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Cholera outbreak: Nigeria runs out of vaccine as death toll hits 40

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As the death toll from the latest cholera outbreak hits 40, the Nigeria Centre for Disease Control says the country does not have enough vaccines. According to the Director General of the Nigeria Centre for Disease Control and Prevention, Dr Jide Idris, Nigeria has placed an order for more cholera vaccines from donor agencies, even though the date of delivery is still unknown.

The NCDC boss stressed the need for the country to embrace the use of vaccines and other preventive measures to curb the spread of the acute diarrhoeal infection.

Cholera is a food and water-borne disease caused by the ingestion of the bacterium, Vibrio cholerae, in contaminated water and food.

Cholera kills 4,364 in four years

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No fewer than 4,364 people have died out of the 139,730 Nigerians suspected to have been infected with the disease across the country in the last four years, an investigation by Saturday PUNCH has indicated. The incidence rate was derived from an analysis of the weekly cholera situation reports released by the Nigeria Centre for Disease Control between 2021 and 2024.

Recall that the NCDC recently alerted the public to the increasing trend of cholera cases across the country as the rainy season intensifies. In a statement signed by Idris on Thursday, June 13, 2024, the agency said that from January 1 to June 11, 2024, a total of 1,141 suspected cases, 65 confirmed cases, and 30 deaths from cholera had been reported from 96 local government areas in 30 states of the federation.

The NCDC listed the 10 states that contributed 90 per cent to the burden of cholera as Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos. As of then, the Lagos State Ministry of Health said it had recorded 350 suspected cases of the disease in 29 wards across multiple LGAs with 17 confirmed cases and 15 fatalities attributed to severe dehydration caused by delayed presentation.

However, on Friday, the state Commissioner for Health, Prof Akin Abayomi, said the cholera incidence rate in the state had risen to 417 suspected cases, and 35 confirmed cases, with 24 deaths.

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In a post made on his Instagram handle on Friday afternoon, Abayomi said, “The situation report as of June 19, 2024, indicated 417 suspected cases, 35 confirmed cases, and 24 recorded deaths.”

“Let’s adhere strictly to personal and environmental hygiene. Let’s stay safe #ForAGreaterLagos.”

He said the cases were reported from the Agege, Badagry, Ikeja, Mushin, Ajeromi-Ifelodun, Epe, Ikorodu, Ojo, Alimosho, and Eti-Osa areas of the state.

Others he mentioned include Kosofe, Oshodi-Isolo, Amuwo-Odofin, Ibeju-Lekki, Lagos Island, Shomolu, Apapa, Ifako-Ijaiye, Lagos Mainland, and Surulere.

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Also, the Ogun State Commissioner for Health, Dr Tomi Coker, told our correspondent on Thursday that the state had recorded one death and 14 cases.

This implies that in the last 12 days, the incidence rate of the disease in the country for this year had hit 1,222 suspected cases, 88 confirmed cases, and 40 fatalities.

The NCDC, however, stated that a multi-sectoral National Cholera Technical Working Group, led by the centre and comprising the Federal Ministries of Environment and Water Resources, the National Primary Health Care Development Agency, the World Health Organisation, the United Nations Children’s Fund, and other partners, had been providing support to the affected states.

With the latest incidence rate from Ogun and Lagos, investigations by Saturday PUNCH showed that a total of 4,364 deaths had been recorded out of the 139,730 people suspected to have been infected by the disease across the country since 2021.

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Going by one of the NCDC’s cholera situation reports for week 52, there were a total of 111,062 suspected cases of the disease with 3,604 deaths across 435 local government areas in 34 states of the federation in 2021.

Another Cholera Week 52 report published by the NCDC and analysed by our correspondent revealed that in 2022, the country recorded 23,763 suspected cases with 592 deaths across 271 LGs in 33 states of the federation.

In 2023, there was a reduction in the incidence rate of the disease as the country recorded 3,683 suspected cases with 128 deaths across 166 LGs in 31 states of the country.

The prevalence rate of the disease further went down in 2024 with 1,141 suspected cases and 30 deaths recorded across 84 LGs in 30 states of the federation.

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There were 473,000 cholera cases reported to the World Health Organisation in 2022, which was a 100 per cent increase compared to the rate reported to the global health organisation in 2021.

More so, a further increase in cases by 700,000 was estimated in 2023, while the latest data from the WHO showed that a cumulative total of 145,900 cholera cases and 1,766 deaths had been reported from 24 countries across five WHO regions.

