Male involvement in the management of infertile couples at Kenyatta National Hospital

Abstract

Infertility remains a global health challenge with devastating psychosocial consequences in many African communities. It is estimated that 50-80 million people worldwide are afflicted by infertility. The global prevalence is 8-12%, but this is higher in African countries ( 20:- 30%).2 In Kenya, upto 31% of the consultations made at KNH and MTRH (the two national referral hospitals) are related to infertility? The distribution of causes of infertility among infertile couples has male factor accounting for 23% and unexplained causes 28%.4 In a WHO multicentre study, male factor was found to contribute 20% and both male and female to contribute 27%.5 From the above statistics it is clear that male factor contributes significantly to the burden of disease, yet clinical and research work is concentrated on the female,' Failure to target men has weakened the impact of reproductive health programmes.? From literature review, there is minimal information on male involvement in the management of infertile couples. Study Design A hospital based cross-sectional descriptive study that involved couples presenting to the KNH Infertilility and Gynaecology clinics. Broad objective To determine the extent, predictors and impact of male involvement in -the management of infertile couples at the Kenyatta National Hospital. Main outcome measures The proportion of males involved in the management of infertile couples at the Kenyatta National Hospital. Results A total of 163 women and 34 men were recruited into the study. At least 69.9%(114) of the women who participated were ever accompanied to the clinic by their spouses. Knowledge on infertility among male participants was generally low especially whed it came to matters that concerned their spouses. Couple awareness on male participation in infertility was 61.8% by the men and 67.5% by the women but they all agreed that it would improve the care given. The male partners who came to the clinic were more involved in the care of their partners, in terms of paying hospital bills, having investigations performed on them, participating in the decision making process and accepting treatment (p<0.05). On multiple logistic regression, it was found that male partners of accompanied women were paying the medical bills (p-value = 0.017, OR=3.0[1.2-7.4]), being investigated (p-value=O.O 11 , OR=3. 1 [1.3-7.5]), helping decide the treatment the partner receives (p-value = 0.04, OR=2.5[1.0-5.9]) and accepting treatment if found to have a problem (p-value=0.005, OR=4.0[1.5-10.5]). Men with male factor infertility were more likely to accompany the spouse to the clinic if there was an associated female factor infertility, p=0.002. There was no statistical significance between accompanied and unaccompanied women in terms of education and employment. Majority of the male participants (55.9%) had received pressure from the community to ~et children. Conclusion Male partner participation improved the quality of care. There is need to address the negative pressure from family and community about a couple's childlessness. Recommendations Health care providers should offer appropriate counseling for the male partners and educate the community on infertility. In light of our findings, further research should be done on ways to improve male partner attendance and participation in the infertility clinic.