Semen quality of male partners of infertile couples in Ile-Ife, Nigeria

Objectives: The objective was to evaluate seminal fluid indices of male partners of infertile couples so as to identify the current status of the contributions of male factor to infertility in our environment.Materials and Methods: This is a prospective study of the seminal fluid indices of consecutively consenting male partners of infertile couples seen at the Fertility and Endocrinology Research unit of the Department of Obstetrics Gynaecology and Perinatology, Obafemi Awolowo University Teaching Hospital Ile-Ife between May 2004 and June 2008.Results: The results of the semen analysis of 661 male partners of the infertile couples were retrieved and analyzed. The patterns of semen parameters noted in infertile males were oligozoospermia, teratozoospermia, asthenozoospermia, azoospermia,  oligoteratozoospermia, oligoasthenozoospermia, and  oligoasthenoteratozoospermia, asthenoteratozoospermia found in 25.6%, 18.5%, 11.5%, 6.2%, 3.2%, 2.3%, 2.1%, and 0.9%, respectively. Among the age groups, age group 31-40 had a higher prevalence of oligozoospermia (13.3%) while among the occupational groups, the civil servants had the highest prevalence of oligozoospermia (12%). There was a high of level of leucocytospermia and bacterial infections in both normospermic and oligospermic semen.Conclusion: This study showed a high rate of abnormal semen quality of male partners of infertile couple in our environment and is an indication for the need to focus on the management of this condition and the institution of preventive program for male infertility. There is urgent need for advocacy for men to accept responsibility for their contribution to infertility and to reduce stigmatization and ostracizing of women for infertility.Key words: Abnormal semen parameters, infertility, male partners, semen analysi

Retrograde ejaculation related infertility in Ile-Ife, Nigeria

Background: Globally, the incidence of male infertility is on the increase1,2. However, the contribution of retrograde ejaculation to this increasing incidence of male infertility is not known locally.Objectives:1. To determine the incidence of retrograde ejaculation by using the WHO criterion among male partners of patients who were being managed for infertility at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between 1st of February and 31st of August 2006 . 2. To determine the Retrograde-ejaculation ratio (RER) of each subject by a proposed formula as an extension of the WHO criterion.3. To highlight the risk factors and the management options available for the treatment of retrograde ejaculation.Subjects and methods: During the study period, 71 male partners of consecutive female patients who reported at the Infertility clinic were recruited. However, the specimens of 70 male partners were analyzedbecause one of them inadvertently spilled his post-ejaculatory urine specimen and consequently was excluded from the study. Prior to the collection of ejaculatory fluid and post-ejaculatory urine specimens foranalysis, they were instructed to abstain from sexual intercourse for at least 3 days and to collect the first post-ejaculatory urine specimen for analysis. The WHO criterion 1 states that a cloudy urine specimen with the presence of a total number of spermatozoa in urine equal to or exceeding the number of spermatozoa in semen, strongly supports the diagnosis of retrograde ejaculation. The sperm counts in seminal fluid and urine for each subject were determined. Thereafter, the sperm concentration in urine (SCU) and sperm concentration in seminal fluid(SCSF) were determinedrespectively thus: sperm count in urine/volume of urine; sperm count in seminal fluid/ volume of seminal fluid. The Retrograde ejaculation ratio (RER) was calculated thus: sperm count in urine / sperm count inseminal fluid. A questionnaire containing the bio-data and risk factors associated with retrograde ejaculation was completed for each subject.Results: Of the 70 cases included in the analysis, 32(45.7%) had primary infertility while 38(54.3%) had secondary infertility. The age range was 28-65(mean for primary and secondary infertility were 36 and 42.1respectively) years. The duration of infertility ranged from 1-16 years (mean4+ 2.92). Based on the WHO criterion previously stated, only 1/70(1.42%) of the cases was positive with a retrograde ejaculatory ratio(RER) of infinity as he had azoospermia. This was in a 47 year old man with secondary infertility who had no identifiable risk factor prior to the study. There were 8/70(11.42%) of the cases studied with azoospermia but only 1/8 (12.5%) of those azoospermic had retrograde ejaculation.Conclusion: To make a diagnosis of male factor infertility, semen analysis remains the cornerstone of all the laboratory assays. However, to make acategorical diagnosis of retrograde ejaculation, focused laboratory testing is imperative. The incidence of retrograde ejaculation appeared low (1.42%) in our environment but this is in consonance with studies elsewhere. It is strongly advisable that cases of azoospermia and severe oligozoospermia be screened for retrograde ejaculation as there are manymodalities of therapy to aid the affected males fulfil their wishes of becoming fathers. Lastly, when the retrograde ejaculation ratio (RER) is > 1 with the presence of a cloudy urine, the diagnosis is highly probable.Key words: Retrograde ejaculation, azoospermia, male infertility

