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

COVID-19 in sub-Saharan Africa: impacts on vulnerable populations and sustaining home-grown solutions

© 2020, The Canadian Public Health Association. This commentary draws on sub-Saharan African health researchers’ accounts of their countries’ responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries’ responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power—the authority and resources—to study and endorse solutions

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

Association between serum vitamin D status and uterine leiomyomas: a case-control study

Objective Uterine leiomyoma is a common gynecological condition that negatively affects women’s quality of life. Vitamin D plays an important role in tumor development and progression. However, clinical studies comparing serum vitamin D levels between women with and without uterine leiomyomas are limited and inconclusive. This study aimed to compare serum vitamin D levels in women with and without uterine leiomyomas. Methods This hospital-based case-control study included 150 women who visited a gynecological clinic. The cases included 75 women with uterine leiomyoma, whereas the controls included 75 age-and parity-matched participants without uterine leiomyoma. Serum vitamin D levels were measured in each participant and volumes of the uterine leiomyomas were determined using the water displacement method following myomectomy. The statistical significance was inferred at P<0.05. Results The mean serum vitamin D level was 15.26±4.96 ng/mL and 22.45±6.93 ng/mL for the case and control groups, respectively. The difference was statistically significant (t-value −7.302 and P<0.001). Within the fibroid group, nine (12.0%), 49 (65.33%), and 17 (22.67%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively; and in the control group, two (2.67%), 24 (45.33%), and 39 (52.0%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively. There was significant negative correlation between the fibroid volume and the serum vitamin D level (r=−0.591, P<0.001). Conclusion Women with uterine leiomyoma had lower vitamin D levels than women in the control group. Lower vitamin D levels were associated with larger fibroid masses. Therefore, vitamin D supplementation may reduce fibroid growth and development

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

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

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