In the latest global rate, Africa recorded the highest numbers, followed by the Eastern Mediterranean region, the region of the Americas, the South-East Asia region, and the European region.

However, speaking with Saturday PUNCH, the NCDC boss said while it is the National Primary Health Care Development Agency that is dealing with the issue of cholera vaccines, he is aware that the health minister has requested more vaccines from donor agencies.

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“I know that the minister has requested more vaccines. But, I don’t know when they will come, because other countries also make requests internationally. I know that when they come, NPHCDA will decide how to distribute or use them.

“We don’t have enough to prevent an outbreak, because we need to give these things before that time. The problem is that to get vaccines, we need to plan ahead, and we don’t have the funds. Most countries plan ahead. When it comes to health security, we are supposed to stockpile some things in anticipation of an emergency.

“We don’t manufacture vaccines. We get them from donor agencies, just like any other country does. Whatever they supply will not be enough for us to use and in any case, it doesn’t give long-lasting immunity, so it has to be a combination of all control measures.

“The minister has requested support for these vaccines. He told me that last week. When they will come, I don’t know. However, we don’t necessarily have to rely on all those things if we can adopt other control measures,” the NCDC boss said.

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Dr Idris also noted that the demand for cholera vaccines outpaces supply, adding that to consistently have adequate vaccines to curb diseases, the nation must plan ahead. He also stressed that Nigeria must embrace a combination of preventive measures to curb cholera outbreak, noting that cholera vaccines are not long-lasting.

“Cholera vaccine demand is far ahead of supply so most people who need them place orders and plan ahead. It is the same thing with all vaccines, not just cholera.

“We also know that cholera vaccines are not long-lasting. They only work for some time, so a combination of vaccines where necessary and all other preventive measures are the mainstay of the effort to curb the infection.

“The mainstay is to treat people if they are dehydrated, so they can replace lost fluids, maintain personal, environmental and sanitary hygiene, etc. We talk about boiling water before eating, washing hands after using the toilet, and before and after preparing food. If anybody suspects contamination, they should boil water before drinking and using it. It is a combination of all these preventive measures that will go a long way in helping to curb the outbreak,” Idris said.

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Also speaking during a recent programme on Channels Television, the NCDC Director General had said that prevention was key in fighting the disease in Nigeria.

Idris noted that as the rainy season intensified, there were possibilities of increasing cases of cholera in the country. He said, “The Nigerian Meteorological Agency has said that the rains this year are going to be heavier, and when you have rains, you’re going to have floods, and this leads to contamination of our water sources. So, the chances are that cholera cases will increase.”

The DG, who blamed the outbreak of the infection on poor sanitation, personal and environmental hygiene, and lack of access to clean water, noted that the agency was conducting a risk assessment, and had alerted all the states about the outbreak. He said the state governments must ensure access to clean water and toilets for their citizens.

Cholera vaccine can help – Experts

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Meanwhile, public health expert, Prof Tanimola Akande; and consultant physician, Kenechukwu Igwegbe, have urged Nigerians to consider taking the cholera vaccine as preventive vaccination to provide cover against the acute diarrhoeal disease.

The medical experts said cholera vaccines were not as popular as other vaccines, because they were often given to targeted populations, such as travellers to countries that have active transmission of cholera or given during cholera outbreaks, or to some populations that are at risk.

Due to the yearly recurring outbreaks, Prof Akande suggested that “preventive vaccination could be done in anticipation of cholera outbreaks.”

The World Health Organisation identified three WHO-prequalified oral cholera vaccines as Dukoral®, Shanchol™, and Euvichol-Plus®. All three vaccines require two2 doses for full protection.

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But, Akande added that each of them conferred different levels of protection. “The protection varies from 65 per cent to about 89 per cent, depending on the type of vaccine. Most of the vaccines give protection for two years. There is however a type of cholera vaccine that gives protection of over five years when given in two doses,” he said.

Igwegbe noted that cholera vaccines were uncommon, because they were considered special vaccines that are paid for to obtain.

He however encouraged people to take the vaccine even with the outbreak. “Even now there is an outbreak, if a person tests and is negative, they can get the vaccine. When there is no outbreak, people can still take it.”

Unregistered tiger nuts drink caused Lagos outbreak

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Meanwhile, the Lagos State Government has said that it has traced the latest cholera outbreak in the state to an unregistered tiger nut drink.

Speaking with our correspondent, Dr Kemi Ogunyemi, the Special Adviser to the Lagos State Governor on Health, said the officials of the Environmental Health Services from the Ministry of Health and the Ministry of Environment, were able to trace the cholera outbreak in the Eti=Osa Local Government Area to a particular brand of unregistered tiger nut drink.