Emergency non–obstetric abdominal surgery in pregnancy

Background: Despite recent advances in anaesthetic, perinatal and preoperative care, surgical intervention during pregnancy may still result in fetal loss from either spontaneous abortion (especially in the first trimester) or premature labor (especially in the third trimester). This study was aimed at determining the factors that affect fetal and maternal outcome following emergency non-obstetric abdominal surgery in pregnancy.Methods: We reviewed all cases of emergency non-obstetric abdominal surgery performed on pregnant women at Obafemi Awolowo University Teaching Hospital complex from January 1991 and December 2006. The socio-demographic characteristics, obstetric history, diagnosis and outcome of management were documented and analyzed.Results: A total of 46 pregnant patients presented with various conditions necessitating emergency non-obstetric abdominal surgery during the study period. Their ages ranged from 23 to 39 years with a mean age of 29.33 +/-4.904. Six (13%) of the patients presented during the first trimester, 32 (69.6%) patients during the second trimester and 8 (17.4%) were seen in the third trimester. Thirty-two (69.6%) patients presented with features of acute appendicitis out of 12 had ruptured appendicitis and 8 had appendicular abscess. Eight (17.4%) had intestinal obstruction, 5 (10.8%) had haemoperitonueum from abdominal injury and 1 (6.7%) had an ectopic foetus in bladder. Four (8.8%) mothers and 20(43.5%) babies died. Factors affecting maternal outcome included parity (P=0.010), duration of symptoms (P<0.0001) and delay in surgery (P<0.0001) while the factors affecting fetal outcome include maternal age (P<0.0001), booking status (P<0.0001), educational status (P<0.010), parity (P<0.040), gestational age (P=0.048) and delay in surgery (P=0.016).Conclusion: Complicated appendicitis is the most common indication for abdominal surgery in pregnancy in our center. High foetal loss seen in this study can be reduced by early presentation of the patients, early booking and high index of suspicion and prompt treatment by the attending surgeon

Have you seen a rape kit? A snapshot at the quality of care of rape survivors in Nigerian tertiary hospitals

Context: The rape kit has become a fundamental tool in the evaluation of the rape survivor in many countries. Itsavailability and use in Nigeria has however not been documented.Objective: To assess the current availability and usage of the rape kit in Nigerian tertiary hospitals, and evaluate the management of rape survivors.Methodology: Resident Doctors attending the Obstetrics and Gynaecology update course, held in Abuja in March,2009 were interviewed using a self-administered questionnaire assessing experience in rape management, knowledge about the rape kit and its availability, as well as current management of rape survivors.Results: There were 138 respondents from 25 tertiary hospitals, with a male-to-female ratio of 2.8:1 and a meanduration of 3.3 (SD 1.4) years in training. 120 (87%) had personally managed one or more rape survivor(s), but none of the respondents had ever seen a rape kit, and only 29% were aware of it. Although all the respondents indicated availability of emergency contraception, antibiotics and tetanus prophylaxis in their centres, only 32.4% had access to HBV vaccine, and about 8% indicated lack of HIV prophylaxis. Only 28.7% and 45.6% indicated access to clinical psychologists and medical social workers respectively.Conclusion: The rape kit is not available in Nigerian tertiary hospitals. We recommend its provision, and regulartraining of doctors, especially Obstetrics and Gynaecology Residents on rape management, to improve the care ofrape survivors in Nigeria.Key Words: Rape, Rape kit, Rape survivor, Nigeria

