Association Between Urinary Parabens and Sperm Quality in Nigerian Men: A Case-Control Study.

Background: Parabens, which are chemicals used as preservatives in cosmetic and pharmaceutical products, have been reported to be associated with low sperm quality in animal and human models. Despite the high exposure of men to paraben-containing products in Nigeria, there are no known studies that investigate the association of parabens with sperm quality in the country. Objective: To determine the association of urinary levels of metabolites of parabens with sperm count and quality. Design/Setting: A multicenter case-control study among fertile and infertile men in five hospitals in southern Nigeria. A total of 136 men diagnosed with male infertility (cases) were compared with 154 controls with normal fertility. Urinary levels of parabens (ethyl-paraben, methylparaben, propylparaben, and butylparaben) were measured using liquid chromatography mass spectrometry, while semen analysis and hormone assays were carried out using World Health Organization standards and radioimmunoassay, respectively. Data were analyzed with non-parametric statistics and non-parametric linear regression. Results: The results showed high levels of parabens in both cases and controls. However, there was no statistically significant difference in urinary levels of ethyl-paraben, methylparaben, propylparaben, and butylparaben between cases and controls. In contrast, propylparaben had a decreasing association with total motility in both groups, but the effect was only statistically significant in the case of male infertility. The results of the regression analysis showed that a unit increase in propylparaben significantly decreased total motility in the cases (infertile men). Similarly, a unit increase in propylparaben decreased morphology significantly in the unadjusted model for infertile men. Only serum testosterone showed an insignificant correlation with urinary parabens. Conclusion: We conclude that urinary parabens are associated with features of poor sperm quality - motility, morphology, and volume. Measures to reduce exposure of men to agents containing parabens in Nigeria may reduce the prevalence of male infertility in the country.

Term delivery of a heterotopic pregnancy coexisting with ruptured tubal ectopic pregnancy: A case report.

Pregnancies that occur in two different implantation sites simultaneously is described as Heterotopic pregnancy (HP). In the current study, a case of term delivery of a heterotopic pregnancy coexisting with ruptured tubal ectopic pregnancy, diagnosed by ultrasound (US) and clinical examination findings, which was managed successfully. A 25 year old Nigerian female, gravida 4, para 2 (2 term gestation, 1 spontaneous abortion) presented at the Emergency room with acute abdominal pain associated with vomiting. She had 8 weeks amenorrhea and a positive pregnancy test three weeks prior to presentation. Transvaginal ultrasound scan revealed a six-weeks viable intrauterine gestation. A diagnosis of possible ectopic pregnancy was made. Further trans-abdominal ultrasonography imaging revealed viable intrauterine pregnancy with evidence of an echogenic mass measuring 6.5 x 7.5cm in the abdominal cavity with significant fluid collection, and both ovaries were visualized and separate from the mass. An emergency exploratory laparotomy with right salpingectomy was performed with minimal handling of the uterus and other pelvic structures. At 37 weeks and 5 days gestation, she had an elective C/S for a transverse lying fetus and delivered a live normal birth weight baby girl with a good Apgar score.

Risky sexual behaviors and associated factors among high school students of Dawuro Zone, South West Ethiopia.

Risky sexual behavior still results in human health problems, especially affecting young people. So, this study aimed to determine the magnitude of risky sexual behavior and associated risk factors among high school and preparatory students in Dawro Zone, Southern Ethiopia. A total of 630 students participated in the study; making the response rate 99.5%. Among those students, 305 (48.4%) had started sexual intercourse before data collection. The mean and standard deviation of the age of study participants was 19.12 years (+SD 1.1827) respectively. Of those who started sex, 278 (91%) of them reported unsafe sexual practices. Being in the 20-25 age group (AOR=2.5, 95% CI=1.42, 4.49), having monthly pocket money (AOR=9.4, 95% CI=5.28, 16.81), rare church attendance (AOR=8.8, 95% CI=4.95, 15.73), living without families (AOR=2.37, 95% CI=1.26, 4.44), parental polygamous marriage type (AOR=5.41, 95% CI=1.55, 18.90), no access to information to unsafe sexual practice (AOR=3.60, 95% CI=2.11, 6.13) and poorly knowledgeable to unsafe sexual practice(AOR=4.59, 95% CI=2.630,8.018), were significantly associated with the unsafe sexual practice.

Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria.

Background: Data in Nigeria suggests a high level of dissatisfaction among women attending maternity care in health facilities due to long wait times, disrespectful care, and poor attention by healthcare personnel. Objective: To examine the effectiveness of a multifaceted intervention in improving self-reported indicators of maternal healthcare satisfaction by women who use referral facilities in two regions of Nigeria. Method: The design was quasi-experimental and consisted of two intervention facilities and two control facilities. The interventions included strategic planning, staff re-training, a computerized appointment system, health education/feedback, maternal death reviews and surveillance, and advocacy. A random sample of 2262 women was selected (1205 in the intervention sites and 1057 in the two control sites) to respond to a 24-item questionnaire on service satisfaction as they exited the health facilities. Adjusted Poisson and binary regression analyses were used to assess and compare proportions of reported satisfaction by women between the intervention and control sites. Results: Women in the intervention sites were 54% more likely than those in control sites to report overall satisfaction with services. They were significantly less likely to report inadequate security arrangements in accessing the health facilities (p < .1); and three times more likely to agree that health workers were extremely thorough and careful in attending to them (p < .1). Conclusion: The interventions had positive effects on improving women's satisfaction with care. The findings from this study have implications for the design and implementation of interventions that address women's concerns relating to the provision of care and consequently improve service utilization.

Prevalence and Factors Associated with Institutional-based Delivery in The Gambia: Further Analysis of Population-based Cross- Sectional Data.

Institutional-based delivery could be the major strategy to avoid most maternal deaths occurring from preventable obstetric complications. The study examines the prevalence and factors associated with institutional-based delivery in The Gambia. The secondary data, from The Gambia Multiple Indicator Cluster Survey (MICS) - 2018 for 3,791 women aged 15-49 years who had given birth, were extracted for the analysis. Chi-square analysis and multivariable logistic regression model were used to determine factors associated with institutional-based delivery with statistical significance set at p < 0.05. About three-quarters (78.1%) of Gambian women had institutional-based delivery. The study identified that women from richer (AOR= 2.38; 95%CI: 1.49, 3.79) and richest households (4.14; 95%CI: 2.06, 8.33) were more likely to have institutional-based delivery when compared with women from poorest households. Furthermore, women with secondary or higher education (AOR= 1.66; 95%CI: 1.28, 2.16) were more likely to have institutional-based delivery, when compared with women without formal education. Conversely, rural dwellers (AOR= 0.63; 95%CI: 0.47, 0.84), women with high parity and advanced age had significant reduction in the odds of institutional-based delivery in The Gambia. There is a need for concerted efforts to improve skilled birth attendance among women of low socioeconomic status, those living in hard-to-reach communities and the multiparous women in The Gambia.