Adeyemi O. Adekunle

Gossypol blood levels and inhibition of spermatogenesis in men taking gossypol as a contraceptive. A multicenter international dose-finding study.

The safety and efficacy of gossypol continues to be controversial. The aim of this study was to evaluate gossypol as a contraceptive pill for men at doses lower than those previously prescribed and in men from various ethnic origin. A total of 151 men from Brazil, Nigeria, Kenya, and China were divided into two groups. Both groups received 15 mg gossypol/day for 12 or 16 weeks to reach spermatogenesis suppression. Subjects were then randomized to either 7.5 or 10 mg/day for 40 weeks. In addition, 51 men were enrolled as a control group. In all, 81 subjects attained spermatogenesis suppression. Only one man discontinued treatment because of tiredness. Potassium levels fluctuated within the normal range. FSH increased consistently. Testicular volume decreased, but after discontinuation, values returned to levels not statistically different from admission. Of 19 subjects on the 7.5 mg/day dose group, 12 recovered sperm counts >20 million/mL within 12 months of discontinuing gossypol. In the 10 mg/day group, sperm counts recovered in only 10 of 24 subjects. Eight of the 43 patients remained azoospermic 1 year after stopping gossypol. All men diagnosed with varicocele failed to reverse spermatogenesis suppression. Gossypol blood levels indicated that sperm suppression occurs independently of concentration, whereas spermatogenesis recovery appears to be concentration-dependent. Gossypol may become a medical alternative to surgical vasectomy when the delay in onset of infertility is acceptable. When taken for 1 year, gossypol causes no reduction in sexual desire or frequency of intercourse. The possibility of reversal, occurring in 51% of the men on this regimen within 1 year after stopping gossypol, is an advantage of this compound as compared with surgical sterilization in many parts of the world.

Multicenter clinical trial on the efficacy and acceptability of a single contraceptive implant of nomegestrol acetate, Uniplant

Uniplant, a single Silastic implant containing nomegestrol acetate, provides contraceptive efficacy for one year. Uniplant use for one year was studied in 1,803 healthy women of reproductive age, enrolled from 10 centers in 9 countries, after informed consent. Implants were placed subdermally either in the upper arm or in the gluteal region. Two-hundred-seventy-six subjects discontinued prior to completing one year of study. Cumulative discontinuation rate at 12 months was 15.72%. Medical reasons for discontinuation were principally menstrual-related. Fifteen pregnancies occurred during the one year study period, resulting in a 12-month net cumulative pregnancy rate of 0.94%. Approximately 56% of subjects using Uniplant had bleeding patterns similar to normal menstruation. Results from this study confirm that Uniplant is an efficient, well tolerated, 12-month contraceptive implant, with the advantage of easier insertion and removal of the single implant compared to other multiple implant methods.

Reproductive Tract Infections in Nigeria: Challenges for a Fragile Health Infrastructure

Reproductive tract infections (RTIs) are frequent and troublesome disorders during the reproductive life of women. In many developed countries, accurate annual data on RTIs are available; in Nigeria, however, most information on RTIs emanate from hospital-based studies that often are not representative of the true incidence of RTIs at the community level.

Biosocial Profiles and Pattern of Complaints of New Intrauterine Device Acceptors at the University College Hospital, Ibadan, Nigeria

Objective To determine the pattern of biosocial characteristics of the new IUD acceptors and describe their concerns. Methods This was a retrospective review of records of new IUD acceptors at the University College Hospital, Ibadan, Nigeria from January to December 2007. Results The age range of subjects was 19 to 49 years with a mean of 33.5 ± 2.4 years. The commonest source (46.0%) of clientele referral was through the health care providers — doctors and nurse/midwife. Other referral patterns were from friends/ relative (23.5%), media — TV and radio (17.0%), outreach programmes (7.3%), self referral (5.2%) and others — the source was not indicated (1.2%). Of the total participants, only 239 (56.1%) reported for follow-up visits. Majority had at least one visit; about a third had two, while others had three or four and above visits. About 43.2% of those at follow-up visits had complaints. The commonest (37.5%) complaint was menstrual irregularity. Other complaints were cramping abdominal pain (22.2%), vaginal discharge (19.6%), amenorrhoea (10.3%), penile discomfort during sexual intercourse (4.3%), expulsion of IUD (3.8%) and 2.2% of missing IUD. Conclusion This audit shows that new IUD acceptors are largely referred by health care providers and are mainly offered the TCu380A version. Community outreach programmes as alternative strategy is likely to boost the uptake of this particular method in Nigeria.

Factors behind Institutional Delivery Preference in the Republic of Benin: An Analysis of 2011-2012 Benin Demographic and Health Survey (BDHS) data

Background: Ending preventable maternal and newborn morbidity and mortality remains a core component of the Sustainable Development Goals (SDG) which is a continuation of the Millennium Development Goals (MDG). It has been documented that most women in developing countries give birth at home without the intervention of skilled attendants despite the prevailing multitude risks associated with childbirth for both mother and the unborn child. The study was aimed at identifying the most significant factors influencing selection of health facility based delivery among reproductive age mothers. Data and methods: Data was obtained from Benin Demographic and Health Survey (BDHS) of 2011-2012 using percent distribution, binomial logistic regression and multinomial regression. Out of 16,599 interviewed only 9,111 were eligible for the present study. Results: Most (76.0%) of the respondents gave birth at public health centers, 11% in private health centers and the rest outside health institutions. Out of 17 variables examined, 13 were found (using Akaike Information Criterion in a stepwise algorithm) to be the most important factors for institutional delivery. Among them, Antenatal Care (ANC) frequency, mother’s education, and household wealth index had most impact on institutional deliveries with positive and linear relationships. Most of the educated women (secondary or above) were more likely to give birth in a private health facility (Private Health OR=5.2, 95% CI 2.47-10.88; Public Health OR=3.7, 95% CI 1.82-7.6). Similar results were found among the richest women (Private Health OR=8.6, 95% CI 3.5-21.3; Public Health OR=4.4, 95% CI 1.90-10.4). Female education and economic status were the most important factors for institutional delivery preference. Conclusion: Encouraging regular ANC visits (at least the four recommended visits), and girls’ education up to secondary school will help getting women to deliver in a well-equipped health facility. There is also a need to investigate thoroughly through qualitative researches reasons behind their preference of health facility for reproductive health services, including institutional delivery.