Diminished mental- and physical function and lack of social support are associated with shorter survival in community dwelling older persons of Botswana

<p>Abstract</p> <p>Background</p> <p>Mortality rates for older persons in Botswana have been unavailable and little is known of predictors of mortality in old age. This study may serve as a precursor for more detailed assessments.</p> <p>The objective was to assess diminished function and lack of social support as indicators of short term risk of death.</p> <p>Methods</p> <p>A national population based prospective survey was undertaken in Botswana; twelve rural areas and three urban centers were included.</p> <p>372 community-dwelling persons aged sixty years and over, were included; 265 were followed-up. Sixteen subjects were deceased at follow-up.</p> <p>Subjects were interviewed and clinically assessed at home. Measures of cognitive function, depression and physical function and sociodemographic information were collected. Subjects were followed-up at average 6.8 months after baseline.</p> <p>Results</p> <p>Overall mortality rate was 10.9 per 100 person years. Age-adjusted odds ratios (OR) for death during follow-up were; 4.2 (CI 1.4–12.5) and 3.6 (CI 1.0–12.7) for those with diminished physical- and cognitive function, respectively.</p> <p>Indicators of limited social support; household with only 1 or 2 persons and eating alone, yielded age adjusted ORs of 4.3 (CI 1.5–12.5) and 6.7 (CI 2.2–20), respectively, for death during follow-up.</p> <p>Conclusion</p> <p>Older community dwelling persons with diminished cognitive- or physical function, solitary daily meals and living in a small household have a significantly increased risk of rapid deterioration and death.</p> <p>Health policy should include measures to strengthen informal support and expand formal service provisions to older persons with poor function and limited social networks in order to prevent premature deaths.</p

Prevalence, awareness, treatment, and control of hypertension in Nigeria in 1995 and 2020: A systematic analysis of current evidence

Improved understanding of the current burden of hypertension, including awareness, treatment, and control, is needed to guide relevant preventative measures in Nigeria. A systematic search of studies on the epidemiology of hypertension in Nigeria, published on or after January 1990, was conducted. The authors employed randomeffects meta-analysis on extracted crude hypertension prevalence, and awareness, treatment, and control rates. Using a meta-regression model, overall hypertension cases in Nigeria in 1995 and 2020 were estimated. Fifty-three studies (n = 78 949) met our selection criteria. Estimated crude prevalence of pre-hypertension (120-139/80-89 mmHg) in Nigeria was 30.9% (95% confidence interval [CI]: 22.0%-39.7%), and the crude prevalence of hypertension (≥140/90 mmHg) was 30.6% (95% CI: 27.3%-34.0%). When adjusted for age, study period, and sample, absolute cases of hypertension increased by 540% among individuals aged ≥20 years from approximately 4.3 million individuals in 1995 (age-adjusted prevalence 8.6%, 95% CI: 6.5-10.7) to 27.5 million individuals with hypertension in 2020 (age-adjusted prevalence 32.5%, 95% CI: 29.8-35.3). The age-adjusted prevalence was only significantly higher among men in 1995, with the gap between both sexes considerably narrowed in 2020. Only 29.0% of cases (95% CI: 19.7-38.3) were aware of their hypertension, 12.0% (95% CI: 2.7-21.2) were on treatment, and 2.8% (95% CI: 0.1-5.7) had at-goal blood pressure in 2020. Our study suggests that hypertension prevalence has substantially increased in Nigeria over the last two decades. Although more persons are aware of their hypertension status, clinical treatment and control rates, however, remain low. These estimates are relevant for clinical care, population, and policy response in Nigeria and across Africa

