Abstract
BackgroundTraditional male circumcision (TMC) is primarily associated with a religious or cultural purpose and may lead to complications. To reduce risks of complication and long-term disabilities that may happen from circumcisions that are undertaken in non-clinical settings, information concerning TMC is very important. Therefore, this study is aimed at identifying spatial distribution of TMC and the factors associated with TMC in Ethiopia.MethodsA secondary data analysis was conducted among 11,209 circumcised males using data from 2016 Ethiopian Demographic and Health Survey (EDHS). Global Moran’s I statistic was observed to check whether there was a significant clustering of TMC. Primary and secondary clusters of TMC were identified by fitting Bernoulli model in Kulldorff’s SaTScan software. Multilevel Generalized Linear Mixed effects Model (GLMM) was fitted to identify factors associated with TMC.ResultThe spatial distribution of TMC was nonrandom across the country with Global Moran’s I = 0.27 (p-value < 0.0001). The primary clusters of TMC were identified in the southern part of Oromia and Tigray, northern part of SNNPR, Amhara, Gambella and Benishangul regions. Current age, age at circumcision, ethnicity, religion, place of residence, wealth index, media exposure, sex of household head and age of household head were factors associated with TMC in Ethiopia.ConclusionsThe spatial distribution of TMC was varied across the country. This variation might be due to the diversity of culture, ethnicity and religion across the regions. Thus, there is a need to rearrange the regulations on standards of TMC practice, conduct training to familiarize operation technique and general hygiene procedures, and launch cross-referral systems between traditional circumcisers and health workers. While undertaking these public health interventions, due attention should be given to the identified clusters and significant factors.
Highlights
Traditional male circumcision (TMC) is primarily associated with a religious or cultural purpose and may lead to complications
The spatial distribution of TMC was varied across the country
There is a need to rearrange the regulations on standards of TMC practice, conduct training to familiarize operation technique and general hygiene procedures, and launch cross-referral systems between traditional circumcisers and health workers
Summary
Traditional male circumcision (TMC) is primarily associated with a religious or cultural purpose and may lead to complications. Traditional male circumcision (TMC) refers to the procedure of performing male circumcision on adolescents or young male in a non-clinical setting by a traditional provider with no formal medical training. It is usually associated primarily with a religious or cultural ceremony. Studies from Africa suggest that male circumcision (MC) reduces human immunodeficiency virus (HIV) acquisition in heterosexual male by 50–60% [3,4,5] It is recommended as HIV prevention program by the World Health Organization (WHO) and United Nations (UN) considering its effectiveness in reducing HIV by around 60% among males. Infant MC is more effective in terms of cost and makes adverse events less likely [6,7,8]
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