HORMONAL PARAMETERS AND SEMEN MICROBIOLOGICAL PATTERN OF INFERTILE MALES: A COMPARATIVE CROSS-SECTIONAL STUDY IN BENIN CITY, SOUTH SOUTH NIGERIA.

BACKGROUND: In many Nigerian studies, male factors were responsible for up to 50 to 70% of infertility. AIM: To evaluate the contribution of endocrinopathy and bacteriospermia to male infertility in Benin. STUDY DESIGN: A comparative cross-sectional study. SETTING: Department of Obstetrics and Gynecology of Central Hospital, Benin City. METHODOLOGY: Male partners of 355 couples who presented with infertility over 8 months were studied. The data collected included socio-demographics, clinical features, hormonal assays, semen analysis, and semen culture. These were analyzed using Statistical Package for Social Sciences version 21.0, employing both univariate and bivariate analyses, and multivariate logistic regression to identify independent determinants of abnormal semen analysis. RESULTS: The mean age of the subjects was 34.98±4.67 years and mean duration of infertility was 4.5±2.17 years. A total of 59.7% patients were of low socioeconomic status. The participants had at least a primary school education, and 81.7% dwelt in the urban areas of the state. Secondary infertility was the commonest (82.3%); while 56.6% of the subjects were overweight and 14.9% obese. 66.5% of participants had abnormal semen parameters. Oligospermia was the commonest (22.8%) abnormality. The commonest hormonal disorders were abnormality of luteinizing hormone (79.1%) and follicle stimulating hormones (26.8%). There was positive semen culture in 162(43.6%) of participants, of which 135(83.3%) had abnormal semen analysis (p=0.000). Men with positive semen culture had more than four-fold odds of having abnormal semen analysis (OR=4.554; 95%CI=2.761-7.513). CONCLUSION: This study has shown that male endocrinopathy and bacteriospermia contributed significantly to male infertility in our environment.

Antenatal determinants of oro-facial clefts in Southern Nigeria.

OBJECTIVES: Cleft lip with or without cleft palate, is the most common serious congenital anomaly that affects the orofacial regions. The management and care of the cleft patient constitutes a substantial proportion of the workload of the Nigerian maxillofacial surgeon and allied specialties. Yet, there are no specific programmes targeted at this group. We believe that the findings of this study is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of orofacial cleft in Nigeria. METHODS: It was a transverse cross-sectional study that was undertaken at the Maxillofacial Units of the University of Benin Teaching Hospital and the Central Hospital, Benin City respectively. The prevalence and antenatal determinants of cleft lip and palate were determined. RESULTS: Cleft lip and palate were often encountered in clinical practice in Benin City with a prevalence of 1.35%. The results showed that orofacial clefts were commoner in females and that the combined unilateral cleft lip and palate was the commonest entity encountered amongst the cases. The following risk factors were associated with the risk of development of cleft lip and palate: Paternal age >40 years, maternal age >35 years, genetic/family history, low socio-economic status, alcohol consumption and indulgence in the intake of herbal medications in pregnancy. CONCLUSION: Public health education programmes and advocacy activities geared towards raising awareness of the identified risk factors for the development of cleft lip and or cleft palate would go a long way to obviate the occurrence and reduce the burden.

The story of abortion: issues, controversies and a case for the review of the Nigerian national abortion laws.

Abortion continues to be a major public health issue that evokes social, political, legal, cultural and religious sentiments and debates in all societies. This is particularly so in countries with restrictive abortion laws. It is one of the leading causes of maternal mortality and morbidity. Despite variations in the legal status of abortions in favor of restrictiveness in developing countries compared with developed countries, overall rates are quite higher in the developing countries. This review article therefore, examines the historical perspectives of induced abortion as well as the issues and controversies associated with induced abortion. Also, a review of the Nigeria national abortion law is made. We believe that this is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of unsafe abortion in developing countries.

