Effects of Vitamin A Deficiency in Primary School Pupils
Effects of Vitamin A Deficiency in Primary School Pupils
Effects of Vitamin A Deficiency in Primary School Pupils
BY
FATIMA BELLO
HEPCD/19/006
PROMOTION
MARCH, 2021
DECLARATION
derived from the literature was duly acknowledged in the text and a list of
references provided. No part of this project was previously presented for any
__________________________ _______________
FATIMA BELLO Date:
HEPCD/19/006
ii
APPROVAL PAGE
__________________________ ______________________
Project Supervisor Date
Malam Sanusi Umar Radda
__________________________ ______________________
Director, Consultancy Service Unit Date
Malam Sani Aliyu Runka
__________________________ ______________________
External Supervisor Date
iii
DEDICATION
Funtua and my Mothers Hajiya Hauwa’u Abubakar Garba and Hajiya Aisha
completion level.
iv
ACKNOWLEDGEMENT
I seek the protection of Allah (SWT) against devil (Shaidan) and his act.
In the name of Allah, the most gracious the most merciful; All praises are to
Allah the lord of the world owner of the Day of Judgment, the creator of all
level
Sanusi Umar Radda who dedicated and fervent himself, in guiding and
Health Technology, Kankia may Allah reward them all with Jannatul
Firdausi Amen.
v
TABLE OF CONTENTS
Cover Page i
Declaration ii
Dedication iv
Acknowledgement v
Table of Contents vi
Abstract viii
CHAPTER ONE: INTRODUCTION
1.1 Introduction 1
1.2 Background of the Study 1
1.3 Statement of the Problem 3
1.4 Purpose/Objectives of the Study 4
1.5 Significance of the Study 4
1.6 Research Question/Hypothesis 5
1.6.1 Research Hypothesis 5
Vitamin ‘A’ is a one of the most important vitamins which plays a vital role
in normal vision. This is aimed to find out the causes of vitamin ‘A’
deficiency among children; to find out the measures of preventing and
controlling vitamin ‘A’ deficiency and also to health educate people on
important of giving the children vitamin ‘A’ in their meals. The main scope
of the research project is limited only to the effects of vitamin ‘A’ deficiency
among pupils of Funtua Model primary School, Funtua Local Government
Area Katsina State. The research method adopted was descriptive research
method and Questionnaire was used in the research work for uniform data
collection. The research findings which were obtained through the method
of data collection applied showed that the majority of the respondents
representing 98% are agreed the vitamin ‘A’ can help in growth and
development of the children; However, as regards to the awareness and
knowledge of the respondents 86% strongly agreed that immunization and
supplementation of vitamin ‘A’ can prevent vitamin ‘A’ deficiency. The
study has also found most of the respondents accounting 91.8% agreed that
vitamin ‘A’ deficiency is a major cause of non-accidental blindness and also
another finding showed that few of the respondents representing 6.2%
disagreed that vitamin ‘A’ deficiency is a major cause of non-accidental
blindness.
viii
CHAPTER ONE
1.1 INTRODUCTION:
terms.
Vitamin ‘A’ is a one of the most important vitamins which plays a vital role in
the two distinct photoreceptor systems that is rods and cones (Burton 1913.)
Vitamin ‘A’ deficiency constitute one of the major public health problem
Asia, and South America are especially susceptible because their inadequate
intake and diminished store of vitamin ‘A’ fails growth. Among the world’s
year because they lack vitamin ‘A’. Currently, vitamin ‘A’ deficiency is
Mended, et-al (1973) demonstrated that, the rate of developing eye irritation
1
To remedy the situation, the Nigerian Government in collaboration with
action for the prevention and control of vitamin ‘A’ deficiency. The overall
employed until food fortification has solved the problem and it included the
Consideration for plan of action was provided by the world summit for children
held at the United Nations in New York in September, 2000 where 71 Heads of
The research topic was aimed to study/investigate the effects of vitamin ‘A’
Funtua Local Government Area, Katsina State. Moreover, effects have been
made to highlight how important the vitamin ‘A’ was especially in regeneration
of visual purple to retina, and also maintenance of epithelial tissue. Again, some
of the diseases associated with the deficiencies of that vitamin were reviewed
This research work is based on information from the area of the study, that is
Funtua Central primary school, on the effect of vitamin ‘A’ deficiency among
primary school pupils which is a major problem in Funtua because there are
people that have low socio-economic status and hence they cannot provide their
health problems. So for vitamin ‘A’ deficiency it was also identified to play
as some families in general have little knowledge about the proper diet to be
3
taken, rather they consumed stable foods always which are deficient in many
Sequel to the above that is low socio-economic status and ignorance which are
significant role in the prevalence of the problem in the area of study. As some
cultures and traditions deprived children from eating certain valuable food
a. To find out the causes of vitamin ‘A’ deficiency among children in the
in their meals.
