The case for gynaecologist-led point of care ultrasound services in sub-Saharan Africa

No Abstract

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

Aim: The purpose of this study was to evaluate the association between selected potential socio-demographic and behavioural risk factors and infertility in Nigeria males. Methods: The study consisted of cases and controls. The cases were 150 males with proven male infertility, while the controls were 150 fertile males with normal semen parameters. Both cases and controls were matched for age places of residence, and were similar in key socio-demographic variables. They were compared for sexual history, past medical and surgical history, past exposures and treatment of symptoms of sexuality transmitted diseases, past and current use of drugs and history of smoking and alcohol intakes. Results: The results showed infertile men to be significantly more likely than fertile men to report having experienced penile discharge, painful micturition and genital ulcers. Infertile men were less likely to seek treatment for these symptoms, and to seek treatment with informal sector providers rather than formal sector providers in private, district and referral hospitals. Multivariate analysis showed that male infertility was also significantly associated with bacteria in semen cultures, self-reporting of previous use of traditional medications and moderate to heavy alcohol intake. By contrast, infertility was not significantly associated with smoking and occupational types. Conclusion: We conclude that infertility is associated with various proxies of sexually transmitted infections (STIs) and poor healthcare-seeking behaviour concerning for STIs in Nigeria men. Efforts to address these problems will likely contribute to reducing the prevalence of male infertility in Nigeria. Tropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 136-14

Interpreting the real-time dynamic ‘sliding sign’ and predicting pouch of Douglas obliteration: an interobserver, intraobserver, diagnostic-accuracy and learning-curve study

Objective: To determine inter- and intraobserver agreement, diagnostic accuracy and the learning curve required for interpreting the ‘sliding sign’ and predicting pouch of Douglas (POD) obliteration. Methods: This was an inter-/intraobserver, diagnostic-accuracy and learning-curve study involving six observers with different medical backgrounds, clinical skill sets and prior gynecological ultrasound experience: five non-specialist observers who had performed 0–750 previous gynecological scans and an expert sonologist who had performed > 15 000. Following a formal theoretical and practical training session, they each viewed 64 offline transvaginal ultrasound (TVS) ‘sliding-sign’ videos from two anatomical locations (retrocervix and posterior uterine fundus (PUF)) in 32 women presenting with chronic pelvic pain, interpreting the videos as positive or negative for sliding sign and predicting, on that basis, the POD status. For intraobserver agreement analysis they re-analyzed the same video sets, in a different order, at least 7 days later. The expert sonologist was the reference standard for interpreting the sliding sign and the gold standard, laparoscopy, was used for the POD analysis. Learning-curve cumulative summation (LC-CUSUM) tests were conducted to assess if observer performance reached acceptable levels, using LC-CUSUM score < −2.45 as a cut-off. Results: With respect to interpretation of the sliding sign, the overall multiple-rater agreement was moderate (Fleiss' kappa, K = 0.499). Observers were more consistent in their interpretation of the second compared with the first observation set (K = 0.547 vs 0.453) and for the retrocervical compared with the PUF region (K = 0.556 vs 0.346). Regarding prediction of POD status, the accuracy, sensitivity, specificity and positive and negative predictive values for individual observers ranged from 65.4 to 96.2%, 80.0 to 100%, 64.7 to 100%, 50.0 to 100% and 94.7 to 100%, respectively. Using LC-CUSUM score < −2.45, the observer with experience of 200 previous gynecological scans reached acceptable levels for predicting POD obliteration and interpreting the sliding sign at each region (retrocervix and PUF) at 39, 54 and 28 videos and the observer with experience of 750 scans at 56, 53 and 53 videos. Conclusions: Performance of a minimum number of gynecological ultrasound examinations is necessary for interpreting offline videos of the real-time dynamic sliding sign and predicting POD obliteration. Non-specialist observers with prior experience of 200 or more gynecological scans were more consistent in interpreting the sliding sign at the retrocervix vs PUF