Linn
H. sabdarriffa commonly known as Roselle (English), Sobolo (Akan Ghanaian language) is widely cultivated among the tropical and subtropical regions of the world. These include some parts of Asia and West Africa. This plant was domesticated by natives of Western Sudan before 4000 BC [61]. The plant is an erect herbaceous annual and a shrub that can grow up to about 2 m in height. It consists of smooth cylindrical and typically red stems. The leaves are simple, deeply lobed, petiolate and alternately arranged with reddish reticulate veins. The flowers occur singly in the axils of the leaves. The calyces are typically red and made up of five sepals fused at the base which become fleshy and juicy upon maturity [62, 63].
The main class of phytochemicals present in H. sabdariffa is anthocyanins and flavonoid, as well as organic acids and polysaccharides. Citric acid, malic acid, tartaric acid and ascorbic acid are also present [64]. Some flavonoids that have been described in H. sabdariffa extracts include hibiscitrin, sabdaritrin, gossytrin and gossypitrin [65, 66]. Different parts of H. sabdariffa are used for various medicinal purposes. The calyces of the flower are commonly incorporated in hot and cold drinks due to its pleasing taste. In many parts of Africa, it has been used for its spasmolytic, antioxidant [67, 68, 69], antibacterial [70, 71], antipyretic [72], diuretic and anthelmintic properties [73]. It is also used for the treatment of high blood pressure and liver diseases. Additionally to their medicinal uses, various parts of the plants are incorporated in meals and used for other culinary purposes. In some cultures, H. sadariffa is included in some herbal mixtures and consumed by nursing mothers to increase milk supply [74]. In Nigeria also, the decoctions of the seeds have been reported to be used to increase lactation in cases of poor milk supply [75]. In 66 healthy mothers who took extracts of hibiscus, fennel, fennel oil, verbena, raspberry leaves, fenugreek and vitamin C, there was an increase in breastmilk production by the third day [76]. Toxicity studies have shown that the prolonged usage of the aqueous-methanolic extract of H. sabdariffa calyces at the dose of 250 mg/kg could cause liver injury in rats [77]. Also, the 12-week subchronic effect of H. sabdariffa calyx aqueous extract at the doses of 1.15, 2.30, and 4.60 g/kg induced testicular toxicity [78].
4.7.2 Gossypium herbaceum L. (Malvaceae)
G. herbaceum is an erect, shrubby, hairy plant that grows up to 2–8 m high [79]. The decoction of this plant is used traditionally across West Africa as an aphrodiasiac, galactagogue, spermatogenic, expectorant, laxative, demulcent, emenagogue, dysmenorrhea, and for the expulsion of retained placenta [80, 81]. In human studies G. herbaceum was shown to be efficacious, safe and cost effective in augmenting lactation in perceived insufficient milk supply [9]. This plant is known to contain carbohydrates, tannins, saponins, steroids, glycosides, phenolics, sitosterol, ergosterol, lipids, gossypol, oleic, palmitic and linoleic acid [79]. Extracts from this plant and it active constituents gossypol have shown anti-cancer, anti-infertility, anti-malarial, anti-oxidant, anti-trypanosomal, anti-viral, anti-microbial, anti-viral, hepatoprotective and anti-depressant activities in animal models [16, 82, 83].
4.8 Moraceae
4.8.1 Milicia excelsa (Welw.) C.C. Berg
M. excelsa is commonly known as odum or iroko in Ghana. It is a large, dioecious tree that grows up to 50 m high [84]. This plant is widely used in African folk medicine as a decoction to treat several ailments. A root decoction is taken to treat female sterility. A decoction of the root and stem bark is taken as an aphrodisiac. The extracts from the bark are taken to treat cough, asthma, heart trouble, lumbago, spleen pain, stomach pain, abdominal pain, edema, ascites, dysmenorrhea, gonorrhea, general fatigue, rheumatism, sprains, and as a galactagogue, aphrodisiac, tonic and purgative. Also the stem bark preparations are topically applied to treat scabies, wounds, and loss of hair, fever, venereal diseases and sprains. They are applied as an enema to cure piles, diarrhea and dysentery. The latex is applied on burns, wounds, sores, eczema and on other skin problems as well as taken to treat type 2 diabetes [85, 86]. Additionally, it is taken against stomach problems, hypertension, tumors, and obstruction of the throat and as a galactagogue [87]. Leaves are eaten to treat insanity; a leaf maceration is drunk as a galactagogue. A decoction of the leaves is taken for the treatment of gallstones. Leaf preparations are externally applied to treat snakebites and fever and as eye drops to treat filariasis. Alkaloids, flavonoids and saponins are present as well as triterpenes and glycosides [79, 88]. The leaf extract of M. excelsa is reported to be safe in rodents [79, 89, 90].