4
1.5 SIGNIFICANCE OF THE STUDY:
The research work on this topic would be significant in the following areas:-
a. It would help on finding out the actual factors associated with the
c. It would also play a central role in arousing the interest of policy makers
nutrient deficiency.
d. It would provide the basis for further research for any students who want
d. Did over cooking of food which contains vitamin ‘A’ lead to the
5
1.6.1 RESEARCH HYPOTHESES:
b. Are washing of vegetables which contain vitamin ‘A’ lead to the loosing
The main scope of the research project is limited only to the effects of vitamin
‘A’ deficiency among pupils of Funtua Model primary School, Funtua Local
Government Area Katsina State. This research topic is not aimed at studying
The researcher limited himself to this topic and this very area due to some
problems. So it was hoped that other researchers would cover the effects of
6
1.8 DEFINITION OF TERMS:
FOOD: Food is one of the basic needs of man and indeed of all living
things. It is required for growth and replacement of worm out or
broken tissue and also for the production of energy for various body
functions.
BALANCE DIET: Is the food that contain correct proportion of all nutrients
that is vitamin, minerals, calcium, phosphorus, potassium, chlorine, sulphur,
magnesium, and other trace element and dietary fibre, as well as water,
carbohydrates, and fat (which provide energy) and proteins require for growth
and maintenance.
MALNUTRITION: Is the condition caused by a improper balance between
what an individual eats and what he requires to maintain health.
VITAMINS: Are essential organic food factors required for normal growth
and development, building of resistance to infectious and maintenance of the
integrity and normal function of various system of the body.
DEFICIENCY DISEASE: Any disease caused by the lack of an
essential nutrient in the diets. Example vitamin essential amino acid
and fatty acid.
BLINDNESS: Is the visual acuity of less 3/60 in better eye with best
correction (Oladipo 2011).
RODS: Is a photoreceptor in the retina that control the day vision
CONES: Is a photoreceptor in the retina that control the day vision
KERATOMALACIA: Softening of the cornea of the eye leading to
blindness.
XEROPHTHALMIA:- Dryness of the cornea and conjunctiva
FOLLICULAR KEROTOSIS:- Skin condition characterized by
dryness of the skin.
7
CHAPTER TWO
2.1 INTRODUCTION:
The chapter contained Literature review, vitamin ‘A’, role of vitamin ‘A’ in the
body, vitamin ‘A’ in vision, source of vitamin ‘A’, function of vitamin ‘A’,
children under the age of 12 years of age around the World. It is estimated to
claim the lives of 670,000 children under twelve (12) years annually.
blind each year owing to vitamin ‘A’ deficiency with the highest prevalence in
South East Asia and Africa (National Institution of Health. Retrieved, 2008)
Vitamin ‘A’ deficiency can occur as either a primary vitamin ‘A’ deficiency or
and adults who do not consume and adequate intake of vitamin ‘A’ carotenoids
8
exposure to oxidants, such as cigarette smoke and chronic alcoholism. (Combs,
Gerald. 2008).
Vitamin ‘A’ is a fat soluble vitamin and depends on micelle solubilization for
depression into the small intestine, which result inpoor use of vitamin ‘A’ from
low fat diets. World Health organization (WHO), (Global prevalence of vitamin
series of changes, the most devastating which occur in the eye. Some other
This is followed by the blind up of keratin plaques (Bitots spots) and eventually
Louis, mo).