“When we noticed an increase in cases in Eti-Osa Local Government Area of Lagos specifically, we went there to investigate. We carried out a survey and found that the common denominator, which was one of the deadly factors, was a tiger nut drink. People who came to the hospitals all identified that they had drunk tiger nut drink.

“We couldn’t just take their word for it, so we had to take that drink and test it to see what was in it. We immediately sent people out to look for those selling it, so we could take a sample. We found empty bottles with a name on them, but we discovered that it wasn’t even registered with the National Agency for Food and Drug Administration and Control, the regulatory body that ensures the safety of consumables,” she said.

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NCoS preventive efforts

Meanwhile, in a decisive move to safeguard the health of inmates and staff, the Nigerian Correctional Service has intensified its efforts to prevent a cholera outbreak across its facilities.

The proactive stance came amidst rising health concerns.

The spokesperson for the NCoS, Abubakar Umar, who spoke to our correspondent on Friday highlighted the service’s rigorous measures.

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“Our primary mandate includes the secure and humane custody of inmates, ensuring their welfare in all aspects, including health,” Abubakar stated.

He emphasised that due to proactive measures, there had been no cholera outbreaks or similar epidemics in any NCoS facilities.

“Due to our proactiveness, we have not recorded any outbreak of cholera or any such epidemic in any of our custodial centres. Therefore, no inmate or staff is affected,” he added.

Abubakar outlined the comprehensive healthcare system in place, which included a variety of medical professionals and consistent medical supplies.

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For severe cases, inmates were referred to government hospitals.

Cholera vaccine not routinely available – NPHCDA

Also speaking with Saturday PUNCH, a source in the NPHCDA who spoke anonymously because he was not authorised to speak said the cholera vaccine was not routinely available in Nigeria.

“Cholera vaccine is not one of our routine vaccines. So, it is not routinely available. But, there are global stocks from which any country could draw in the event of outbreaks.

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“Previous attempts at stockpiling cholera vaccine have led to expiry of the stock due to improved hygiene practices. But, it makes sense to have a stockpile of the vaccine for rapid response before applying for global support during an outbreak. We have done that, and will continue to do it,” he said.

Credit: PUNCH

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Health

ANC: Why pregnant women with non-communicable diseases should register in teaching hospitals

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By Francesca Hangeior

Maternal health experts have advised pregnant women with non-communicable diseases such as heart disease, hypertension, diabetes, and sickle cell disorder to register for antenatal care in teaching hospitals where they can get specialist care.

The gynaecologists noted that pregnancy among women with these health conditions was associated with high risk, especially during delivery, and therefore should be managed where there are specialists to avoid losing the baby or the mother or both.

The experts reiterated that pregnant women with those conditions needed to use tertiary hospitals for their ANC to reduce complications during and after birth.

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A Consultant Obstetrician and Gynaecologist at the Nnamdi Azikiwe Teaching Hospital, Akwa, Anambra State, Dr. Stanley Egbogu, said pregnancy among women with co-morbidities comes with concern and lots of complications.

Egbogu said, “Women who have diseases like hypertension, diabetes, and heart disease before pregnancy must not use primary health centers for their antenatal care.

” It is important they register in a teaching or specialist hospital for their antenatal care because they need specialized care by experienced obstetricians and gynaecologists.

“If such women should visit PHCs for antenatal care, they should be referred to a teaching hospital immediately because they are prone to so many complications during pregnancy.”

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The gynaecologist noted that people with hypertension could convulse during pregnancy.

“Those who have diabetes can have renal failure during pregnancy and delivery.

Those who have sickle cell disease can have anemia, and their blood can be so low that many of them have issues during delivery. For those who are asthmatic, pregnancy can worsen the asthmatic condition, and some of the drugs they use can affect the baby if not monitored.

“So, these women need specialised care and that cannot be offered at the primary healthcare level. The truth is that if those complications are not effectively managed, they could lead to the death of the woman or her baby”, he said.

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Egbogu also advised the women to start antenatal care early and be regular at the antenatal clinic because “we want to see those that have problems more often than those that do not have problems.”

The Centres for Disease Control and Prevention says a woman with sickle cell disease is more likely to have problems during pregnancy that can affect her health and the health of the unborn baby than a woman without the disease.

During pregnancy, the disease can become more severe, and pain episodes can occur more often. A pregnant woman with SCD is at a higher risk of preterm labor, having a low birth weight baby, or other complications. However, with early prenatal care and careful monitoring throughout pregnancy, a woman with SCD can have a healthy pregnancy”, the CDC said.

