Evaluation of Internal Audit as a Veritable Control Machinery for Efficient Management in Public Enterprises

Evaluation of Internal Audit as a Veritable Control Machinery for Efficient Management in Public Enterprises

Chapter One

Aims and Objectives of the Study

The aim of the study

This study aims to investigate the genetic structure and variation of population in Kogi State, Nigeria, with respect to ABO blood group and Rhesus factor.

Objectives of the study

The objectives of the study are to:

describe the genetic structure of Kogi State indigenes with respect to ABO and Rh blood groups.
describe the pattern of distribution of ABO and Rh blood groups among the ethnic groups of Kogi State.
investigate any association between blood groups and some disease and physiological traits.
provide baseline data on ABO and Rh blood groups for scientists, health professionals, health-care providers and policy makers in Kogi State.

CHAPTER TWO

LITERATURE REVIEW

Blood Group Antigens

The cells that make up the body’s tissues and organs are covered with surface markers, or antigens (Dean, 2005). Antigens are foreign substance which, when injected parenterally into an animal lacking that substance, cause the production of antibodies to those antigens (Faller et al., 2004; Rastogi, 2008). For well over a century, blood group antigens have been recognized as differences between the red blood cells (RBCs) of one person and another. Antigens have been defined by human antibodies, immune and ‗naturally occurring‘, as well as those deliberately stimulated in animals (Storry and Olsson, 2004). RBC of individual have either A or/ and B surface antigens often called agglutinogens (blood group A, B or AB) or neither both and are referred to as blood group O (Martini, 2004).

Human blood is not the same, people belong to different blood groups, depending upon the surface markers found on the red blood cell (Dean, 2005). The two main blood groups are called ABO (with blood types A, B, AB, and O) and Rh (with Rh D-positive or Rh D-negative blood types). Both are useful in blood transfusion and organ transplantation (Khan et al., 2009, Eweidah et al., 2011). The system was first described with three antigens, six genotypes and four phenotypes, but has now been shown to be highly polymorphic (Chester and Olsson, 2001). In addition to the well known ABO classified groupings, and Rh factor, there are over 260 “minor” antigens that can complicate blood transfusions have been identified. About one person in 1,000 inherits a rare Blood type. These antigens may appear in varying combinations. The presence or absence of these 7 specific “minor” antigens single out that particular blood type as being “rare” (Beckman, 2008). ABO blood groups are defined by carbohydrate moieties on the extracellular surface of the red blood cell membranes (Turcot et al., 2003; Jeremiah, 2006). Along with their expression on red blood cells, ABO antigens are also highly expressed by epithelial and endothelial cells, and in secretor type individuals they are also expressed on mucins secreted by exocrine glands (Yamamoto et al., 2014). Red blood cell antigens have various functions, including membrane structural integrity, transportation of molecules through membranes, and adhesion (Anstee, 2010, Xie et al., 2010; Than et al., 2011).

The antigens expressed on the red blood cell determine an individual’s blood group. The associated anti-A and anti-B antibodies are usually IgM antibodies, which are usually produced in the first years of life between 2-8 months after birth (Garatty, 2005) by sensitization to environmental substances such as food, bacteria, and viruses (Dean, 2005; Damulak et al., 2011). Hence, individuals of blood group O contain antibodies to A and B antigens (anti AB), group A contains anti B and group B has anti A in their serum (Yamamoto et al., 2012).

CHAPTER THREE

MATERIALS AND METHODS

Study Location

The study was carried out in Kogi State College of Nursing and Midwifery, Obangede located in Okehi LGA (in the central senatorial District) of the State. The college was established in 1980 by the then Kwara State Government and is the only Government owned training institution for Nurses in the State, and hence admission into the college is on quota basis.

Approval of the authority was obtained for this study from the College management for access to health and other records of the students. Records of admitted students into the College of different ages (16 and 40years old) and sexes spanning 11 years (2002–2013) consecutively was retrospectively and prospectively collected from the various record units of the College (Registry, Exams Office and Sickbay).

Study Population

This study was designed to investigate the gene frequencies for the ABO and Rh (D) blood groups in a population consisting of different tribes, sexes and ages in Kogi State, Nigeria, (using those that attended Kogi State College of Nursing and Midwifery, Obangede) over a period spanning 11 years (2002–2013).

Kogi state is one of the 36 states in Nigeria, is located in the middle belt region, north-central Nigeria. The State was founded in 1991 from parts of Kwara State and Benue State (6⁰37′N 5⁰29′E and 8⁰41′N 7⁰33′E) with a total land area of 29,833km² (11,519 sq miles).The State as presently constituted is made up of 21 Local Government Areas,

There are three main ethnic groups and languages in Kogi: Igala, Ebira, and Okun with other minorities like Bassa, a small fraction of Nupe, Koton, Oworo and Ogori Magongo community with a total population of 3,314,043. The climatic condition of the state is Savannah and the inhabitants are largely farmers.