Excess vitamin ‘A’ which is most common in high dose vitamin supplement
can cause birth defects and there should exceed recommended daily values.
2009).
deficiency are led by the Global Alliance for vitamin ‘A’ (GAVA), which is an
International children and emergency Fund (UNICEF), United State Agency for
24% About 75% of the vitamin ‘A’ required for supplementation activity by
becoming increasingly feasible but cannot yet ensure coverage levels. The
world health organization has averted 1.25 million deaths due to vitamin ‘A’
10
deficiency in 40 countries since 1998. (Rosen Bloom, Mark.Emedicine). Since
vitamin ‘A’ is fat soluble, disposing of any excess taken in through diet takes
much longer then with water soluble B vitamin and vitamin C. this allows for
early research work was concerned with dietary factors which will prevent
classical deficiencies like night blindness, for vitamin ‘A’; Rickets vitamin D;
Scurvy for vitamin C; and beriberi for vitamin B 3. All of the above, used to
diet.
More knowledge of vitamin action was later obtained from annual experiment
“vitamin rates”. The most significant attainment of modern research in this field
2.3 VITAMIN A:
Vitamin ‘A’ (or vitamin ‘A’ Retinol, retinal, and four carotenoids including
beta carotene) is a vitamin that is needed by the retina of the eye in the form of
a specific metabolite the light absorbing molecule retinal that is necessary for
both low light (scotopic vision) and colour vision. Vitamin ‘A’ also functions in
11
a very different role as an irreversibly oxidized form of retinol know as an
retinoic acid which is an important hormones – like growth factor epithelial and
other cells. (Vitamin ‘A’ News medical Retrieved 1st May, 2012).
Reshaping requires vitamin ‘A’ to undo existing bones. Vitamin ‘A’ maintains
infection and assuring optimum function. Hormone life effect of vitamin ‘A’
2000).
Vitamin ‘A’ plays a role in a variety of functions throughout the body, such as:-
Vision
Gene transcription
Immune function
Embroyonic development
Bone metabolism
Haemotopoiesis
Skin and cellular health
Antioxidant activity.
VISION: The role of vitamin ‘A’ in the visual cycle is specifically related to
the retinal form within the eye 11-cis-retinal is bound to rhodopsin (rods)
12
and idopsin (cones) at conserved lysine residues. As light enters the eye, the
11-cis-retinal is isomerizes to the all – “trans” form. The all – “trans” retinal
dissociated from the opsin in a series of steps called photo bleeding. (Mc
GENE TRANSCRIPTION:
Vitamin ‘A’ in the retinoid acid form, plays an important roles in gene
regulated, due to its activity as lig and for nuclear receptors the physiological
Vitamin ‘A’ has several functions in the body. The most well known is its
role in vision – hence carrots “make you able to see in the dark”. The retinol
from 11 – cis form to the all-trans form, initiating a chain of events which
Preformed vitamin ‘A’ is found in dark green and yellow vegetables and
yellow fruits, such as broccoli spinach, turnip greens, carrots, squash, sweet
vitamin ‘A’ are highest in liver and fish oils. Other sources of preformed
vitamin ‘A’ comes from leafy green, vegetable, orange and yellow
vegetables, tomato products, fruits and some vegetable oils. The top food
preventing of night blindness, proper new cell growth, hair and associated
14
i. Vitamin ‘A’ reduces the complication of nutritional diseases like
iii. Helps the digestive, respiratory tract and cornea of the eye to resist
infection.
iv. Also for proper intake of vitamin ‘A’ reduces the complication of
Vitamin ‘A’ deficiency exist when the chronic failure to eat sufficient
vitamin ‘A’ that are below a defined range. Beta-carotene is a form of pre-
vitamin ‘A’ which is readily converted to vitamin ‘A’ in the body – Night
severe deficiency of vitamin ‘A’ can produce total and irreversible blindness
(McGraw, 2013).