According to the Asthma and Allergy Foundation of America, about 30 percent of all women with asthma report their asthma worsened while pregnant.

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The foundation notes “Pregnant women with asthma may have a bit greater risk of delivering early. Or the infant may have a low birth weight. High blood pressure and a related condition known as pre-eclampsia are also more common in pregnant women with more severe asthma.”

Another maternal health expert and a Senior Registrar in the Obstetrics and Gynaecology Department at the Aminu Kano Teaching Hospital, Kano State, Dr. Mahmoud Magashi, says it is better and safer for pregnant women with co-morbidities to deliver in a specialist hospital to effectively manage associated risks both during and after delivery.

According to the World Health Organisation, in 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100,000 live births, with approximately 58,000 maternal deaths during that year.

But the Demographic and Health Survey 2018 showed that Nigeria’s latest maternal mortality ratio is 512 per 100,000 live births, which experts say is still very high.

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Psychiatrists link Nigerians’ declining happiness to economic hardship

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By Francesca Hangeior

Psychiatrists have attributed Nigeria’s declining ranking in the World Happiness Report to worsening economic hardship, insecurity and political instability.

They warned that the rising cost of living and social instability was increasing anxiety, depression, and suicide rates among Nigerians, predicting a reduction in the country’s life expectancy rate.

The mental health experts who was speaking in an interview said that the inability of many citizens to afford necessities such as food, healthcare, and social interactions has significantly reduced happiness levels.

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They noted that financial stress has prevented people from engaging in social activities that previously served as coping mechanisms, further worsening their emotional and mental well-being.

The experts urged the government to reverse the harsh economic situation and encouraged individuals to assist those in need and keep the hope alive.

On Thursday, March 20, the world marked the International Day of Happiness.

The Global Happiness Report released on Thursday by the Global Happiness Council ranked Nigeria 105th out of 147 countries.

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The report evaluates happiness levels based on individuals’ assessments of their lives.

This year’s report showed that Nigeria, which used to rank the happiest African nation, now ranks 10th, dropping three steps from its usual position.

In 2003, the New Scientist magazine in the United Kingdom named Nigeria the happiest country in the world out of 65 countries surveyed.

In 2010, the Gallop World Poll also ranked Nigeria the happiest place on earth out of 53 countries surveyed.

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Gradually, Nigeria’s rank began to drop as the years went by.

For example, before 2021, the World Happiness Report ranked Nigeria the sixth happiest country out of 155 countries.

But in 2024, the WHR placed Nigeria as the 102nd happiest nation out of 143 countries.

Speaking on the health and mental implications of the 2025 WHR, the President of the Association of Psychiatrists in Nigeria, Professor Taiwo Obindo, stated that the sad economic and socioeconomic realities of the country, insecurity situation and political difficulties were factors dwindling the happiness levels of many citizens.

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He added that the lack of happiness could increase anxiety and depression levels, consequently causing a rise in death by suicide.

The don further noted that unhappy people were less likely to give their best at work or at home, leading to reduced economic output and a negative impact on the future of children in the country.

“The first question we need to ask ourselves is, what has driven us back, and then why we are where we are? What are the implications, is it the way and the manner in which things are going in the country? We are largely, generally, having difficulties economically, in terms of security, even politically. Things happening around us are not cheering.

“So, one won’t be too surprised that the cost of living is so high, the standard of living is so low, that people cannot afford to live a decent life,” Obindo said.

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The APN president further stated that measures that previously helped Nigerians to socialise and be cheerful have become unaffordable, stating that these contributed to a drop in the country’s WHR.

The psychiatrist stated that a rise in unhappiness would lead to higher depression rates, which could, in turn, contribute to an increase in physical illnesses like high blood pressure.

“It affects virtually all parts of our body, all parts of our systems. And of course, those who are using one medication to control their blood pressure may need to do more. Of course, one of the things that I didn’t mention is that the costs of drugs have multiplied and a lot of people are not able to afford to buy some of the drugs for their medication. Therefore, situations are becoming more and more complicated.

“So, in all this, somebody who has hypertension and doesn’t have good control of it and needs more medication, because they cannot afford, may develop a stroke, may have a heart attack, and therefore, their life is cut short,” the don said.

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The APN president further noted that the situation would reduce the life expectancy rate of Nigerians.

He warned, “It’s a vicious cycle and we need to have this reversed soon enough for people to go back to living their happy and their social life.”

