Prevalence of complications of male circumcision in Anglophone Africa: a systematic review

BACKGROUND: There is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent. METHODS: A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers. RESULTS: There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals. CONCLUSION: The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision

Experience With Immediate Post-partum Circumcision

Circumcision of males amongst most ethnic groups in Nigeria is often carried out at about the 8th day after delivery, when the umbilical stump must have fallen off. Our aim is to study the acceptability, practicability and outcome of circumcision in male babies immediately after birth. This prospective study was carried out at St. Victoria Specialist Hospital, Ekwulobia, Anambra State, Nigeria, a rural- based hospital serving a rural community and Mac Benson Specialist Hospital Onitsha, an urban-based hospital serving an urban community. 67 consecutive male babies who were delivered at St. Victoria Specialist Hospital Ekwulobia as well as 52 consecutive male babies who were delivered at Mac Benson Specialist Hospital Onitsha between 1st January 2002 and 31st December 2002 were assessed for the possibility of offering them circumcision immediately after birth. Out of a total of 119 male babies, 17 were excluded for a number of reasons. The remaining 102 babies were recruited into this study and were circumcised immediately they were delivered using the Plastibell (Hollister Ltd, USA) method. No complications were recorded soon after the circumcision, and after more than one year of follow-up. Immediate post-partum circumcision is practicable and devoid of any serious complications if babies and plastibell (Hollister Ltd, USA) sizes are properly selected. Therefore, it is likely to become easily and widely acceptable. Key words: Immediate, post-partum, circumcision, acceptability. Nigerian Medical Practitioner Vol.47(1-2) 2005: 9-1