15
Vitamin ‘A’ status depends mostly on independency of vitamin ‘A’ stores,
90 percent of which are in the liver. Vitamin ‘A’ status also depends on a
person’s protein status because retinol blinding protein serve as the vitamin
symptom would not begin to appear until after store depleted one to two
years for a healthy adult but much sooner for a growing child. Then the
More than 100 million children worldwide have some degree of vitamin ‘A’
ii. Clinical where there are ocular sigh collectively called xerophthalmia
16
significantly to maternal morbidity and mortality and may play a role in the
The major causes of vitamin ‘A’ deficiency is diets which include few
with vitamin ‘A’ deficiency containing little vitamin ‘A’, which provides a
breast fed child with too little vitamin ‘A’. (Sltop, 2008).
deficiency. Iron deficiency can affect vitamin ‘A’ uptake. Excess alcohol
consumption can deplete vitamin ‘A’ and a stressed liver may be more
alcohol should seek medical advice before taking vitamin ‘A’ supplements.
In general, people should seek medical advice before taking vitamin ‘A’
supplements if they have any associated with fat mal-absorption such as:
million children to have some degree of visual loss related to VAD. Night
17
blindness and it worsened condition xerophthalmia are markers of VAD, as
VAD can also lead to impaired immune function, cancer and birth defects.
Night blindness is the difficulty for eyes to adjust to dim light. Affected
People with night blindness have poor vision in the darkness, but see
the retina and is composed of retinal (an active form of vitamin ‘A’) and
rhodopsin in the eye, as there is inadequate retinal to bind with opsin, night
blindness results.
Treatment of vitamin ‘A’ deficiency can be undertaken with both oral and
reducing mortality from measles and all cause mortality. The studies has
18
shown that vitamin ‘A’ supplementation to children 6-12 years who are
at risk of vitamin ‘A’ deficiency can reduce all cause mortality by 23%
(Geueva, 1993).
ii. Food fortification is also useful for improving vitamin ‘A’ deficiency ‘A’
variety of oily and dry forms of the retinol esters, retinal acetates and
Margarine and oil are the ideal food vehicles for vitamin ‘A’ fortification.
They protect vitamin ‘A’ from oxidation during storage and prompt
form of vitamin ‘A’ for vitamin ‘A’ fortification of fat based foods.
iii. Dietary diversification can also control vitamin ‘A’ deficiency. Non-
account for greater than 80% of intake for most individuals in the
DEFICIENCY:
Prevention and control of vitamin ‘A’ deficiency can be achieved in two (2)
phases:
19
2.10.1 DIETARY CONTROL:
intake of foods rich in vitamin ‘A’; Vitamin ‘A’ deficiency can be prevented
mass production of carotene rich foods. The health team should make
awareness the public on the importance of vitamin ‘A’ intake through foods,
such as; palm oil, oranges, fruits, vegetable, dark green leaves, milk and egg
yolk etc.
including kerotomalacia.
Those programmes are usually linked to or are part of the primary health
care system as such exists. They can facilitate the regular delivery of vitamin
‘A’ to children particularly as such people are at high risk of trachoma and
blindness.
tract infections, Diarrhoea and measles. All are long term measures
20
involving intensive nutrition education of public and community
participation. Since vitamin ‘A’ can be stored in the body for 6–9 months
and liberated. Slowly, a short term, simple technology had been resolved by
months to pre-school children 1 – 6 years, and half that dose 100,000 I.U to
children between 6 months and one year of age. In this way the child would
21
CHAPTER THREE
3.1 INTRODUCTION:
The research methods adopted for the research work was descriptive, non-
‘A’ deficiency among Funtua Model Primary School pupils. The descriptive
and Funtua.
and 570, 110 according to 2016 estimate. The Chairman is the official Head
the second largest city in the state after Katsina. It borders with Giwa Local
Government of Kaduna State to the south, Bakori to the east, Danja to the
The postal code of the area is 830. The source of the Sokoto River is located
near Funtua.
Funtua has been an industrial and commercial centre since colonial days,
Integrated Flour Mills, Funtua Bottling Company, Salama Rice Mills etc.
Transport
Educational Institutions
students from all over the country, one is a remedial school known as
24
ABU Zaria, Imam Saidu College of Education, which awards NCE. Also
from Mando receiving Station via Zaria and from there it extends to Gusau
problem much because the town enjoys electricity for good 12–20 hours
As for Water Supply; Funtua is blessed with 2 dams, namely; Mairuwa and
Gwagwaye that served the city and some parts of Faskari and Bakori Area
councils.
