Interventions to reduce psychological morbidities associated with infertility in Nigeria

Introduction: Infertility affects up to 30% of Sub Sahara Africa population. In African societies, having infertility can come with dire consequences, depending on the level of empowerment and the ability to resist infertility related stigma, leading to psychological distress, anxiety and depression for those affected. Cognitive Behavioural Therapy (CBT) has been shown to be more effective than the pharmacological treatment of infertility-related depression (Faramarzi et al, 2008), therefore a need for the development of a culturally appropriated CBT based intervention for the management infertility-related psychological distress. Objectives: 1. To determine the prevalence of psychological morbidities amongst infertility patients in 2 Nigerian hospitals 2. To develop and test Fertility Life Counselling Aid (FELICIA), an intervention for the management psychological morbidities associated with infertility 3. To understand patients’ perspectives of the potential benefits of the FELICIA intervention, 6 weeks post intervention Methods: An intervention was developed using the MRC framework for development of complex health interventions (Craig et al, 2008). Research was carried out using mixed methods involving a cross-sectional survey, a feasibility study using external pilot randomised controlled trial, and qualitative research using semi structured one-to-one interviews. Results: FELICIA, a CBT based intervention was developed based on the WHO Thinking Healthy Programme to manage the psychological morbidities associated with infertility. In a survey of 224 patients attending infertility clinics in 2 Nigerian cities, 96 patients (43%) had scores of 3 or more on the 12 item-GHQ, indicating psychological morbidity. High prevalence of psychological morbidity was recorded amongst patients with history of domestic violence, and a longstanding history of infertility treatment. Participants were randomised into 2 groups for an external pilot randomised controlled trial to determine the feasibility of carrying out the FELICIA intervention within a busy clinical setting. Results showed those in the intervention group to have marked improvement, with 7 out of 8 returning to normal GHQ scores, compared to only 1 out of 8 participants in the control group (p value= 0.01; RR= 0.143; 95% CI 0.023 - 0.91). The estimated number needed to treat (NNT) for one additional patient to benefit is 1.33 patients. The results also provided parameters used to determine the sample size required to conduct a full randomised controlled trial. Qualitative research findings suggest that the FELICIA intervention was well received by participants, who found the intervention to be empowering and beneficial in helping them manage infertility induced psychological distress. Implications of Research: Although infertility-related psychological distress remains highly prevalent amongst Nigerian infertility population, the development of a culturally appropriated counselling intervention, such as FELICIA, has the potential to reduce infertility related psychological distress, and can be conducted by clinic staff with minimal training.