4.8.2 Ficus sp. L.
Ficus species comprises one of the largest genera of angiosperms with more than 800 species of trees, shrubs, hemiepiphytes, climbers, and creepers in the tropics and subtropics worldwide [91]. The bark, root, leaves, fruit and latex of this plant are frequently used for the treatment of various illnesses including gastro-intestinal, liver, venereal, respiratory, metabolic and cardiovascular disorders. It is used in traditional medicine as a galactagogue [92]. The fresh juice (50–100 ml) of leaves of F. racemosa L. is given with water for about 10 days to treat gastrointestinal problems. Bark of F. arnottiana and F. hispida shows hypoglycaemic activity. Roots of F. bengalensis show anthelmintic activity. This extract is also reported to inhibit insulinase activity from liver and kidney. Fruit extracts exhibits anti-tumor activity. Various pharmacological actions such as anti-ulcer, anti-diabetic, lipid lowering and antifungal activities have been described for F. exasperata. Ethanolic leaf extract of F. exasperata shows anti-bacterial activity. Leaves exhibit hypotensive activity. Ethanolic and aqueous wood extracts of F. glomerata shows Anti-HIV-1 integrase activity. F. religiosa is reported to be used for the treatment of asthma, cough, sexual disorders, diarrhea, hematuria, ear-ache and toothache, migraine, eye troubles, gastric problems and scabies; leaf decoction has been used as an analgesic for toothache; fruits for the treatment of asthma, other respiratory disorders and scabies; stem bark is used in gonorrhea, bleeding, paralysis, diabetes, diarrhea, bone fracture, antiseptic, astringent and antidote. Fruit of F. carica shows spasmolytic activity, mediated through the activation of K+-ATP channels along with anti-platelet activity. Hence, it can be used in gut motility and inflammatory disorders [93]. Most species of Ficus contain phenolic compounds, organic acids, and volatile compounds [91]. Some species have been reported not to be toxic in rodents [93].
4.9 Musaceae
4.9.1 Musa paradisiaca L.
M. paradisiaca is an herbaceous plant that grows up to about 9 m with a robust treelike false-stem. The unripe fruits and juice of M. paradisiaca is used in folk medicine to treat and manage diarrhea, dysentery, cholera, intestinal lesions, ulcerative colitis, diabetes, sprue, uremia, nephritis, gout, hypertension, cardiac disease, otalgia and hemoptysis [94, 95]. The flowers are also employed in treating dysentery, diabetes and menorrhagia [94]. The root is also used traditionally as an anthelmintic [95], for treating blood disorders and venereal diseases [94]. It is also used as an anti-inflammatory, analgesic and anti-dote for snakebites [96].
The green fruits of M. paradisiaca has been reported to possess anti-hypertensive [97] as well as hypoglycemic effect due to effects on insulin production and glucose utilization [98]. M. paradisiaca inhibits cholesterol crystallization in vitro [99]. M. paradisiaca has also been shown to induce atherosclerosis [100]. There have been reports of the potential of M. paradisiaca flower to enhance milk production of nursing rats [101, 102]. Serotonin, nor-epinephrine, tryptophan, indole compounds, tannin, starch, iron, crystallisable and non-crystallisable sugars, vitamins, albuminoids, fats, mineral salts have been found in the fruit pulp of M. paradisiaca [94] with several other compounds that have been isolated and identified from various parts of the plant [103].
4.10 Ranunculaceae
4.10.1 Nigella sativa L.
N. sativa is a small herb of about 45 cm long with linear-lanceolate leaves and a pale blue flower. It is used as a food and medicine frequently to treat a variety of health conditions pertaining to the respiratory system, digestive tract, kidney and liver functions, cardiovascular system, and immune system support, as well as for general well-being [104] and as a galactagogue [105].
