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

Background. Male circumcision services have expanded throughout Africa as part of a long-term HIV prevention strategy. Morbidities may increase which impact on health service delivery and patient safety. Objectives. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision-related morbidities. Study design. This population-based cross-sectional study was conducted in rural Ghana between May to December 2012 and involved 2847 circumcised infant males aged 6-11 weeks. Multivariable logistic regression was used to assess effects and models were adjusted for maternal age, maternal education, income, birth weight, site of birth and site of circumcision. Results. Overall, the risk of experiencing a morbidity after circumcision was not significantly increased if performed by informal health service providers (121, 7.2%) compared to formal health service providers (109, 9.8%) (adjusted odds ratio [aOR] 1.11, 95% CI 0.80–1.47 p=value 0.456). Poor hygiene practices were associated with significantly increased risk of morbidity, including: no hand washing 148 (11.7%) (aOR 1.78, 95% CI 1.27–2.52 p=value 0.001); not cleaning circumcision instruments 174 (10.6%) (aOR 1.80, 95% CI 1.27– 2.54 p=value 0.001); and uncleaned penile area 190 (10%) (aOR 1.84, 95% CI 1.25–2.70 p=value 0.002). Conclusion. The risk of morbidity following infant male circumcision was high. Hygiene practices were associated with morbidity risk. Government and non-government organisations need to improve training of formal and informal health care providers in hygiene practices in rural Africa. Key Message 1. Risk of morbidity following infant male circumcision high 2. Hygiene practices associated with morbidity risk 3. Training for circumcision providers needed

Thomas Gyan

University of Western Australia

Thomas is a PhD candidate at the University of Western Australia Perth, Australia. He has over ten years experience in running clinical trials, epidemiological studies, program & project management and coordination, monitoring and evaluation and health systems research from the Kintampo Health Research Centre, Ghana Health Service in collaboration with the London School of Hygiene and Tropical Medicine, the World Health Organisation and UNICEF. He has special interest in public health, clinical trials, epidemiological studies, maternal newborn and child health, health systems research, capacity building, project management and coordination, monitoring and evaluation and systematic reviews.