Factors Associated with the Knowledge; Perceptions and Practice of Pap Smear Screening for Cervical Cancer in Southern Nigeria

Background: Cervical cancer persists as a major reproductive health challenge in Nigeria with most cases presenting at advanced stage. Methods: This was an analytical cross-sectional survey of the factors associated with the knowledge; perceptions and practice of Pap smear screening amongst 238 women attending antenatal clinic at Central Hospital; Benin City; South-south Nigeria. Results: The median age of the respondents was 30 years (range = 18-49 years). The median parity was 1 (range = 0-5). Most of the respondents (49.2) had tertiary level of education closely followed by secondary level of education (42.2). Forty-five percent of the respondents were aware of cervical cancer and 22.3were aware of Pap smear screening. The sources were largely from the health personnel (32.1); journals/textbooks (26.4) and electronic media (26.4). Only 2.7of the respondents had ever had Pap smear screening done. The major determinants of utilization of Pap smear screening were knowledge of the test; non-availability of service delivery points; lack of spousal consent; fear that the test will detect cervical cancer and cost; with level of education strongly correlated with awareness of Pap smear screening. Awareness was shown on multiple logistic regression analysis as the only strong predictive factor for the practice of Pap smear screening. Conclusion :The knowledge and practice of Pap smear screening was poor; but the perception of the respondents was favorably excellent. We recommend reproductive health education programmes and advocacy activities; strengthening the existing opportunistic screening and establishing national guidelines for routine Pap smear screening

Coitally Related Traumatic Injury of the Female Genital Tract in a Nigerian Urban Setting: A-5 year review.

BACKGROUND: Available evidence suggests that most female lower genital tract injuries are primarily of coital origin and may result in death where prompt diagnosis and treatment is not obtained. Yet there is paucity of recent reports on this clinical entity from our setting. METHODS: This was a retrospective study of the service delivery records of patients with coital trauma seen at the University of Benin Teaching Hospital over 5 years. RESULTS: The incidence of coital trauma was 0.7% of the total gynaecological patients (3,300) seen within the study period. Majority (52.2%) of the patients were nulliparous. A significant proportion (73.9%) of the patients were single and 82.2% had primary or no formal education. Coital laceration occurred in sexual intercourse with boyfriends in 39.1% of patients and casual sex partners in 30.4% of cases. Non-consensual sex was reported in 47.8% of the patients and 39.1% had consensual sex. Sex was pre-marital in 65.2% of the cases. Inadequate or lack of foreplay was a significant predisposing circumstance to coital trauma (56.5%). Pain was a presenting symptom in 60.9% of cases, and same proportion of patients had laceration > 4cm. CONCLUSION: The incidence of coitally associated trauma was low. Nulliparity, low levels of education, non-consensual and premarital sex with little or no foreplay were strongly correlated with the risk of coital trauma. Severe forms of intra-peritoneal complications were not documented in this series. Management strategies were quite adequate.

Factors associated with the knowledge, practice and perceptions of contraception in rural southern Nigeria.

BACKGROUND: Significant proportion of maternal deaths in Nigeria is due to complications of unsafe abortions, and these abortions are responses to unwanted pregnancies that could have been prevented by effective contraceptive programming. Despite intense programmatic efforts by the Nigerian government and various non-governmental agencies to reverse the trend, there has been little evidence to suggest a systematic improvement in these indicators. METHODOLOGY: A household random survey of 1,528 women aged between 15-49 years was undertaken at Amukpe community in Nigeria, to determine their knowledge, practice and perceptions of contraception. RESULTS: The results showed that 86.2% of the respondents had secondary or less level of education and 19.2% of the respondents were single parents. The level of contraceptive awareness was high (92.3%) and 88% of the respondents became aware of contraception in the last 14 years. Friends/relatives (40.6%), followed by nurses (31.7%) and then doctors (17.3%) were the common sources of contraceptive awareness. The most widely known contraceptive methods were injectables, condoms, POP and OCP. The specific knowledge of emergency contraception was poor. The factors associated with low contraceptive usage were poor level of training and ineffective conveyance of relevant information to clients by health personnel, low literacy levels, extremes of reproductive age and extremes of parity. Others were fear of side effects, lack of knowledge, and lack of spousal consent. CONCLUSION: Contraceptive usage remain poor despite high level of awareness. Effective educational and counseling interventions are likely to improve providers' and consumers' knowledge and subsequent uptake of contraceptive usage.

