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 journalArticle

    4 Citations (Scopus)

    Abstract

    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
    Volume22
    Issue number3
    Early online date12 Jan 2017
    DOIs
    Publication statusPublished - 1 Mar 2017

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    Male Circumcision
    Ghana
    Hygiene
    Odds Ratio
    Morbidity
    Population
    Logistic Models
    Hand Disinfection
    Africa South of the Sahara
    Maternal Age
    Caregivers
    Health Services
    Cross-Sectional Studies
    Mothers
    HIV
    Organizations
    Education

    Cite this

    Gyan, Thomas ; McAuley, Kimberley ; Strobel, Natalie A. ; Shannon, Caitlin ; Newton, Sam ; Tawiah-Agyemang, Charlotte ; Amenga-Etego, Seeba ; Owusu-Agyei, Seth ; Kirkwood, Betty ; Edmond, Karen M. / Determinants of morbidity associated with infant male circumcision : community-level population-based study in rural Ghana. In: Tropical Medicine and International Health. 2017 ; Vol. 22, No. 3. pp. 312-322.
    @article{89247774d2124f9794fa9e4278448f29,
    title = "Determinants of morbidity associated with infant male circumcision: community-level population-based study in rural Ghana",
    abstract = "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.",
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    author = "Thomas Gyan and Kimberley McAuley and Strobel, {Natalie A.} and Caitlin Shannon and Sam Newton and Charlotte Tawiah-Agyemang and Seeba Amenga-Etego and Seth Owusu-Agyei and Betty Kirkwood and Edmond, {Karen M.}",
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    Determinants of morbidity associated with infant male circumcision : community-level population-based study in rural Ghana. / Gyan, Thomas; McAuley, Kimberley; Strobel, Natalie A.; Shannon, Caitlin; Newton, Sam; Tawiah-Agyemang, Charlotte; Amenga-Etego, Seeba; Owusu-Agyei, Seth; Kirkwood, Betty; Edmond, Karen M.

    In: Tropical Medicine and International Health, Vol. 22, No. 3, 01.03.2017, p. 312-322.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Determinants of morbidity associated with infant male circumcision

    T2 - community-level population-based study in rural Ghana

    AU - Gyan, Thomas

    AU - McAuley, Kimberley

    AU - Strobel, Natalie A.

    AU - Shannon, Caitlin

    AU - Newton, Sam

    AU - Tawiah-Agyemang, Charlotte

    AU - Amenga-Etego, Seeba

    AU - Owusu-Agyei, Seth

    AU - Kirkwood, Betty

    AU - Edmond, Karen M.

    PY - 2017/3/1

    Y1 - 2017/3/1

    N2 - 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.

    AB - 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.

    KW - circumcision

    KW - community level

    KW - determinants

    KW - Ghana

    KW - infant

    KW - male

    KW - morbidity

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    U2 - 10.1111/tmi.12829

    DO - 10.1111/tmi.12829

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