Cost in USD (%) of one MC surgery using PrePex and forceps-guided method under various assumptions.

<p>AE, Adverse Event; F/U, follow-up; not all percentages add to 100 due to rounding.</p><p><b>Consumable Supplies.</b><i>Both methods:</i> non-sterile gloves, alcohol hand rub, antiseptic soap, providone antiseptic solution, diclofenac {analgesic} tabs, paraffin gauze {Vaseline gauze}, gauze swabs, cohesive bandage. <i>PMC:</i> Lignocaine cream {local anesthesia cream}. <i>FGMC:</i> sterile gloves, face mask, Bupivacaine, Lignocaine, Needles (21 gauge and 19 gauge), 10 ml syringe, surgical blade (size 10), chromic catgut suture 3/0.</p><p><b>Non-consumable supplies.</b><i>Both methods:</i> client underpants. <i>FGMC:</i> weighing scale, blood pressure cuff, thermometer, surgical scrubs, shoe cover, sterile drape, center 'o', circumcision surgical tray (gallipot Kocher clamp mosquito artery forceps, blade holder, kidney dish, Dunhill artery forceps, tissue scissors, suture scissors, Adson forceps, needle holder, sponge holding forceps), emergency tray supplies. <i>PMC:</i> dressing tray (kidney dish, gallipot, sponge holding forceps, scissors).</p><p><b>Direct Personnel:</b><i>Both methods:</i> counselor, hygiene officer. <i>FGMC:</i> Clinical officer, nurse, consultant urologist (for AEs). <i>PMC:</i> Nurse/nurse pair or nurse/nurse aide pair.</p><p><b>Training:</b><i>Both methods</i>: 3 days of theory. <i>FGMC:</i> 7 days practicum PMC: 3 days practicum; costs include staff time, lunch/refreshments for participants and trainers, stationery, and MC manual.</p><p><b>Capital:</b><i>Both methods:</i> autoclave (PMC assumed to use 1/2 that of FGMC), surgical couch, cell phones, incinerator, office furniture, vehicles, facility space, generator, surgical equipment (mayo tray, trolley, waste bin).</p><p><b>Maintenance and Utility:</b><i>Both methods:</i> internet, office rent, electricity (power), water, vehicle costs (maintenance, insurance, and fuel). <i>FGMC:</i> facility renovations.</p><p><b>Support Personnel:</b><i>Both methods:</i> MOH supervision, quality assurance/quality improvement (QA/QI) team, training team, department managers and staff (human resources, transport, finance, administration, stores, information technology, data, mobilization). <i>PMC:</i> MOH supervision, mobilization team, QA/QI team and training team assumed to require 1/2 the full-time equivalents of FGMC.</p><p><b>Management and Supervision:</b><i>Both methods:</i> senior management team salaries, travel expenses for circumcision camps and management supervision.</p

Percent of Government of Kenya Health Facilities in Kisumu and Nyando Districts with Components of the Minimum Criteria for VMMC Service Provision as Outlined in the National Guidance Document in Kenya.

<p>Percent of Government of Kenya Health Facilities in Kisumu and Nyando Districts with Components of the Minimum Criteria for VMMC Service Provision as Outlined in the National Guidance Document in Kenya.</p

Selected features the participants liked and disliked about PrePex procedures.

<p><b>¹N = number of men endorsing the feature in open-ended questions; more than one response possible.</b></p><p><b>²Denominators for percentages; the number of men who completed this section of the Interview Form.</b></p

Cumulative probability of complete wound healing for first 50 men, life table method¹.

<p><b>S.e. = standard error; CI = confidence interval; mean days to complete healing = 48.0; median = 49 (range 35–82; interquartile range 42–51).</b></p><p><b>¹From placement date to the date when complete healing is first recorded.</b></p><p><b>²Effective number in the interval.</b></p><p><b>³100% probability at >Day 56 interval reflects censoring at study exit as well as healing; assumes healing occurred at some point after the last contact.</b></p><p><b>Mean number of days to complete healing = 48.0; median = 49 (range 35–82; interquartile range 42–51) taking censoring into consideration.</b></p

Safety of over Twelve Hundred Infant Male Circumcisions Using the Mogen Clamp in Kenya

Background: Several sub-Saharan African countries plan to scale-up infant male circumcision (IMC) for cost-efficient HIV prevention. Little data exist about the safety of IMC in East and southern Africa. We calculated adverse event (AE) rate and risks for AEs associated with introduction of IMC services at five government health facilities in western Kenya. Methods: AE data were analyzed for IMC procedures performed between September, 2009 and November, 2011. Healthy infants aged ≤2 months and weighing ≥2.5 kg were eligible for IMC. Following parental consent, trained clinicians provided IMC services free of charge under local anesthesia using the Mogen clamp. Odds ratios and 95% confidence intervals were used to explore AE risk factors. Findings: A total of 1,239 IMC procedures were performed. Median age of infants was 4 days (IQR = 1, 16). The overall AE rate among infants reviewed post-operatively was 2.7% (18/678; 95%CI: 1.4, 3.9). There was one severe AE involving excision of a small piece of the lateral aspect of the glans penis. Other AEs were mild or moderate and were treated conservatively. Babies one month of age or older were more likely to have an AE (OR 3.20; 95%CI: 1.23, 8.36). AE rate did not differ by nurse versus clinical officer or number of previous procedures performed. Conclusion: IMC services provided in Kenyan Government hospitals in the context of routine IMC programming have AE rates comparable to those in developed countries. The optimal time for IMC is within the first month of life

Moderate and severe adverse events among all participants with device placement (N = 427), by type of site¹.

<p><b>¹Includes all events that are at least possibly related to the circumcision procedure.</b></p><p><b>²More than one AE could be recorded for a given participant.</b></p><p><b>³Maximum severity.</b></p

Type and frequency of adverse events and other events.

<p>AE, adverse event; IMC, infant male circumcision.</p

Characteristics of research and non-research IMC procedures.

<p>IQR, Inter-quartile range; N/A, Not applicable.</p>‡<p>Question wording: “If you were to do it again, would you circumcise your baby?”</p

Mtoto Msafi Mbilii Study Forms

This pdf file contains the Ministry of Health client form and mother and father questionnaires

Adverse event rate and risk factors for adverse events in research and non-research circumcisions.

<p>AE, adverse event; CI, confidence interval; IMC, infant male circumcision; OR, odds ratio.</p