ICPD at 30 - What African countries need to do better.

In September 1994, the International Conference on Population and Development (ICPD), that gave birth to the doctrine of sexual and reproductive health and rights (SRHR), was held in Cairo, Egypt1. This year is the 30th year following the conference. Given that a total of 179 governments attended the ICPD and agreed to the Platform for Action for promoting and improving sexual and reproductive health and rights, it is appropriate to take stock of changes, expectations, and commitments that have occurred as a result of actions taken by governments. The 57th session of the Commission on Population and Development will be held in April 2024 and will be dedicated to assessing the status of sexual and reproductive health and rights 30 years after Cairo. Additional post-30years events will take place in Geneva, Switzerland in October 19-20, 2024 which are intended to enable the global community to take a look backwards identify ways in which the ICPD processes have influenced global development.

En septembre 1994, la Conférence internationale sur la population et le développement (CIPD), qui a donné naissance à la doctrine de la santé et des droits sexuels et reproductifs (SDSR), s'est tenue au Caire, en Égypte1. Cette année marque la 30e année après la conférence. Étant donné qu'un total de 179 gouvernements ont participé à la CIPD et ont accepté le Programme d'action pour promouvoir et améliorer la santé et les droits sexuels et reproductifs, il convient de faire le point sur les changements, les attentes et les engagements qui se sont produits à la suite des mesures prises. par les gouvernements. La 57e session de la Commission sur la population et le développement se tiendra en avril 2024 et sera consacrée à l'évaluation de l'état de la santé et des droits sexuels et reproductifs 30 ans après. D'autres événements post-30 ans auront lieu à Genève, en Suisse, les 19 et 20 octobre 2024, destinés à permettre à la communauté mondiale de jeter un regard en arrière et en avant pour identifier la manière dont les processus de la CIPD ont influencé le développement mondial.

Association of Urinary Mycotoxins with Sperm Quality: A Case-Control Study in Southern Nigeria.

The objective of this study was to determine the association between mycotoxins and the quality of spermatozoa in Nigeria. We designed a prospective case-control study involving 136 men diagnosed with reduced sperm count and quality in five infertility clinics in southwest Nigeria and 154 normal fertile controls. Sperm analysis was conducted in accordance with the recommendations of the World Health OrganizationWHO, while Liquid Chromatography-Mass Spectrometry was used to assay three metabolites of mycotoxins (zearalenone, ochratoxin A, and deoxyvinelol) in the urine samples of cases and controls. The data were analysed with descriptive statistics and non-parametric linear regression. The results showed no overall significant difference in levels of these metabolites between the cases and control groups. In contrast, higher levels of zearalenone and ochratoxin A significantly decreased sperm motility in the cases. Similarly, an increase in the level of ochratoxin A decreased sperm morphology in the unadjusted model in the cases. We conclude that exposure to mycotoxins reduces the quality of spermatozoa (motility and morphology) in Nigerian men but may have no effect on sperm count. Efforts to reduce the exposure of men to mycotoxins are important interventions to improve sperm quality and reduce the prevalence of male infertility in the country.

An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique.

BACKGROUND: Given the health and economic benefits of family planning (FP), Nigeria's very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria. MATERIALS AND METHODS: A multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities. RESULTS: The mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women's husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women's empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of '1', signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities. CONCLUSIONS: Our study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.

Reaffirming the value of continuing professional development.

With advances in clinical knowledge and changing norms for health services delivery, lifelong learning is essential for practitioners of sexual and reproductive health. Clinical topics should be complemented by various items, such as communications and management, to optimise the provision of care. Aiming to update knowledge, improve skills and enhance competence, professional development can take the form of diverse modalities ranging from the reading of professional journals through attendance at meetings to formal participation in schemes organised by licensing authorities. Already mandatory in numerous countries in Africa, continuing professional development is assuming more importance for medical, nursing, and midwifery practitioners.

Avec les progrès des connaissances cliniques et l'évolution des normes en matière de prestation de services de santé, l'apprentissage tout au long de la vie est essentiel pour les praticiens de la santé sexuelle et reproductive. Les sujets cliniques doivent être complétés par divers éléments, tels que la communication et la gestion, pour optimiser la prestation des soins. Visant à mettre à jour les connaissances, à améliorer les compétences et à améliorer les compétences, le développement professionnel peut prendre la forme de diverses modalités allant de la lecture de revues professionnelles à la participation à des réunions en passant par la participation formelle à des programmes organisés par les autorités chargées des licences. Déjà obligatoire dans de nombreux pays d'Afrique, la formation professionnelle continue prend de plus en plus d'importance pour les praticiens médicaux, infirmiers et obstétricaux.

Spontaneous second trimester rupture of a previous caesarean section scar: A case report.

