Determinants of morbidity associated with infant male circumcision: community-level population-based study in rural Ghana

Thomas Gyan, Kimberley McAuley, Natalie A. Strobel, Caitlin Shannon, Sam Newton, Charlotte Tawiah-Agyemang, Seeba Amenga-Etego, Seth Owusu-Agyei, Betty Kirkwood, Karen M. Edmond

    Research output: Contribution to journalArticlepeer-review

    6 Citations (Scopus)


    Objective: Male circumcision services have expanded throughout Africa as part of a long-term HIV prevention strategy. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision-related morbidities in rural Ghana. Methods: Population-based, cross-sectional study conducted between May and December 2012 involving 2850 circumcised infant males aged under 12 weeks. Multivariable logistic regression models were adjusted for maternal age, maternal education, income, birthweight and site of circumcision. Results: A total of 2850 (90.7%) infant males were circumcised. Overall, the risk of experiencing a morbidity (defined as complications occurring during or after the circumcision procedure as reported by the primary caregiver) was 8.1% (230). Risk was not significantly increased if the circumcision was performed by informal providers (121, 7.2%) vs. formal health service providers (109, 9.8%) [adjusted odds ratio (aOR) 1.11, 95% CI 0.80–1.47, P = 0.456]. Poor hygiene practices were associated with significantly increased risk of morbidity: no handwashing [148 (11.7%)] (aOR 1.78, 95% CI 1.27–2.52, P = 0.001); not cleaning circumcision instruments [174 (10.6%)] (aOR 1.80, 95% CI 1.27–2.54, P = 0.001); and uncleaned penile area [190 (10.0%)] (aOR 1.84, 95% CI 1.25–2.70, P = 0.002). Conclusion: The risk of morbidity after infant male circumcision in rural Ghana is high, chiefly due to poor hygiene practices. Governmental and non-governmental organisations need to improve training of circumcision providers in hygiene practices in sub-Saharan Africa.

    Original languageEnglish
    Pages (from-to)312-322
    Number of pages11
    JournalTropical Medicine and International Health
    Issue number3
    Early online date12 Jan 2017
    Publication statusPublished - 1 Mar 2017


    Dive into the research topics of 'Determinants of morbidity associated with infant male circumcision: community-level population-based study in rural Ghana'. Together they form a unique fingerprint.

    Cite this