Perceptions of Infertility and In Vitro Fertilization Treatment among Married Couples in Anambra State, Nigeria

There is a high rate of infertility among couples in Nigeria. This challenge is perceived differently in each socio-cultural context in which it is experienced but solution to the problem is adversely affected by the people‘s perception of the phenomenon. This study thus explored the perceptions of infertility and in vitro fertilization (IVF) and how to enhance the use of IVF treatment among married couples. This was a cross-sectional survey in Anambra State, Nigeria involving household respondents (married couples) and hospital respondents (couples undergoing infertility evaluation). Structured questionnaire and key informant interview (KII) guide were used for data collection. Altogether 600 questionnaires were administered and 589 were validly completed and analysed. The main outcome measures included perceptions of infertility and IVF treatment, utilization of IVF treatment and association between some demographic variables and IVF utilization. The results showed that infertility was perceived majorly as - destiny/supernatural powers (17.1%), threat to men‘s procreativity/continuity of lineage (14.3%), women‘s problem only (15.6%). Solutions to the challenges were adversely affected by perception. The use of IVF treatment was low with misconceptions like it‘s too costly (15.4%) and unnatural (7.6%), giving rise to unmet need for assisted reproductive technology. Women (especially above 35 years) were more likely to accept IVF treatment than men. Reproductive health education and awareness creation should target the misconceptions about infertility/IVF and fertility treatment should be covered by national health insurance to reduce the cost of IVF treatment and improve its use in Anambra State.Keywords: Married couples, Infertility, In vitro fertilization, Perception, Anambra State, Nigeri

Prevalence of complications of male circumcision in Anglophone Africa: a systematic review

BACKGROUND: There is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent. METHODS: A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers. RESULTS: There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals. CONCLUSION: The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Teenage Pregnancy: Knowledge and Attitude of Adolescents in Southeast Nigeria.

Aim: A cross –sectional study carried out in Awka, Anambra State, Nigeria to determine the perception of adolescents to teenage pregnancy. Subject and Method: Four secondary schools were randomly selected for the conduct of the survey. One hundred and thirty (130) students in the senior secondary classes were randomly selected in each of the chosen school giving a total of 520 subjects. Trained interviewers were used to administer structured questionnaires to the students. Results: The result revealed a high level of awareness of teenage pregnancy amongst the adolescents (71.8%); 5.1% (16) of the girls and 8.1% (15) of the boys reported having been involved in teenage pregnancy. Over 92% (444) of the respondents showed disapproval to it while 4.4% (21) were indifferent and 3.5 (17) consider it acceptable. Substantial proportions of the students 29.8% (143) do not know how to avoid teenage pregnancy. Contraception is not the favoured option but rather abstinence. Abortion is low on the line of action subjects will take if they fall victim to unintended pregnancy. Conclusion: It is advocated that an urgent action be taken by policy makers to reduce the prevalence of teenage pregnancy to save the youths from undue hardship imposed on them by unintended pregnancy and also check the spread of AIDS. Adolescents should be encouraged to use contraceptives if they cannot abstain from sex before marriage. Key Words: Teenage Pregnancy, Knowledge. Attitude, Adolescents. [Jnl College of Medicine Vol.7(2) 2002: 104-107

Displaced intra-uterine contraceptive device causing severe menorrhagia

The intrauterine contraceptive device (IUCD) is a common method of contraception in developing countries. Expulsion/displacement is a common complication of its use, occurring in 2-8 % of users per 100 women years. Two cases of menorrhagia resulting from displacement of Copper-T-380 IUCD to the cervical canal were presented. The diagnosis was made by simple gentle speculum examination of the vagina and confirmed in one case with ultrasonography. The IUCD was pulled out with an artery or sponge forceps and the bleeding stopped. Awareness of this possible complication and simple speculum examination in any woman wearing an IUCD and presenting with vaginal bleeding or menorrhagia is advocated to avert undue morbidity. Keywords: IUCD, displacement, expulsion, menorrhagia Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 70-7

Pregnancy loss: a rare consequence of premenstrual endometrial curettage for infertility management

