| The shift in focus on men's reproductive health was influenced by the 1994 Cairo (ICPD) Action Plan to promote gender equality and equity. Recently, men's needs in sexual and reproductive health and health care are receiving increased attention. The present evidences proved that male reproductive health is declining worldwide. However, to date not much is known about reproductive health problems and health care needs in men from developing countries.Male reproductive health in China also is declining. WHO together MOH in China organized an investigation in male reproductive health in China. Results showed that 25% men had sex disorder, infertility rate ranged between 3% and 11%, individual place reached 14%. Many studies consistently found that semen quality of fertile men decreased between 1980 and 2010. Male reproductive health has drawn attention in China. October 28 in every year is designed as“Man Health Day”in order to raise public awareness about male reproductive health care. China is one of a few countries to set aside a special day highlighting male health.In Chongqing, southwest of China, the investigation between 2005 and 2006 found that the infertility rate was 5.5%. Our previous study found 61.1% of healthy males in Chongqing had at least one sperm parameter below normal threshold values compared with the WHO criteria. However, there is no study to comprehensively explore the male reproductive health needs and risk factors for male reproductive health in this area.Aim: This thesis focus on investigating health needs of male reproductive health in Chongqing, exploring the risk factors for male reproductive health (particularly socio- psycho-behavioral factors) widely in this area, and identifying the possible strategies for male reproductive health promotion by utilizing interdisplinary methods. Methods: This investigation used mixed research methods such as in-depth interview, participatory research method, questionnaire survey, literature analysis, second data analysis, and meta-analysis and etc.Main results:1. Health needs assessment on male reproductive health in Chongqing1.1 Main reproductive health problemsThrough in-depth interviews of 16 males and ranking of 5 males, STDs prevention and control, prostate diseases control, sexual disorders were identified as the first three priorities of reproductive health problems in males in Chongqing.1.2 Determinants related to male reproductive healthLittle Attention form government: Traditionally main attention to reproductive health was given to female and men were marginalized. There is no a professional clinic or health sectors for male reproductive health. Though there was some kind of health propagandas on“Man Health Day”in each year, yet all males in the in-depth interviews reflected they never access to any professional health service(including health propagandas) for male's health.Lack of awareness and health knowledge in male: In-depth interviews found that male's health awareness need improve. Though the vast majorities(14/16)cared about male reproductive health, yet individual male didn't mind male reproductive health. Generally speaking, males were rather lack of knowledge related to male reproductive health. Quite a few males(6/16)never heard of male reproductive health. The vast majorities only heard of STDs, but have no knowledge of symptoms or sign, or the route of transmission. Safe sexual behaviors and risk sexual behaviors were strange for around 1/4 males. Many men didn't hear of male menopause and majorities have no knowledge on any symptoms of it. It is notably, number of male didn't know any information about the places to get condom or its use; vast majorities thought condom was only used for contraception. Risk behaviors related to male reproductive health when they suspect they have reproductive health problems, the vast majorities (12/16) would see doctors directly, but minorities (4/16) of them would take self-treatment and then would see doctor when they feel it is difficult to recover by itself. Some men even just let it alone just because they were busy with work.1.3 Urgent health needs of male reproductive healthThe In-depth interviews and ranking reflected that urgent health services reported by men included setting up professional clinics for male reproductive health, strengthening health information dissemination, screening reproductive diseases and provided various consultation services.2. Meta-analysis on risk factors for male semen quality2.1 Fifty seven eligible articles were identified altogether including 29914 subjects (including 4516 fertile people, 13001 infertile people, 9080 healthy people and 3317 men from general population) from more than 26 countries and regions.2.2 13 Factors were investigated: age, BMI, psychological stress, smoking, alcohol and coffee consumption, passive smoking, sedentary posture, hot bath/sauna, wearing tight pants, tea drinking, electric blanket utilization, and genitalia washing.2.3 There were six factors including age, body mass index, psychological stress, smoking, alcohol, and coffee consumption that were included in this meta-analysis. The results showed that smoking can deteriorate all of the sperm parameters (the pooled mean differences were -0.25, -7.07, -32.20, -1.85, -4.92, respectively, P<0.05); higher age and alcohol consumption are risk factors for lower semen volume (the pooled mean differences were -0.57 and -0. 30, respectively, P<0.05); psychological stress can lower sperm density and sperm progressive motility and increase abnormal sperm (the pooled mean differences were -23.01, -6.49 and 7.43, respectively, P<0.05).2.4 We did not identify enough data for a meta-analysis on the relationship between the rest factors and semen quality. But, the effect of tea drinking, electric blanket use, passive smoking, sedentary posture, and wearing tight pants on semen quality were implicated in the qualitative analysis in a few present studies. Great efforts should be needed to examine their role on semen quality with a better study design.3. Socio-psycho-behaviour factors associated with male semen quality in Chongqing3.1 Cross-sectional studyThis cross-sectional study investigated the association between 16 socio-psycho-behaviour factors and semen quality of 1346. Results indicated that age and often wearing fiber underwear were negatively associated with sperm morphology (beta coefficient: 0.69 and 0.83 respectively, P<0.01); occupation class was negatively correlated with sperm density and sperm progressive motility (beta coefficient: 0.79 and 0.81 respectively, P=0.02 and 0.04 respectively); men with less stress had higher total sperm count and percentage of morphologically normal sperm(beta coefficient: 1.19 and 1.25 respectively, P=0.02 and 0.04 respectively). Noticeably, regular physical exercise was negatively correlated with semen pH value. In addition, we observed that regular physical exercise participation was significantly different among different age groups, years of education, occupation classes and level of income (P=0.000). Age, education and income were significantly associated with fiber underwear wearing (p=0.005, 0.000, 0.01 and 0.036 respectively). Age, education and occupation were associated with psychological stress (p=0.036, 0.003 and 0.004 respectively).3.2 Case-controls studyThis case-control study found that semen PH was negatively associated with habit of taking hot bath, having multiple sexual partners and visiting prostitute(Beta: 0.51, 0.54 and 0.51 respectively; P: 0.006,0.015 and 0.008 respectively); semen volume was negatively related to divorce/separate or winded marital status(Beta: 0.65; P: 0.008); age, smoking, tight pants wearing in past 3 month decreased significantly sperm density (Beta: 0.51, 0.61 and 0.49 respectively; P:0.036, 0.036 and 0.003 respectively);total sperm count was negatively associated with divorce/separate or winded marital status, and fiber underwear wearing in past 12 months (Beta: 0.69 and 0.50 respectively; P: 0.026 and 0.003 respectively); rapid progressive motility was negatively influenced by age and alcohol(Beta: 0.002 and 0.50 respectively; P: 0.00 and 0.006 respectively); progressive motility was negatively affected by age, alcohol drinking, and age at sex initiation(Beta: 0.57, 0.72, 0.44 and 0.57 respectively; P: 0.001,0.046,0.001 and 0.040 respectively). Besides, we explored socio-economic factors indirect associated with semen quality and found that education level, occupation and poverty influence sexual behaviours; marital status, education, occupation and poverty did influenced alcohol drinking, habit of taking hot bath and wearing fiber underwear.4. Strategies suggestions for improvement of male reproductive health in Chongqing4.1 To attract attention to male reproductive health from government Up to date, in developing countries, the tendency is still to exclude men from reproductive health work other than vasectomy or condom distribution. Health needs assessment also indicated that policy makers was expect to give high light to male involvement in family planning and reproductive health when they make or perfect related policy; government should gradually increase financial input in every aspect of male reproductive health, such as organisational and environmental development, training and skills development of health workers, provision of health services.4.2 Organizational capacity building It is important to set up professional health sectors for male reproductive health and to staff a group of professional health workers with essential knowledge and skill. Another one choice is to combine female reproductive health service with male reproductive in existing family planning networks, and to staff and train health workers in this network. Besides, in order to improve awareness, it is of great significance to build cultural environment through widely health education by TV, broadcast, newspaper, propaganda column.4.3 Provision of health services for men reproductive health Health needs assessment discovered that men are thirty for accessible health education, providing counselling, regular examination. Accordingly, following measures can be considered: Regular publicity activities should be conducted through public media or other popular means so that local communities, families and the public can benefit and form healthy lifestyle/behaviours; professional health education programs can be conducted in local communities or work units; knowledge can also be disseminated by giving volunteer medical consultation or hotline. Professional, accessible, affordable, acceptable, counselling by qualified counsellors should be provided in free-standing counselling services, by hotline or by integrating it into other health services. Regular examinations for some common male reproductive diseases can be organized by related health sectors. Besides, provision of treatment is another one need because once males meet any reproductive health problem, accessible treatment is of great importance.4.4 Strengthening 100% CUP strategy The 100% CUP strategy is now recommended to implement in Asian countries and worldwide. It has also been proven effective to in reducing the prevalence of STI and HIV/AIDS in China. Therefore, it is important to emphasize the importance of 100% using condom in establishments and provide skills-building services on condom use.4.5 Unhealthy sexual behavioural interventions With social and economic development, unhealthy sexual behaviours are increasing largely in China and Chongqing. Providing comprehensive sex education for youth and improving access to health care are important strategies to help individuals achieve and maintain good sexual health.4.6 Implications for research: Firstly, target research efforts should address prevent/minimize the occurrence of disorders rather than develop drug treatment. Secondly, strengthen interdisciplinary, translational research in male reproductive health issues. Thirdly, implementing long-term, epidemiology studies aimed at better understanding the causes and effects of male reproductive disorders. Besides, national/international exchanges and cooperation, collaborative research in the field of male reproductive health should be improved.Conclusion:This thesis primarily investigated health needs of male reproductive health and socio-psycho-behavioural risk factors associated with semen quality of males in Chongqing. Health needs of men health was far from fulfilling. Many socio-psycho-behavioural factors associated with male reproductive and semen quality. Increasing attention had been given to male reproductive health, but there is still a long way to go. Attention from government, organization capacity and environment building, health service provision (including health education, counselling, regular examination and treatment), strengthening 100% CUP, interventions on unhealthy sexual behaviours, further research are major strategies for male reproductive health improvement in Chongqing. |
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