Abstract
BackgroundThere 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.MethodsA 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.ResultsThere 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.ConclusionThe 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.
Highlights
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 the literature has focused on the role of MC in the prevention of transmission of HIV in sub-Saharan Africa, we argue that there has not been commensurate interest in the estimation of safety and complications potentially associated with any scale-up in MC in Africa
Search strategy and selection criteria We searched for all reports in peer-reviewed journals that reported on complications of male circumcision in subSaharan Africa and abstracts from the International Conference on AIDS (2004 and 2006)
Summary
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. Several studies have reported on the acceptability of male circumcision for the prevention of HIV in sub-Saharan Africa [5,6,7]. Westercamp and Bailey report that there is sufficient research evidence to suggest that male circumcision is acceptable in sub-Saharan Africa for the prevention of HIV transmission [8]. There is ongoing debate as to whether male circumcision should be routinely performed for the purpose of preventing heterosexual transmission of HIV in sub-Saharan Africa [10,11,12,13,14,15]
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