Phytochemical analysis has revealed the presence of nigelline, nigellicine, nigelimine, nigellimine-N-oxide, avenasterol-5-ene, avanasterol-7-ene, campesterol, cholesterol, citrostadienol, cycloeucalenol, sitosterol, stigmasterol, stigmastanol, 24-ethyl-lophenol, obstafoliol [105]. This plant is reported to have anti-cancer, anti-microbial, analgesic, antipyretic, contraceptive and anti-fertility, anti-oxytocic, anti-tussive, anti-inflammatory, and anti-oxidant potentials. Anti-cancer activity has been demonstrated for blood, breast, colon, pancreatic, liver, lung, fibrosarcoma, prostate, and cervix cancer cell lines and in animal models as well [106, 107, 108, 109]. Toxicological studies showed no toxic effect in rodents [105].
4.11 Solanaceae
4.11.1 Solanum torvum Swartz
S. torvum is an evergreen, widely branched, prickly shrub that grows up to 5 m tall [110]. The fruits of S. torvum are edible and commonly available in the markets for incorporation into stews and soups across West-Africa. A decoction of the fruits is given for cough ailments and is considered useful in cases of liver and spleen enlargement. The plant is used as a sedative and diuretic and the leaves are used as a hemostatic. The ripened fruits are used in the preparation of tonic and hemopoietin agents and also for the treatment for pain. It has antioxidant properties. It is intensively used worldwide in traditional medicine as a poison anti-dote and for the treatment of fever, wounds, tooth decay, reproductive problems and arterial hypertension [17, 111, 112, 113]. S. torvum fruits are reported to contain alkaloids, flavonoids, saponins, tannins, glycosides, fixed oil, vitamin B group, vitamin C and iron salts. It also has number of chemical constituents like neochlorogenin 6-O-β-D-quinovo-pyranoside, neochlorogenin 6-O-β-D-xylopyranosyl-(1 → 3)-β-D-quinovopyranoside, neochlorogenin 6-O-α-L-rhamnopyranosyl-(1 → 3)-β-Dquinovopyranoside, sola-genin 6-O-β-D-quinovopyranoside, solagenin 6-O-α-Lrhamnopyranosyl-(1 → 3)-β-D-quinovopyranoside, isoquercetin, rutin, kaempferol and quercetin [16, 113, 114]. S. torvum also possesses antimicrobial, antiviral, immuno-secretory, antioxidant, analgesic, anti-inflammatory, anti-ulcerogenic activities, cardiovascular, nephroprotective, antidiabetic, angiotensin and erotonin receptor blocking activities [110]. It is reported to be used in a concoction to nourish pregnant and lactating mothers with vitamins and proteins and to enhance lactation [115].
4.12 Verbanaceae
4.12.1 Lippia multiflora Moldenke
L. multiflora is an aromatic, perennial plant with woody stems growing up to 3 m high [53]. The plant is locally harvested in Ghana and Benin and the leaves are steeped in hot water for tea. It is used in the treatment of stomach aches, nausea and fever. The leaves and immature flowering stems have anti-biotic, laxative and vermifuge activities [116]. The leaves contain limonene, a-caryophyllene, trans-farnesene, caryophyllene oxide and farnesol [117]. Tea infusion of plant is used for the treatment of arterial hypertension in Ghana [118]. A herbal extract of the plant exhibits anti-malarial, anti-microbial, anti-inflammatory, diuretic, laxative, muscle relaxant and is also used in lactation failure [22]. Lippia oil is effective topically gram-negative bacteria [117] and body lice, head lice, scabies’ mites [119]. This plant possesses a tranquilizer and analgesic activities as diazepam [118].
4.13 Zingiberaceae
4.13.1 Aframomum melegueta (Roscoe) K. Schum
A. melegueta is commonly known as grains of paradise or alligator pepper. It is a spicy edible perennial fruit which grows to about 1 m high. A. melegueta produces reddish-brown seeds, which have a strong aromatic flavor and a pungent taste. These seeds are widely employed as spices and it is also an ingredient in numerous West African ethno medical practices. A. melegueta is a remedy for a number of diseases such as constipation, rheumatic pains and fever [120, 121]. The medicinal uses of A. melegueta also include its use as an aphrodisiac, measles and leprosy. It is also taken to treat excessive lactation, post partem hemorrhage, purgation and used as a galactagogue, anthelmintic and hemostatic [122]. A. melegueta exhibits anti-inflammatory, anti-oxidant and anti-tumor effects [123, 124] as well as anti-protozoal activity against schistosomes [22]. The phytochemical constituents are essential oils—such as gingerol, shagaol, paradol. Alkaloids, flavonoids, saponins, tannins, cardiac glycosides, terpenoids, steroids [125] as well as essential oils and resins have also been identified in this plant [126]. The LD₅₀ of 273.86 mg/kg body weight and lower than normal hemoglobin and red blood cells in animal studies seems to confirm the possibility of toxicity from this plant [125].