Obindo urged the government to intervene and reverse the harsh economic situation to make life easy for Nigerians, stating that the high cost of things was becoming unbearable.

“At the community level, we must be our brother’s keeper. There are those who are more well-to-do, they must reach out, particularly in this particular season of fasting and lent. We must set up a good way of reaching out to people and the true less privileged around us.

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“We must find a way of increasing job opportunities and making sure that the cost of living is reduced. We need to reverse the trend of pharmaceutical companies leaving the country.

“On the individual and family level, we must make sure that we don’t allow this situation to overwhelm us. We should make sure that we don’t allow our joy to disappear and be taken away by the situations around us. There is hope. Hope is what keeps us going. Things may not be as we expected now, but if we look and hope for a better tomorrow, that keeps us going,” the psychiatrist advised.

Also, a Consultant Psychiatrist, Dr Samuel Aladejare, emphasised the importance of happiness, explaining that when people are happy, the brain releases dopamine, a hormone that boosts motivation.

He noted that when dopamine was not released, it meant that there was sadness, adding that when sadness got to an extent, it led to depression, death by suicide and poor mental health outcomes.

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The psychiatrist further stated that the inability to conveniently meet basic needs such as food, shelter and social connections has contributed to Nigeria’s declining WHR.

Aladejare also highlighted factors such as rising food prices, insecurity, kidnappings, and brutality from security agents, adding that the increasing migration rate has further impacted the social well-being of Nigerians.

The psychiatrist noted that countries that have maintained a top rank for a long time had robust social packages for their people, describing them as “one of the most secure countries in the world.”

He further noted that unhappiness could cause an inability to sleep, anxiety, and depression, leading to high blood pressure or worsening present health conditions.

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Aladejare added that it could cause less concentration at work, leading to avoidable mistakes and frustration.

The mental health experts noted the inability of persons living with certain health conditions to afford their medications and treatment, would lead to poorer health outcomes and avoidable deaths.

Aladejare advised, “It would be good for Nigerians, now that we have this kind of situation, to prioritise their health. Prevention should rank high in everybody’s priorities and three measures are very important for preventing whatever illness it is, exercise, good sleep and proper diet. Those three things would save us a lot of issues.

“Yes, things are difficult but you can decide that whatever happens, you make time for exercise. 30 minutes in the morning or night or of more daily serious activities. Also, eating healthy. I know that has also become very difficult but try doing the least that we can do to make that happen. Despite how difficult it is, get adequate rest.”

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He advised persons with non-communicable illnesses to adhere to their drug regimen to prevent further complications that required expensive interventions.

The mental health expert also advised avoiding negative news or social media posts and encouraged the use of good music to lighten the mood regardless of the situation.

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Men who desire healthy children should marry before 40, expert advises

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By Francesca Hangeior

Men who wish to father healthy children have been advised to get married and start a family before the age of 40.

The President of the Nigerian Association of Urological Surgeons, Professor Nuhu Dakum, revealed that ageing negatively affects sperm quality, thereby increasing the chances of passing on genetic disorders to offspring.

“Sperm quality reduces with age. The count, motility, and morphology are all adversely affected. Also, there is an increase in damage to the sperm DNA, thus predisposing babies to genetic diseases,” he explained.

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The consultant urologist further stated that while the age at which sperm quality varies, “generally it’s more significant from about 40 years of age.”

He attributed factors including “biological changes with age, lifestyle, e.g., smoking and alcohol, unhealthy nutrition, occupational exposure to toxins, etc.”

Dakum’s statement follows a recent viral conversation on X, formerly Twitter, that older men have weak sperm.

The tweet by Queen read, “Older men are more likely to give you children with genetic mutations like dwarfism, autism, Down syndrome, and schizophrenia.

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“Their weak sperm has a higher risk of causing mutations in kids. Try your best not to have kids with their sperm.”

According to the Texas Fertility Centre, sperm quality and quantity decline over time, leading to age-related male infertility.

However, Healthline, a health portal, pointed out that sperm quality declines significantly in men over the age of 50, with factors such as sperm count and lifestyle habits being responsible for the deterioration.

Speaking further, Dakum stated that older men who desired to have healthy children could do so if they maintained good sperm health, noting that living healthily improves life generally and thus sperm health.

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He added, “There may not be much to prevent it if the man is already old, but living healthy improves general and thus sperm health. However, genetic selection in the embryo or sperm checks for sperm damage can be done to reduce the chances, but these are expensive and not widely available. Donor sperm for such couples is also an alternative.”

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