The 2 water bodies can be utilized for other things such as irrigation and
25
Funtua Inland Container Dry Port
the 2006, in which Funtua is among the host. presently the work is in
progress at the site and when completed, the dry port would provide job
3.4 POPULATION:
in the 2006 Census. However the people living within Funtua local
government are mostly Hausa and Fulani which covered about 99% of the
population and Igbo, Yoruba and other tribes covered only of the population.
The local government consist (5) secondary schools, (52) Primary schools
(B.A.T.C).
In this research study, questionnaires were used to get all the necessary
26
Fifty (50) questionnaires were distributed to the respondents by random
every subject has an equal chance of being selected and there is no bias in
this method.
Data was collected from the respondents after a period of three days from
the day that the questionnaires were distributed the questionnaire in well
interpretation.
The Questionnaires were also used in the research work for uniform data
ii. Section ‘B’ which consisted of closed ended and opened ended questions
the respondents. Those that are illiterate were interviewed by the interviewer
27
and filled in the responses as they answered. All the respondents were fully
Simple frequency table and percentage were used to analyze the data.
Simple statistical test were used to bring out the relationships among the
A pilot study was carried out at Mairuwa and Gwagwaye ward, Funtua
the questionnaire. The questionnaires were collected and analyzed for the
28
CHAPTER FOUR
4.1 INTRODUCTION:
This chapter dealt with how data was collected analyzed and presented in
The above showed that 3 respondents, representing 6% are within the age of
respondents are between 36 -45 years representing 27% and 46 years and
29
This indicated that most of the respondents are in the age range of 26 -35
years.
TABLE 2: SEX
The above table indicated that 39 respondents are males representing 80%
The table above showed that 12 respondents representing 24% are single, 35
TABLE 4: TRIBE
30
S/NO Tribe Respondents Percentage (%)
1 Hausa/Fulani 45 92%
2 Yoruba 3 6%
3 Igbo 0 0%
4 Others 1 2%
Total 49 100%
2%. This table showed that most of the respondents are Hausa/Fulani.
TABLE 5: RELIGION:
The table above showed that 47 respondents are Muslims representing 96%,
belonging to other religion. The table showed that most of the respondents
are Muslims.
The table above showed that not any respondents representing 0% had
having tertiary certificates. This showed that most of the respondents have
tertiary certificates.
The table above showed that 2 respondents are Housewives representing 4%,
20%. This showed that the majority of the respondents are civil servants.
representing 18.4% are disagreed. This table showed that majority of the
The above table showed that 3 respondents are strongly agreed representing
33
1 Strongly Agreed 25 51%
2 Agreed 10 20.4%
3 Strongly Disagreed 10 20.4%
4 Disagreed 4 8.2%
Total 49 100%
The above table showed that 25 respondents are strongly agreed representing
The above table showed that 5 respondents representing 10% are strongly
strongly disagreed that over cooking of food can lead loss of valuable
nutrients.
34
TABLE 12: DO YOU BELIEVE THAT VITAMIN ‘A’ DEFICIENCY
IS THE MAJOR CAUSE OF NON-ACCIDENTAL BLINDNESS?
The table above showed that not any respondents representing 0% are
91.8%.
The table above showed that 35 respondents representing 71.4% are strongly
the statement. This indicated that the majority of the respondents are
35
TABLE 14: DO YOU KNOW THAT IMMUNIZATION AND
SUPPLEMENTATION CAN PREVENT VITAMIN ‘A’
DEFICIENCY?
The above table showed that 42 respondents representing 81% are strongly
Disagreed. This showed that the majority of the respondents are strongly
deficiency.
This table indicated almost all the respondents are agreed representing 98%.
CHAPTER FIVE
5.1 INTRODUCTION:
Recommendations/suggestion.
5.2 SUMMARY:
The research work was aimed at finding the effect of vitamin ‘A’ deficiency
Area. The study was presented in fives chapters, where chapter one dealt
Chapter two discussed the literature, related to the subject that is “Effect of
37
literature starting from the earlier to the most recent publicating such as
‘A’ deficiency.