5. Conclusion
There are numerous references in literature for herbal medicines use to aid breastfeeding. However, the use of herbal galactagogues is mainly based on empirical traditions with little scientific data. With increase in the complexity of breastfeeding, it is imperative that these herbal galactagogues be studied. There is a need to standardize the herbal galactagogues, investigate their nutritional and phytochemical composition as well as conduct clinical trials to generate scientific evidence of their efficacy and safety, as a basis for commercial production and usage. Conducting pharmacodynamics and pharmacokinetic studies will also play a vital role in determining their metabolism in the mother and neonate. Their mechanism of action will also need to be investigated. These herbs will have the advantages of being easily available, cheaper and more tolerable to both mother and neonate.
Acknowledgments
The authors are grateful to the staff of the Ghana Herbarium for making available published literature on some of the medicinal plants.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"galactagogues, lactation, breastfeeding, medicinal plants",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/64667.pdf",chapterXML:"https://mts.intechopen.com/source/xml/64667.xml",downloadPdfUrl:"/chapter/pdf-download/64667",previewPdfUrl:"/chapter/pdf-preview/64667",totalDownloads:1615,totalViews:389,totalCrossrefCites:2,dateSubmitted:"July 26th 2018",dateReviewed:"October 23rd 2018",datePrePublished:"December 14th 2018",datePublished:"June 19th 2019",dateFinished:"December 5th 2018",readingETA:"0",abstract:"The recommended diet for human infants within the first 6 months of life is breast milk. No other natural or artificial formulation has been able to match up to this gold standard. Mothers who have attempted to pursue exclusive breastfeeding can, however, attest to numerous nutritional and non-nutritional challenges mainly resulting in insufficient milk production (hypogalactia) or the absence of milk production (agalactia). There are very few and officially recommended orthodox drugs to increase lactation. The most widely used galactagogues being chlorpromazine, sulpiride, metoclopramide and domperidone are associated with very high incidences of unpleasant side effects including their extra-pyramidal effects in both mother and infant. There is therefore a need to keep searching for more acceptable galactagogues. This section reviews current literature on medicinal plants used within the local Ghanaian community to enhance lactation. Various electronic databases such as PubMed, Science Direct, SciFinder and Google Scholar as well as published books on Ghanaian medicinal plants were searched. A total of 22 plants belonging to 13 families were reviewed with regards to their medicinal values, information on lactation and toxicity.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/64667",risUrl:"/chapter/ris/64667",signatures:"Emelia Oppong Bekoe, Cindy Kitcher, Nana Ama Mireku Gyima, Gladys Schwinger and Mark Frempong",book:{id:"8290",type:"book",title:"Pharmacognosy",subtitle:"Medicinal Plants",fullTitle:"Pharmacognosy - Medicinal Plants",slug:"pharmacognosy-medicinal-plants",publishedDate:"June 19th 2019",bookSignature:"Shagufta Perveen and Areej Al-Taweel",coverURL:"https://cdn.intechopen.com/books/images_new/8290.