CHAPTER FOUR

RESULTS

Analyses of Study Population

The scope of this study was restricted to the students of Kogi State College of Nursing and Midwifery, Obangede in Okehi Local Government Area who are indigene of the State. Participants (males n= 436 and females n=1427) aged 16-40 years collected constituted the analytic subjects. It is interesting to note here that the low sex ratio in male students is due to having pretty high number of female sex studying Nursing sciences as compared to the male gender. Data were recorded after obtaining necessary permission from Health Research Ethic Committee of Ahmadu Bello University, Zaria and from relevant authority of the school after reviewing the study protocols (guidelines). The anthropometrics including height and weight of each subject were measured using standard height and weight (mechanical) scale respectively, following a standard technique by trained investigators on resumption in the College.

Descriptive Statistics of Study Population

The mean and standard deviation (SD) of mean values of age and anthropometrics of the participants are shown in Table 4.1. Age and anthropometric pattern of female and male subjects were not uniform (p <0.05) except BMI that appears to be uniform for both sexes (p > 0.05). The mean height of female subjects was found to be smaller than that of their male counterparts. Male subjects were also heavier and older than their female counterparts.

CHAPTER FIVE

DISCUSSION

Distribution of ABO Blood Groups

ABO and Rh genes and phenotypes are not equally distributed (Adeyemo and Soboyejo, 2006; Akinnuga, 2011) .There are wide variations in racial distribution of ABO antigens despite the fact that the antigens involved are stable throughout life (Enosolease and Bazuaye, 2008; Rai et al., 2009; Chima et al., 2012).

The study of distribution of blood groups is important as it plays a vital role in genetics, blood transfusion, organ transplantation, genetic research, human evolution (Harvey and David, 2005), forensic pathology and some groups have shown associations with diseases like duodenal ulcer (Ziegler et al., 2004), diabetes mellitus (Akhta et al., 2003), urinary tract infection (Qureshi and Bhatti, 2003) and Rh and ABO incompatibilities of newborn (Mourant et al., 1978). Forensic application of blood group studies is of great value in detection of crime (Eweidah et al., 2011).

CHAPTER SIX

CONCLUSION AND RECOMMENDATION

Conclusion

Data from this study have provided information on the genetic variability and polymorphism of the blood group and rhesus antigens among the various ethnic groups that make up Kogi State, Nigeria. With a large sample used in this research, the result obtained shows that the ABO and Rh blood groups distribution pattern in Kogi State conforms with the general pattern across Nigeria and many parts of the world in which blood group O is most predominant while group AB is the lowest, however blood groups A and B shows close proximity. The result for RH blood group is also in conformity with the generally reported trend reported among African with RH positive being commonest. The frequencies of ABO and Rh blood groups however appeared to be stable and consistent with previous published data. The result indicates that there is association between ABO blood group/Genotype, malaria and intelligence. This information would be useful to the geneticists and to the clinicians especially in the planning of blood transfusion programmes since they play integral role of the genetic profile of the Nigerian population.

These reports clearly present the distribution and more importantly, the gene frequencies of the alleles controlling the ABO and Rh blood group system and haemoglobin variants for samples of the Nigerian population in Kogi State. Data obtained may serve as reference for other studies in this field. It may also be useful in the planning of blood transfusion programmes, since they are an integral part of the genetic profile of the Nigerian population.

The result from the present study shows there is a gradual decline in the prevalence of abnormal haemoglobin variants (HbSS) in our black population which could be traced to increase awareness among the people of the abnormality and hence guiding against the occurrence.

The present study is original in that, it is the first comprehensive study that documented the distribution of ABO and RHD blood groups among the different ethnic groups that make up Kogi State, Nigeria. This study could have significant implications for the major blood banks across Kogi State where certain blood groups are needed more than others in emergency conditions. Furthermore, the data generated in this study would be helpful to the researchers in the field of population genetic to explore the factors responsible for the observed distribution patterns of these genetic markers in this part of West Africa

In terms of association of ABO blood groups with certain traits, the present study reveals that there is association with diseases like malaria, hepatitis and academic performance of the subjects. There is also a weak association with BMI, height and weight.

Recommendations

It is recommended that:

Further studies on this topic should be conducted due to its importance in the educational field and usefulness in the effective management of blood banksand in blood transfusion services, to geneticists, biologists, policy makers and Studies should be carried out in the general population not limiting it to school environment in which some categories of people are naturally disadvantaged in gaining admission and coping with the college activities and hence not adequately represented.
Studies should be carried out on all age groups to really ascertain if age has any association to the blood group

Contribution to Knowledge

The present study provides the initial data on the distribution of ABO and RH(D) blood groups in Kogi State, Nigeria and hence it will provide material and serve as reference point for further studies.

To the best of my knowledge,the present study is the first study to show association between blood groups and academic performance in Nigeria school with χ² = 28.24, p = 0.001.

The present study shows that there is association between ABO blood group and malaria infection with χ² = 129.29, p = 0.001. Blood group AB conferred more resistance and blood group O more susceptible to the disease.

The present study shows that there is association between ABO blood group and hepatitis B infection especially in males with χ² = 22.12, p = 0.001 while in the general population, it is a weak association with χ² = 1.60, p = 0.660

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