Two cases of pregnancy loss - a rare complication of pre-menstrual endometrial biopsy (PMEB) are reported. PMEB is an investigation performed for infertile women to assess ovulation and endometrial factors. It is usually performed during the secretory phase of the cycle. This implies that ovulation and possibly fertilization may have taken place. In the two patients presented, histology report in one suggested pregnancy while the second presented with massive vaginal bleeding few days after PMEB requiring evacuation. The histology of the latter confirmed products of conception. Though PMEB is useful, it may lead to pregnancy loss. Couples should be counseled to avoid sex during the fertile days of the cycle scheduled for PMEB investigation. Wider availability and use of ultrasonography to assess ovulatory factor may avert this painful complication. Keywords: pregnancy, abortion, infertility, curettage Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 74-7

Endometriosis presenting as pleural effusion and haemoperitoneum: case report and a review of the literature

A case of endometriosis presenting as haemorrhagic pleural effusion and ascites in a 40 year old multiparous woman is described. Her main clinical features were left groin swelling 12 years prior to this presentation which was confirmed at histology (after excision) to be endometriosis; secondary infertility, peri-umbilical nodule with cyclic pain especially during the menstrual flow; secondary dysmenorrhoea, dyspareunia, irregular menses, inter-menstrual bleeding, dyspnoea and abdominal swelling. Investigations revealed pleural effusion on chest X-ray and a complex pelvic-abdominal mass with ascites on ultrasonography. She was managed with danazol, thoracotomy and, eventually, laparotomy. Subtotal hysterectomy with bilateral salpingoophorectomy was performed and histological examination of the tissues confirmed endometriosis and adenomyosis. Keywords: endometriosis, pleural effusion, ascites Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 77-7

Clinical Correlates of Unexplained Infertility in Southeastern Nigeria

Context: In the absence of any obvious aetiological factor, a couple is said to have unexplained infertility. It is desirable to identify factors associated with unexplained infertility in this environment and to ascertain if there is a causal relationship between infertility and uterine leiomyomata. Objective: The study is aimed at identifying clinical factors associated with unexplained infertility and determining if there is any difference in the prevalence of uterine fibroids between women for whom a cause of infertility is identifiable and those with unexplained infertility. Study Methods: The records of infertility patients from our clinics at Nnewi and Awka were examined for the identifiable causes of infertility and the presence of uterine fibroids. Results: The cause of infertility was obvious in 279 (89%) of the 314 couples that completed their evaluation while 35 couples (11%) had unexplained infertility. The type of infertility (primary or secondary) had no influence on whether the aetiology is identified or not. However, increasing parity and duration of infertility is significantly associated with an identifiable aetiology. Uterine leiomyomata were present in 61 (19%) of the 314 infertile women studied. Fifty (18%) of the women who had an identifiable cause for their infertility had fibroids compared to 11 (31%) of the women with unexplained infertility (P < 0.005). Conclusion: Unexplained infertility is less common with increasing parity and duration of infertility. Uterine fibroids are more common in women with unexplained infertility. Myomectomy in these women may offer a greater chance of achieving conception. Key Words: Infertility, Uterine Leiomyomata, Myomectomy. [Trop J Obstet Gynaecol, 2002, 19: 8-11]

Influence of Antenatal Care on the Haematocrit Value of Pregnant Nigerian Igbo Women

Context: Antenatal care is generally believed to influence the outcome of any pregnancy. Haematocrit values are important in the assessment of anaemia in pregnancy. A good antenatal care is expected to be associated with good haematocrit values, prevent anaemia in pregnancy, and result in an overall good pregnancy outcome. Objective: To determine the prevalence of anaemia in pregnancy and the effect of antenatal care, especially iron and folate supplementation on the blood build-up in pregnancy. Study Design, Setting and Subjects: Single arm clinical study of 186 consecutive booked pregnant women with singleton fetuses attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. The biosocial characteristics (age, parity and social class); gestational age at booking; and compliance with antenatal medication were obtained and analysed. Results: At booking, 66(35.5%) of the women were anaemic, with haematocrit value being less than 30%. At the onset of labour, the number dropped to 32(17.2%) [p < 0.05] representing a 50% improvement in the proportion of anaemic women. Conclusion: The results suggests that antenatal iron and folate supplementation and antenatal care in general promote blood build-up in the pregnant women, thereby reducing the incidence of anaemia before parturition. Key Words: Antenatal Care, Haematinics, Iron, Folate, Anaemia. [Trop J Obstet Gynaecol, 2002, 19: 68-70