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-611-8",printIsbn:"978-1-83880-610-1",pdfIsbn:"978-1-83880-874-7",isAvailableForWebshopOrdering:!0,editors:[{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"186992",title:"Dr.",name:"Emelia Oppong",middleName:null,surname:"Bekoe",fullName:"Emelia Oppong Bekoe",slug:"emelia-oppong-bekoe",email:"emekisseih@yahoo.co.uk",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"280851",title:"Dr.",name:"Cindy",middleName:null,surname:"Kitcher",fullName:"Cindy Kitcher",slug:"cindy-kitcher",email:"cindyasare@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"280852",title:"Dr.",name:"Nana Ama",middleName:null,surname:"Mireku-Gyimah",fullName:"Nana Ama Mireku-Gyimah",slug:"nana-ama-mireku-gyimah",email:"namgyimah@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"280854",title:"Dr.",name:"Mark",middleName:null,surname:"Frimpong",fullName:"Mark Frimpong",slug:"mark-frimpong",email:"mfrimpong@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"280855",title:"Dr.",name:"Gladys",middleName:null,surname:"Schwinger",fullName:"Gladys Schwinger",slug:"gladys-schwinger",email:"odeyschwinger@yahoo.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Challenges with breastfeeding",level:"1"},{id:"sec_3",title:"3. Solutions to breastfeeding challenges",level:"1"},{id:"sec_3_2",title:"3.1 Synthetic galactagogues",level:"2"},{id:"sec_4_2",title:"3.2 Botanical galactagogues",level:"2"},{id:"sec_6",title:"4. Medicinal plants used as galactagogues",level:"1"},{id:"sec_6_2",title:"4.1 Amaryllidaceae",level:"2"},{id:"sec_6_3",title:"4.1.1 Allium sativum L.",level:"3"},{id:"sec_8_2",title:"4.2 Annonaceae",level:"2"},{id:"sec_8_3",title:"4.2.1 Xylopia aethiopica A. rich",level:"3"},{id:"sec_10_2",title:"4.3 Asclepiadaceae",level:"2"},{id:"sec_10_3",title:"4.3.1 Secamone afzelii (Roem. & Schult.) K. Schum",level:"3"},{id:"sec_12_2",title:"4.4 Costaceae",level:"2"},{id:"sec_12_3",title:"4.4.1 Costus afer Ker-Gawl",level:"3"},{id:"sec_14_2",title:"4.5 Euphorbiaceae",level:"2"},{id:"sec_14_3",title:"4.5.1 Euphorbia hirta L.",level:"3"},{id:"sec_15_3",title:"4.5.2 Euphorbia thymifolia wall",level:"3"},{id:"sec_16_3",title:"4.5.3 Hymenocardia acida Tul",level:"3"},{id:"sec_17_3",title:"4.5.4 Plagiostyles africana Prain exDe wild",level:"3"},{id:"sec_18_3",title:"4.5.5 Ricinus communis L.",level:"3"},{id:"sec_20_2",title:"4.6 Leguminosae",level:"2"},{id:"sec_20_3",title:"4.6.1 Tamarindus indica L.",level:"3"},{id:"sec_21_3",title:"4.6.2 Acacia nicolita var. adansonaii (Guill. & Perr.) Brenan",level:"3"},{id:"sec_22_3",title:"4.6.3 Desmodium adscendens (Sw.) DC",level:"3"},{id:"sec_24_2",title:"4.7 Malvaceae",level:"2"},{id:"sec_24_3",title:"4.7.1 Hibiscus sabdariffa Linn",level:"3"},{id:"sec_25_3",title:"4.7.2 Gossypium herbaceum L. (Malvaceae)",level:"3"},{id:"sec_27_2",title:"4.8 Moraceae",level:"2"},{id:"sec_27_3",title:"4.8.1 Milicia excelsa (Welw.) C.C. Berg",level:"3"},{id:"sec_28_3",title:"4.8.2 Ficus sp. L.",level:"3"},{id:"sec_30_2",title:"4.9 Musaceae",level:"2"},{id:"sec_30_3",title:"4.9.1 Musa paradisiaca L.",level:"3"},{id:"sec_32_2",title:"4.10 Ranunculaceae",level:"2"},{id:"sec_32_3",title:"4.10.1 Nigella sativa L.",level:"3"},{id:"sec_34_2",title:"4.11 Solanaceae",level:"2"},{id:"sec_34_3",title:"4.11.1 Solanum torvum Swartz",level:"3"},{id:"sec_36_2",title:"4.12 Verbanaceae",level:"2"},{id:"sec_36_3",title:"4.12.1 Lippia multiflora Moldenke",level:"3"},{id:"sec_38_2",title:"4.13 Zingiberaceae",level:"2"},{id:"sec_38_3",title:"4.13.1 Aframomum melegueta (Roscoe) K. Schum",level:"3"},{id:"sec_41",title:"5. Conclusion",level:"1"},{id:"sec_42",title:"Acknowledgments",level:"1"},{id:"sec_42",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'[Hoddinott P, Tappin D, Wright C. 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Indian Medicinal Plants. Vol. 426. New York, USA: Springer Science+BusinessMedia; 2007]'},{id:"B96",body:'[Coe FG, Anderson GJ. Ethnobotany of the Sumu (Ulwa) of southeastern Nicaragua and comparisons with Miskitu plant loreLa EtnobotÁNica de los Sumu (Ulwa) del Sudeste de Nicaragua y Comparaciones con El saber BotÁNico De los Miskitus. Economic Botany. 1999;54(3):363-386]'},{id:"B97",body:'[Osim EE, Ibu JO. The effect of plantains (Musa paradisiaca) on DOCA-induced hypertension in rats. Pharmaceutical Biology. 