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Friday Ebhodaghe Okonofua,1– 3 Lorretta Favour Chizomam Ntoimo,1,3,4 Emmanuel Unuabonah,5,6 Titus Alfred Makudali Msagati,7 Makuachukwu Chioma Ekwo,3 Oladiran Frederick Ayodeji,8 Michael Emefiele Aziken,2 Kenneth Toby Maduako,1,2 Vivian Ifunanya Onoh,1 Akhere Omonkhua,1,9 Victor Ohenhen,10 Celestina Oluwaseun Olafusi,11 Moses O Alfred5,6 1Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin, Edo State, Nigeria; 2Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, University of Benin, Benin, Edo State, Nigeria; 3Women’s Health and Action Research Centre (WHARC), Benin City, Edo State, Nigeria; 4Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria; 5Department of Chemical Sciences, Redeemer University, Ede, Osun State, Nigeria; 6African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer’s University, Ede, Osun State, Nigeria; 7Institute for Nanotechnology and Water Sustainability, College of Science, Engineering & Technology, University of South Africa, Pretoria, South Africa; 8Department of Obstetrics and Gynaecology, University of Medical Sciences, Ilaje, Ondo State, Nigeria; 9Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin, Edo State, Nigeria; 10Department of Obstetrics and Gynaecology, Central Hospital, Benin, Edo State, Nigeria; 11Department of Biochemistry, Faculty of Basic Medical Sciences, University of Medical Sciences, Ilaje, Ondo, NigeriaCorrespondence: Friday Ebhodaghe Okonofua, Women’s Health and Action Research Centre Km 11 Benin Lagos Expressway, Igue-Iheya, Benin City, Edo State, Nigeria, Email feokonofua@yahoo.co.uk; friday.okonofua@cerhi.uniben.eduBackground: 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.Keywords: male infertility, Nigeria, parabens, LCMS, case–control study, spermatozoa

Friday Ebhodaghe Okonofua,1– 3 Lorretta Favour Chizomam Ntoimo,3,4 Akhere Omonkhua,2,5 Oladiran Ayodeji,6 Celestina Olafusi,6 Emmanuel Unuabonah,7 Victor Ohenhen8 1Department of Obstetrics and Gynecology, University of Benin, Benin, Edo State, Nigeria; 2Center of Excellence in Reproductive Health Innovation, University of Benin, Benin, Edo State, Nigeria; 3Women’s Health and Action Research Centre, Benin City, Edo State, Nigeria; 4Department of Demography and Social Statistics, Federal University, Oye-Ekiti, Ekiti State, Nigeria; 5Department of Medical Biochemistry, School of Basic Medical Sciences, University of Benin, Benin, Edo State, Nigeria; 6Department of Obstetrics and Gynaecology, University of Medical Sciences, Ondo, Ondo State, Nigeria; 7Department of Chemistry, Redeemer University, Ede, Osun State, Nigeria; 8Department of Obstetrics and Gynaecology, Central Hospital, Benin, Edo State, NigeriaCorrespondence: Friday Ebhodaghe Okonofua, Department of Obstetrics and Gynecology, University of Benin, Benin, Edo State, Nigeria, Tel +234 8023347828, Email feokonofua@yahoo.co.ukBackground: Despite the evidence of declining sperm counts worldwide and the increasing prevalence of male infertility, there has been limited documentation of the potential causes and risk factors for male infertility. With limited methods of primary treatment of male infertility, understanding the causes and risk factors will pinpoint specific lines of prevention.Objective: We reviewed published studies on causes and risk factors for male infertility and identify gaps in the literature enabling more focused research and innovations.Design/Setting: The study was a scoping review. The review included studies on the causes and risk factors of male infertility published in scientific/academic publications. It was not limited to any region or date. The following databases were searched: Cumulative Index to Nursing and Allied Health Literature, Wiley online, HINARI, Science Direct, PubMed/Medline, Google Scholar, African Journals Online, and the WHO Repository. In total, 1295 articles were identified. After removing 357 duplicates, 938 articles were screened, and 71 articles were identified for inclusion, while 60 articles met the inclusion criteria.Results: Four broad causes and risk factors of male infertility identified were 1) biological/physiological/genetic causes, 2) behavioral/lifestyle risk factors, 3) environmental factors, and 4) socio-demographic risk factors. However, no substantive results on actual causes under each category were identified, leaving gaps for further research and experimentation.Conclusion: The results indicate limited knowledge of the actual causes of male infertility in published studies. The gaps in knowledge that need to be bridged to enable a fuller understanding of the actual causes of male infertility were highlighted.Keywords: male infertility, causes, risk factors, scoping review, spermatozoa defects