Perceptions and attitudes of a rural community to abortion in the Niger-delta region of Nigeria.

OBJECTIVE: To determine the perceptions and beliefs relating to unwanted pregnancy, family planning and abortion, and identify issues that can be leveraged to initiate positive attitudes towards family planning and abortion in the area. MATERIALS AND METHODS: Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted in Amukpe, Delta State, Nigeria. A highly motivated and well-trained team versed in the local language and culture conducted the FGDs and IDIs. RESULTS: There was unanimity that unwanted pregnancies was quite common amongst women of reproductive age group and constitute a significant problem in the community. Abortion, particularly in the hands of quacks was a major option to handling an unwanted pregnancy. Almost all agreed that their culture and religion abhors abortion, yet widely practiced because of the odium associated with an unwanted pregnancy in the community. The knowledge of the Nigeria National abortion law even amongst the health workers and teachers was generally poor. The participants agreed that there were problems and complications (often severe) including death associated with abortion in the community. It was largely agreed that contraceptive knowledge and usage was poor. The reasons adduced for this include lack of knowledge, lack of spousal consent, socio-cultural taboos and misconceptions, as well as economic reasons. It was suggested that imbibing positive family values by parents in their wards and government leveraging the socio-economic status of the community will go a long way to stemming the tide. CONCLUSION: Unwanted pregnancy, unsafe abortion and abortion complications are reported to be common amongst women of reproductive age group in Amukpe community, whilst contraceptive awareness and usage is poor.

A decade of hysterectomy in a tertiary hospital in urban Niger-Delta region of Nigeria.

BACKGROUND: Hysterectomy is a very common gynaecological procedure which has a significant place in optimizing the reproductive health outcomes of women. OBJECTIVES: To document the indications, the type of hysterectomy commonly performed, the difficulties encountered and complications of the procedure at the Central Hospital, Benin City. MATERIALS AND METHODS: This was a retrospective review of the service delivery records of patients that had hysterectomy in the gynaecological unit between January, 1994 and December, 2003. RESULTS: There were 1216 major gynaecological operations during the study period. Of these, 131 (10.8%) hysterectomies were done. Total abdominal hysterectomy accounted for 80.4% of the procedures performed and most were done by consultants (94.4%). The mean age of the patients was 45.7 years with a median of 46 years and they were commonly grandmultiparous (71.0%). The commonest indication for the procedure was symptomatic uterine fibroid (62.3%) followed by urogenital prolapse (13.1%). The crude morbidity rate was 30.3% and the mortality rate was 1.6%. CONCLUSION: Hysterectomy in this centre is a fairly safe procedure. There is paucity of skills for vaginal and radical procedures. Training is advocated with a view to reducing the presently high morbidity rate as well as achieving our aim of optimizing the reproductive health outcomes of our women.

A case-control study of risk factors for male infertility in Nigeria.

AIM: To evaluate the association between selected potential socio-demographic and behavioral risk factors and infertility in Nigerian men. METHODS: There were two groups in this study. One group consisted of 150 men with proven male infertility, and the other consisted of 150 fertile men with normal semen parameters. Both were matched for age, place of residence and key socio-demographic variables. They were compared for sexual history, past medical and surgical history, past exposures to sexually transmitted infections and treatment, past and current use of drugs as well as smoking and alcohol intake history. RESULTS: Infertile men were significantly more likely than fertile men to report having experienced penile discharge, painful micturition and genital ulcers, less likely to seek treatment for these symptoms and more likely to seek treatment with informal sector providers. Multivariate analysis showed that male infertility was significantly associated with bacteria in semen cultures, self-reporting of previous use of traditional medications and moderate to heavy alcohol intake, but not with smoking and occupational types. CONCLUSION: INFERTILITY is associated with various proxies of sexually transmitted infections (STIs) and poor healthcare-seeking behavior for STIs in Nigerian men.