1991;29(1):9-13]'},{id:"B98",body:'[Ojewole JAO, Adewunmi CO. Hypoglycemic effect of methanolic extract of Musa paradisiaca (Musaceae) green fruits in normal and diabetic mice. Methods and Findings in Experimental and Clinical Pharmacology. 2003;25(6):453-456]'},{id:"B99",body:'[Saraswathi NT, Gnanam FD. Effect of medicinal plants on the crystallization of cholesterol. Journal of Crystal Growth. 1997;179:611-617. 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DOI: 10.1016/S0031-9422(00)83069-1]'},{id:"B115",body:'[Dickson RA, Amponsah IK, Annan K, Fleischer TC. Nutritive Potential of a Polyherbal Preparation from some Selected Ghanaian Herbs. 2014]'},{id:"B116",body:'[Achigan-Dako EG, Pasquini MW, Assogba Komlan F, N’danikou S, Yédomonhan H, Dansi A, et al. Traditional Vegetables in Benin. Cotonou: Institut National des Recherches Agricoles du Bénin, Imprimeries du CENAP; 2010]'},{id:"B117",body:'[Bassole IHN, Ouattara AS, Nebie R, Ouattara CAT, Kabore ZI, Traore SA. Chemical composition and antibacterial activities of the essential oils of Lippia chevalieri and Lippia multiflora from Burkina Faso. Phytochemistry. 2003;62(2):209-212. DOI: 10.1016/S0031-9422(02)00477-6]'},{id:"B118",body:'[Brankov K, Hadzovic S, Erdeljan D. Efficiency of reactivators and spasmolytics after Amitone poisoning in vitro. Arhiv za Higijenu Rada i Toksikologiju. 1976;27(2):123-130]'},{id:"B119",body:'[Oladimeji FA, Orafidiya OO, Ogunniyi TAB, Adewunmi TA. Pediculocidal and scabicidal properties of Lippia multiflora essential oil. Journal of Ethnopharmacology. 2000;72(1-2):305-311. DOI: 10.1016/S0378-8741(00)00229-4]'},{id:"B120",body:'[Fernandez X, Pintaric C, Lizzani-Cuvelier L, Loiseau AM, Morello A, Pellerin P. Chemical composition of absolute and supercritical carbon dioxide extract of Aframomum melegueta. Flavour and Fragrance Journal. 2006;21(1):162-165]'},{id:"B121",body:'[Ajaiyeoba EO, Ekundayo O. Essential oil constituents of Aframomum melegueta (roscoe) K. Schum. Seeds (alligator pepper) from Nigeria. Flavour and Fragrance Journal. 1999;14(2):109-111]'},{id:"B122",body:'[Iwu MW, Duncan AR, Okunji CO. New antimicrobials of plant origin. In: Perspectives on New Crops and New Uses. Alexandria, VA: ASHS Press; 1999. pp. 457-462]'},{id:"B123",body:'[Ilic NM, Dey M, Poulev AA, Logendra S, Kuhn PE, Raskin I. Anti-inflammatory activity of grains of paradise (Aframomum melegueta Schum) extract. Journal of Agricultural and Food Chemistry. 2014;62(43):10452-10457]'},{id:"B124",body:'[Chung WY, Jung YJ, Surh YJ, Lee SS, Park KK. Antioxidative and antitumor promoting effects of [6]-Paradol and its homologs. Mutation Research/Genetic Toxicology and Environmental Mutagenesis. 2001;496(1):199-206]'},{id:"B125",body:'[Akpanabiatu MI, Ekpo ND, Ufot UF, Udoh NM, Akpan EJ, Etuk EU. Acute toxicity, biochemical and haematological study of Aframomum melegueta seed oil in male Wistar albino rats. Journal of Ethnopharmacology. 2013;150(2):590-594. DOI: 10.1016/j.jep.2013.09.006]'},{id:"B126",body:'[Okwu DE. Phytochemicals vitamins and mineral contents of two Nigerian medicinal plant. International Journal of Molecular Medicine and Advance Sciences. 2005;1(4):375-381]'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Emelia Oppong Bekoe",address:"emekisseih@yahoo.com",affiliation:'- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Ghana, Ghana
'},{corresp:null,contributorFullName:"Cindy Kitcher",address:null,affiliation:'- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Ghana, Ghana
'},{corresp:null,contributorFullName:"Nana Ama Mireku Gyima",address:null,affiliation:'- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Ghana, Ghana
'},{corresp:null,contributorFullName:"Gladys Schwinger",address:null,affiliation:'- Department of Plant and Environmental Science, University of Ghana, Ghana