Background. The debate on the benefit of leaving the peritoneum unsutured is ongoing among gynaecologists. There is yet to be a final decision on this surgical step, especially considering the long-term complications of adhesion formation, subfertility and chronic pelvic pain. Objectives. The objective of the study is to determine the attitudes of Nigerian gynaecologists toward the peritoneum during laparotomy for both benign conditions and caesarean sections. Methods. The survey was conducted during the 50th International Conference of Gynaecologists hosted by the Society of Gynaecology and Obstetrics of Nigeria in October 2015. A questionnaire was distributed to attending participants across the board regarding peritoneal closure at laparotomy. A total of 125 respondents completed the survey. Data were entered into SSPA statistical software for analysis. Results. The attitude towards the peritoneum was not associated with the year of experience as a gynaecologist. The reasons for the decision not to close the peritoneum was mostly based on the little evidence there is as regards the benefits. Conclusion. The attitude towards the peritoneum during gynaecological procedures amongst Nigerian specialists appears to be in congruity with international practices where there is no clear-cut preference on the status of the peritoneum. However, the younger specialists gravitate towards non-closure. [ABSTRACT FROM AUTHOR]

Lorretta F Ntoimo,1,2 Friday E Okonofua,1,3,4 Rosemary N Ogu,1,3,5 Hadiza S Galadanci,6 Mohammed Gana,7 Ola N Okike,8 Kingsley N Agholor,9 Rukiyat A Abdus-Salam,10 Adetoye Durodola,11 Eghe Abe,12 Abdullahi J Randawa13 On behalf of the WHARC WHO FMOH MNCH Implementation Research Study Team 1WHO Implementation Research Group, The Women’s Health and Action Research Centre, Benin City, Edo State, 2Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, 3Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, 4Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, 5Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, 6Aminu Kano Teaching Hospital, Kano, Kano State, 7General Hospital, Minna, Niger State, 8Karshi General Hospital, Federal Capital Territory, Abuja, 9Central Hospital, Warri, Delta State, 10Adeoyo Maternity Hospital, Ibadan, Oyo State, 11General Hospital, Ijaye, Abeokuta, Ogun State, 12Central Hospital, Benin City, Edo State, 13Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria Introduction: While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.Methods: A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.Results: The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.Conclusion: MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system. Keywords: maternal death, maternal mortality ratio, emergency obstetric care, pregnancy care, tertiary hospital

The authors reflect on the need for skilled birth attendants (SBAs) in Nigeria, such as midwives, doctors, and nurses who are trained with the skills needed to manage all aspects of pregnancy, including complicated childbirth. They note the differences in the availability of SBAs in the northern and southern parts of Nigeria and offer statistics related to the reduction in maternal mortality when SBAs are present.

This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15-45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used. [ABSTRACT FROM AUTHOR]

In view of the high incidence of rickets in infants of women practising purdah (the use of veils) in northern Nigeria we conducted a study on plasma calcium, phosphate, and serum 25-hydroxyvitamin D (25 OHD) concentrations in pregnant Nigerian women and in cord blood obtained from the newborns. Plasma calcium, phosphate, and serum 25 OHD concentrations were lower in practising women and their newborns than those not practising purdah and their infants, respectively. The concentrations of 25 OHD in all Nigerian women were greater than those observed in caucasian women in the United Kingdom. These data emphasise the role of exposure to sunshine in regulating serum 25 OHD concentrations and the adverse effect of deliberate exclusion of sunshine and are consistent with previous data indicating hypovitaminosis D in purdah clad women and their newborns in Saudi Arabia. These data do not, however, provide an explanation for the pathogenesis of the high incidence of neonatal rickets and tetany in infants born of purdah clad women as these women have 25 OHD concentrations greater than those in caucasian women in the United Kingdom. [ABSTRACT FROM PUBLISHER]

The authors reflect on the need for skilled birth attendants (SBAs) in Nigeria, such as midwives, doctors, and nurses who are trained with the skills needed to manage all aspects of pregnancy, including complicated childbirth. They note the differences in the availability of SBAs in the northern and southern parts of Nigeria and offer statistics related to the reduction in maternal mortality when SBAs are present.