Spontaneous uterine rupture before the onset of labour is rare in pregnancy especially before the third trimester. It is life threatening with devastating consequences to the mother and fetus. We report a case of spontaneous second trimester uterine rupture in a multipara with a previous uterine scar with the aim of creating awareness and sharing the challenges in diagnosis and management of this unusual complication of pregnancy. A 34-year-old woman with two previous deliveries presented at 16 weeks gestation with abdominal pain and vaginal bleeding of one day duration. At presentation, she was pale and in shock. There was generalized abdominal tenderness with guarding and rebound tenderness. At laparotomy, there was uterine rupture involving the lower segment with right lateral upward extension which was repaired. She remained stable at the follow up visit. In conclusion, Spontaneous uterine rupture of a previous caesarean section scar in the second trimester is rare. The diagnosis should be considered in a woman with previous caesarean section who experience an acute abdomen in the second trimester of pregnancy.

La rupture utérine spontanée avant le début du travail est rare pendant la grossesse, surtout avant le troisième trimestre. Elle met la vie en danger et entraîne des conséquences dévastatrices pour la mère et le fœtus. Nous rapportons un cas de rupture utérine spontanée au deuxième trimestre chez une multipare présentant une cicatrice utérine antérieure dans le but de sensibiliser et de partager les défis du diagnostic et de la prise en charge de cette complication inhabituelle de la grossesse. Une femme de 34 ans ayant déjà accouché deux fois s'est présentée à 16 semaines de gestation avec des douleurs abdominales et des saignements vaginaux d'une durée d'un jour. Lors de la présentation, elle était pâle et sous le choc. Il y avait une sensibilité abdominale généralisée avec une sensibilité de garde et de rebond. Lors de la laparotomie, il y a eu une rupture utérine impliquant le segment inférieur avec extension latérale droite vers le haut qui a été réparée. Elle est restée stable lors de la visite de suivi. En conclusion, la rupture utérine spontanée d'une cicatrice de césarienne antérieure au deuxième trimestre est rare. Le diagnostic doit être envisagé chez une femme ayant déjà subi une césarienne et présentant un abdomen aigu au cours du deuxième trimestre de la grossesse.

Climate change and women's health: Call for research and innovations.

Climate change has featured repeatedly in the most recent discourses on global development1. Several global conferences have been held in recent times to discuss and reach consensus on ways to ameliorate the causes and address the consequences of climate change worldwide. These conferences, now called "Conference of the Parties (COP) to the United Nations Framework on Climate change" have taken place in many countries over the last couple of years. The most recent conferences included COP26 and COP27 which took place in Glasgow, UK 2021 and Sham El Sheikh, Egypt in 2022 respectively. The COP28, which took place in Dubai, UAE in 2023 focused on the theme "unite, act, deliver", and was attended by over 85,000 participants.

Menstrual hygiene management among adolescent girls in West Africa: A systematic review.

A systematic literature review was conducted to examine all recent academic, peer-reviewed studies of menstrual hygiene management (MHM) across adolescent girls in Anglophone West Africa. The objective was to assess the status of the scholarship surrounding the knowledge, attitudes, and practices of MHM across English-speaking West African countries and identify gaps in the literature for further research. The authors searched the epidemiological literatures indexed in PubMed and cross-referenced bibliographies for studies published between 2010-2022. Of 59 abstracts and articles screened, 35 met the final inclusion criteria. Despite differences in study design, setting, and data sources, the study results concurred on an average age of menarche between 12-15 years old among adolescent girls. The knowledge of MHM came from multiple sources, most commonly mothers, female siblings, and teachers and higher knowledge was associated with age, source, wealth, religion, and education level. Less than half of the adolescent girls knew about menstruation before menarche. Many studies showed that girls were shocked by their first period and fearful of staining. Menstruation was associated with dysmenorrhea, fear/embarrassment, and missing school. The existing studies suggest that more implementation and evaluation of menstrual hygiene management materials, education, and facilities are needed to address the educational, physical, and social disparities that exist among girls in West African countries.

Une revue systématique de la littérature a été menée pour examiner toutes les études universitaires récentes évaluées par des pairs sur la gestion de l'hygiène menstruelle (MHM) chez les adolescentes d'Afrique de l'Ouest anglophone. L'objectif était d'évaluer l'état de la recherche sur les connaissances, les attitudes et les pratiques de la GHM dans les pays anglophones d'Afrique de l'Ouest et d'identifier les lacunes dans la littérature pour des recherches plus approfondies. Les auteurs ont recherché dans la littérature épidémiologique indexée dans PubMed et des bibliographies croisées pour les études publiées entre 2010 et 2022. Sur les 59 résumés et articles examinés, 35 répondaient aux critères d'inclusion finaux. Malgré les différences dans la conception, le cadre et les sources de données de l'étude, les résultats de l'étude concordaient sur un âge moyen des premières règles entre 12 et 15 ans chez les adolescentes. La connaissance de la GHM provenait de sources multiples, le plus souvent des mères, des frères et sœurs et des enseignants, et les connaissances supérieures étaient associées à l'âge, à la source, à la richesse, à la religion et au niveau d'éducation. Moins de la moitié des adolescentes connaissaient leurs règles avant les premières règles. De nombreuses études ont montré que les filles étaient choquées par leurs premières règles et craignaient les taches. Les menstruations étaient associées à la dysménorrhée, à la peur/à la gêne et à l'absence à l'école. Les études existantes suggèrent qu'une plus grande mise en œuvre et une plus grande évaluation du matériel, de l'éducation et des installations de gestion de l'hygiène menstruelle sont nécessaires pour remédier aux disparités éducatives, physiques et sociales qui existent parmi les filles dans les pays d'Afrique de l'Ouest.