'},{corresp:null,contributorFullName:"Mark Frempong",address:null,affiliation:'- Department of Obstetrics and Gynecology, University Hospital, Ghana
'}],corrections:null},book:{id:"8290",type:"book",title:"Pharmacognosy",subtitle:"Medicinal Plants",fullTitle:"Pharmacognosy - Medicinal Plants",slug:"pharmacognosy-medicinal-plants",publishedDate:"June 19th 2019",bookSignature:"Shagufta Perveen and Areej Al-Taweel",coverURL:"https://cdn.intechopen.com/books/images_new/8290.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",isbn:"978-1-83880-611-8",printIsbn:"978-1-83880-610-1",pdfIsbn:"978-1-83880-874-7",isAvailableForWebshopOrdering:!0,editors:[{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"180699",title:"Dr.",name:"Jiri",middleName:null,surname:"Pribil",email:"umerprib@savba.sk",fullName:"Jiri Pribil",slug:"jiri-pribil",position:null,biography:null,institutionString:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"2",totalEditedBooks:"0",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[],chaptersAuthored:[{id:"52090",title:"Analysis of Acoustic Noise and its Suppression in Speech Recorded During Scanning in the Open-Air MRI",slug:"analysis-of-acoustic-noise-and-its-suppression-in-speech-recorded-during-scanning-in-the-open-air-mr",abstract:"The paper focuses on describing three methods of noise reduction in the speech signal recorded in an open-air magnetic resonance imager (MRI) working in a weak magnetic field during human phonation for the vocal tract modelling. This paper also analyses and compares spectral properties of the acoustic noise produced by mechanical vibration of the MRI device gradient coils. Then, the experiment with mapping of noise sound pressure level (SPL) in the MRI neighbourhood is described. The changes in acoustic noise spectral properties caused by loading of the holder of the lower gradient coils by the weight of the examined person lying in the scanning area of the MRI device is evaluated too. The influence of setting of the basic scan parameters of the used MR sequence (TR and TE times) on the spectral properties of the generated acoustic noise is also analysed. The results achieved are used to create a database of initial MR scan parameters such as the filter bank for noise signal pre-processing and to design a correction filter for noise suppression in the speech signal recorded simultaneously with three-dimensional (3D) human vocal tract scanning.",signatures:"Jiří Přibil, Anna Přibilová and Ivan Frollo",authors:[{id:"34650",title:"Dr.",name:"Anna",surname:"Pribilova",fullName:"Anna Pribilova",slug:"anna-pribilova",email:"Anna.Pribilova@stuba.sk"},{id:"180699",title:"Dr.",name:"Jiri",surname:"Pribil",fullName:"Jiri Pribil",slug:"jiri-pribil",email:"umerprib@savba.sk"},{id:"180785",title:"Prof.",name:"Ivan",surname:"Frollo",fullName:"Ivan Frollo",slug:"ivan-frollo",email:"umerollo@savba.sk"}],book:{id:"5240",title:"Advances in Noise Analysis, Mitigation and Control",slug:"advances-in-noise-analysis-mitigation-and-control",productType:{id:"1",title:"Edited Volume"}}},{id:"66196",title:"Analysis of Energy Relations between Noise and Vibration Produced by a Low-Field MRI Device",slug:"analysis-of-energy-relations-between-noise-and-vibration-produced-by-a-low-field-mri-device",abstract:"Magnetic resonance imaging (MRI) tomography is often used for noninvasive scanning of various parts of a human body without undesirable effects present in X-ray computed tomography. In MRI devices, slices of a tested subject are selected in 3D coordinates by a system of gradient coils. The current flowing through these coils changes rapidly, which results in mechanical vibration. This vibration is significant also in the equipment working with a low magnetic field, and it causes image blurring of thin layer samples and acoustic noise significantly degrading a speech signal recorded simultaneously during