Chapter four of this study presented the data and the statistical analysis
without discussing the findings. The data was presented in simple frequency
Furthermore, the summary of the findings from the questionnaire which was
1. The study carried out showed that most of the respondents said that
culture and taboos contribute to vitamin ‘A’ deficiency.
2. The researcher showed that 84% of the respondents agreed that
xerophthalmia, kerotomalacia, night blindness are among the signs and
symptoms of vitamin ‘A’ deficiency.
3. The study revealed the most of the respondents 51% of the respondents
strongly agreed that blindness is the complication of vitamin ‘A’
deficiency.
4. The study also indicated that most of the respondents are strongly
disagreed that over-cooking of food can lead to lost of valuable nutrient
contained in the food.
38
5. The research showed that most of the respondents agreed that vitamin
‘A’ deficiency is the major cause of non-accidental blindness.
6. The study indicated that 71.4% of respondents strongly agreed that pre-
school children are regarded as high risk group for developing vitamin
deficiency.
7. Also the study indicated that 86% of the respondents are strongly agreed
that immunization and supplementation can prevent vitamin ‘A’
deficiency.
8. The research showed that most of the respondents agreed that vitamin
Finally chapter five which is the last chapter of the study, dealt with
study.
5.3 CONCLUSION/FINDING:
The research findings which were obtained through the method of data
98% are agreed the vitamin ‘A’ can help in growth and development of the
children.
can prevent vitamin ‘A’ deficiency. The study has also found most of the
39
respondents accounting 91.8% agreed that vitamin ‘A’ deficiency is a major
blindness.
The study also found that few of the respondents representing 2% strongly
agreed that vitamin ‘A’ deficiency can help in growth and development of
the children.
5.4 RECOMMENDATIONS/IMPLICATIONS:
Having successfully analyzed and presented the data related to the study, the
green vegetables which can lead to loss of valuable vitamin ‘A’ nutrients.
ii. Good information should be given to mothers and school food vendors to
produce foods that are rich in such vitamins to prevent such deficiencies.
40
iv. School health programme should be carried out on frequency basis so as
to observe the food and to encourage food vendors to provide foods that
months without giving water to the children to avoid cases of vitamin ‘A’
deficiency.
deficiency including importance of eating the food that are enriched with
vitamin ‘A’.
The research is aimed finding out the effect of vitamin ‘A’ deficiency among
Katsina State.
Government Area.
out.
41
REFERENCES:
Davod Shiery Jackie Buttex and Ricki Levis (2000): Textbook of Holes
Essentials of Human Anatomy and Physiology, Seventh Edition.
43
APPENDIX
(QUESTIONNAIRE)
carrying out a research for the award of Diploma in Health Education and
Your response will be treated confidentially. Please tick [√] the option you
consider correct for the questions below and write a comments where
necessary.
1. AGE?
2. SEX?
Male [ ] Female [ ]
3. MARITAL STATUS?
4. TRIBE?
5. RELIGION?
44
Islam [ ], Christianity [ ], Others (specify) ……………………
7. OCCUPATION?
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
9. Staple food such as grains and cereals are the major diet in this
community?
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
11. Do you believe that vitamin ‘A’ deficiency is the major cause of non-
accidental blindness?
45
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
12. Over cooking of food can lead to loss of valuable nutrients contain in
the food. Do you agree with this statement?
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
15. Are pre-school children regarded as high risk group for developing
vitamin ‘A’ deficiency?
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
46
16. Do you know that immunization and supplementation can prevent
vitamin ‘A’ deficiency?
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
17. Vitamin ‘A’ can help in the growth and development of the children.
Do you agree with me?
a. Strongly agreed [ ]
b. Agreed [ ]
c. Strongly disagreed [ ]
d. Disagreed [ ]
SUGGESTIONS:
18. Can you suggest the ways in which we can reduce the effect of vitamin
‘A’ deficiency and reduce it complications.
a. ……………………………………………………………………………..
b. ……………………………………………………………………………..
c. ……………………………………………………………………………..
d. ……………………………………………………………………………..
e. ……………………………………………………………………………..
47