Post partum haemorrhage in a teaching hospital in Nigeria: a 5-year experience

Objectives: The aim was to determine the incidence, causes and the maternal mortality associated with postpartum haemorrhage in a tertiary centre in Nigeria. Methods: Case records of all patients that had postpartum haemorrhage after vaginal delivery at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife unit over a 5-year period (January 1st, 2002 to December 31st, 2006) were reviewed and analysed. Post-partum blood loss was calculated by estimating blood loses in graduated containers and in bed lines and gauze packs. Results: 112 women had postpartum haemorrhage during the period under review. 76(67.86%) had primary postpartum haemorrhage and 36(32.14%) had secondary postpartum haemorrhage. The commonest cause of post partum haemorrhage was retained products of conception due mismanagement of the third stage of labour, this occurred in 88 women (78.57%) of cases. Other causes were uterine atony 12(10.71%), genital tract laceration 9(8.04%), disseminated intravascular coagulopathy 1(0.8%) puerperal sepsis 1(0.8%) and broken down episiotomy, 1(0.8%). The maternal mortality during the period was 90 out of which 6 were due to postpartum haemorrhage. Conclusion: Retained products of conception resulting from mismanagement of the third stage of labour is the most common cause of post partum haemorrhage in our centre

Criteria Based Audit of the Management of Severe Preeclampsia/ Eclampsia in a Nigerian Teaching Hospital

Background: This study discusses the usage of criteria –based audit in a Nigerian teaching hospital to evaluate the quality of care among patients with severe pre-eclampsia/eclampsia (SPE-E) against set standards and proffers possible interventions in order to improve the quality of care.Methods: The study was a prospective, descriptive hospital based study carried out from 1st of March to 31st of December, 2012. We conducted an 18 criterion-based audit on 52 consecutive cases of severe preeclampsia/eclampsia during the study period at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.Results: There were 34 cases of severe pre-eclampsia and 18 eclamptic patients. The case fatality rate for SPE-E was 5.8 % and 13.5 % perinatal deaths among 59 infants delivered (multiple pregnancies inclusive). From the pre-determined standard of care based on 18 criteria, the performance score ranged from 17.3 to 100% (average 69.1%). Standard of care was optimal (100%) in taking detailed history and documentation, administering magnesium sulfate, initiating drug treatment for severe hypertension, respiratory rate monitoring and steroid treatment for fetal lung maturity and very sub-optimal for various laboratory investigations and initial consultant obstetrician input in the management of patients.Conclusion: For improvements in maternal and perinatal outcomes for patients with SPE-E, there should be strengthening of hospital facilities and avoidance of Phase 3 treatment delays in carrying out the comprehensive emergency obstetric and neonatal care needed. Hospital leaders should also be trained in hospital management for qualitative care.Keywords: Severe pre-eclampsia, eclampsia, criteria-based audit

The use of magnesium sulphate (MgSO4) for seizure prophylaxis: clinical correlates in a Nigerian tertiary hospital

Background: Magnesium sulphate use in the prevention of seizures resulting from preeclampsia and eclampsia is widely accepted. However, several protocols exist worldwide. Aim: To determine serum magnesium levels and associated clinical outcomes in severe pre-eclamptic and eclamptic women treated with magnesium sulphate. Methods: Women, 28-41 weeks pregnant or in the puerperium with severe pre-eclampsia or eclampsia, participated in this cross sectional study and their serum magnesium levels were measured using the Atomic Absorption Spectrophotometer (AAS) machine. All participants received the standard Pritchard regimen, including monitoring. Results: Seventy five patients participated in the study. They were mostly overweight (mean BMI 26.38 ± 3.40kg/m2). Mean pre-treatment serum magnesium level was 1.96 ± 0.29 mg/dL; eclamptics had significantly lower levels (p&lt;0.001). Mean treatment serum magnesium level attained was 5.41 ± 0.58 mg/dL. No evidence of magnesium toxicity was observed. Therapeutic range of serum magnesium was required to prevent seizures, and was attained ≥4-hours after loading dose in most of the eclamptics (74%). All convulsions occurred in the interval between the loading dose and the first maintenance dose; eclamptics had greater risk of convulsing while on treatment (RR=11.56, 95%CI= 0.62-216.36, P=0.049). Conclusion: Low serum magnesium level before or during treatment with magnesium sulphate is a risk factor for convulsion in OAUTHC. The Pritchard regimen has a low risk for toxicity thus administration of magnesium sulphate at peripheral centres before referral may be beneficial in preventing repeat convulsions. Modifications involving additions to the loading dose in eclamptics and fewer number of maintenance doses may be beneficial.Key words: Pre-eclampsia, eclampsia, magnesium, convulsion, puerperium, Nigeri