MR scanning of the vocal tract. There are always negative physiological and psychological effects on a person exposed to vibration and acoustic noise. In order to minimize these negative impacts depending on intensity and time duration of exposition, we mapped relationship between energy of vibration and noise signals measured in the MRI scanning area and its vicinity.",signatures:"Jiří Přibil, Anna Přibilová and Ivan Frollo",authors:[{id:"34650",title:"Dr.",name:"Anna",surname:"Pribilova",fullName:"Anna Pribilova",slug:"anna-pribilova",email:"Anna.Pribilova@stuba.sk"},{id:"180699",title:"Dr.",name:"Jiri",surname:"Pribil",fullName:"Jiri Pribil",slug:"jiri-pribil",email:"umerprib@savba.sk"},{id:"180785",title:"Prof.",name:"Ivan",surname:"Frollo",fullName:"Ivan Frollo",slug:"ivan-frollo",email:"umerollo@savba.sk"}],book:{id:"7778",title:"Noise and Vibration Control",slug:"noise-and-vibration-control-from-theory-to-practice",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"151307",title:"Dr.",name:"Min",surname:"Lei",slug:"min-lei",fullName:"Min Lei",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/151307/images/system/151307.jpg",biography:"Dr. Min Lei has worked at Shanghai Jiaotong University as an associate professor since 2004. From February 2003 to February 2004, she worked as a research fellow in the Department of Mechanical Engineering, Nanyang University of Technology, Singapore. From 2000 to 2002, she worked as a postdoctoral fellow in the Institute of Mechanical and Electrical Control, School of Mechanical and Power Engineering, Shanghai Jiaotong University. She received a doctoral degree from the Department of Biomedical Engineering, Shanghai Jiaotong University, in 2000. Dr. Lei has long been engaged in biomedical signal processing, modern signal processing, pattern recognition and classification, and nonlinear dynamics.",institutionString:"Shanghai Jiao Tong University",institution:{name:"Shanghai Jiao Tong University",institutionURL:null,country:{name:"China"}}},{id:"180587",title:"Mr.",name:"Thomas",surname:"Haase",slug:"thomas-haase",fullName:"Thomas Haase",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"German Aerospace Center",institutionURL:null,country:{name:"Germany"}}},{id:"180717",title:"Dr.",name:"Elisabete",surname:"Freitas",slug:"elisabete-freitas",fullName:"Elisabete Freitas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Minho",institutionURL:null,country:{name:"Portugal"}}},{id:"181200",title:"Dr.",name:"Antonio",surname:"Uris",slug:"antonio-uris",fullName:"Antonio Uris",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Universitat Politècnica de València",institutionURL:null,country:{name:"Spain"}}},{id:"185588",title:"Dr.",name:"Constanza",surname:"Rubio",slug:"constanza-rubio",fullName:"Constanza Rubio",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Valencia",institutionURL:null,country:{name:"Spain"}}},{id:"185589",title:"Dr.",name:"Sergio",surname:"Castiñeira-Ibáñez",slug:"sergio-castineira-ibanez",fullName:"Sergio Castiñeira-Ibáñez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"185590",title:"Dr.",name:"Juan Vicente",surname:"Sánchez-Pérez",slug:"juan-vicente-sanchez-perez",fullName:"Juan Vicente Sánchez-Pérez",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"185591",title:"Dr.",name:"Pilar",surname:"Candelas",slug:"pilar-candelas",fullName:"Pilar Candelas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"185592",title:"Prof.",name:"Francisco",surname:"Belmar",slug:"francisco-belmar",fullName:"Francisco Belmar",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"188749",title:"MSc.",name:"João",surname:"Lamas",slug:"joao-lamas",fullName:"João Lamas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"order-print-copies-terms",title:"Order Print Copies - Terms",intro:".
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