Human papilloma virus (HPV) vaccine and cervical cancer prevention in Africa.

Cervical cancer remains a critical challenge in reproductive health worldwide, with especially high burden in Africa. A recent publication in the Lancet reported 604,127 cases of cervical cancer worldwide in 20201, of which 117,316 cases (19.4%) were in the five African regions. East Africa had the highest incidence rate followed by West Africa, while north and South Africa had the lowest rates. Similarly, the highest cervical cancer mortality rate worldwide, 28.6 deaths per 100,000 women years, was reported from East Africa, and was followed by South Africa.

Le cancer du col de l'utérus reste un défi majeur en matière de santé reproductive dans le monde, avec un fardeau particulièrement élevé en Afrique. Une publication récente du Lancet a fait état de 604 127 cas de cancer du col de l'utérus dans le monde en 20201, dont 117 316 cas (19,4 %) dans les cinq régions africaines. L'Afrique de l'Est avait le taux d'incidence le plus élevé, suivie de l'Afrique de l'Ouest, tandis que l'Afrique du Nord et l'Afrique du Sud avaient les taux les plus bas. De même, le taux de mortalité par cancer du col de l'utérus le plus élevé au monde, soit 28,6 décès pour 100 000 femmes-années, a été signalé en Afrique de l'Est, suivi par l'Afrique du Sud.

Prevalence and determinants of condom use among the youth in Malawi: evidence from the 2015/16 Malawi Demographic and Health Survey.

BACKGROUND: Unprotected sexual intercourse among the youth is common in Malawi. This has led to high rates of sexually transmitted infections (STIs), Human Immunodeficiency Virus (HIV), and unplanned pregnancies. The study investigated the prevalence and the determinants of male and female condom use for the prevention of sexually transmitted infections and unplanned pregnancies among the youth in Malawi. METHODS: The 2015/2016 Malawi Demographic and Health Survey (MDHS) data were used among 15 to 24-year-old male and female who had sexual intercourse four months preceding the survey. A total of 1543 male and 5143 female were selected from 3226 male and 10,367 female respectively and analyzed with SPSS version 20 using.descriptive, bivariate, and logistic regression. RESULTS: The study found a low prevalence (27.1%) of condom use among the youth in the last sexual intercourse within four months before the survey. More male (55.8%) used condoms than female (18.5%). The significant predictors of condom use among the male and female youth were: being sexually active (OR 0.39 CI 0.33-0.47), aged 20-24 (OR 0.80 CI 0.68-0.95), ever married (OR 0.07 CI 0.06-0.08), coming from central region (OR 0.56 CI 0.40-0.77), and southern region (OR 0.59 CI 0.42-0.83), residing in the rural area (OR 0.74 CI 0.61-0.90) and ever tested of HIV (OR 1.29 CI 1.03-1.55). CONCLUSION: Having established low prevalence of condom use among the youth in Malawi, there is a need to scale up programs and policies that target the youth to practice safe sex, which will assist in addressing the challenges of STIs, including HIV, and preventing unplanned pregnancies in Malawi.

Outcome of interventions to improve the quality of intrapartum care in Nigeria's referral hospitals: a quasi-experimental research design.

BACKGROUND: Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals. METHODS: Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals. RESULTS: The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals. CONCLUSIONS: We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach. TRIAL REGISTRATION: The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 .

The politics of abortion rights in the 2022 United States midterm election: Lessons for fledgling democracies around the world.

The United States government, under President Donald Trump, retreated from its traditional role as an exemplar of democracy, defender of press freedom and the rule of law but embraced conspiracy theories, virulent anti-Semites, and authoritarian regimes worldwide. Today, democracy is in crisis and is under assault and in retreat globally. The 2022 United States midterm election has come and is now history with many unexpected outcomes. The three impactful issues during the campaign that produced many upsets were abortion rights, election denialism, and threats to democracy. This editorial examines the history of abortion rights in the United States, the impacts of the Dobbs vs. Jackson ruling on the 2022 midterm election, the threats of election deniers to global democracy, the global status of reproductive health rights, and the lessons of abortion ban for burgeoning democracies worldwide.

Nigeria's 2023 presidential election and the future of healthcare in the country.

On February 25, 2023, Nigerians took a step forward as a democratic state by voting for a new president. The election is history as the ruling party's candidate, Bola Tinubu, was declared the winner. He polled 37% of the vote, his main rival Abubakar Atiku garnered 29%, and Labour's Peter Obi 25%. Only 27% of registered voters came out to vote. International election observers noted that the election lacked transparency and was marred by logistical challenges and multiple incidents of political violence. The currency and fuel shortages in the country burdened many voters and election officials and therefore marginalised many groups, especially women, who continue to face barriers to political office. The outcome of the election is in contention and inconclusive. The aggrieved parties have taken their case to court, so the nation awaits the outcome of the court decision. In this Editorial, AJRH analyses the prospects and implications of Tinubu's presidency for healthcare in Nigeria.