The Relationship Between Distance and Post-operative Visit Attendance Following Medical Male Circumcision in Nyanza Province, Kenya.

Abstract

To date, there is no research on voluntary medical male circumcision (VMMC) catchment areas or the relationship between distance to a VMMC facility and attendance at a post-operative follow-up visit. We analyzed data from a randomly selected subset of males self-seeking circumcision at one of 16 participating facilities in Nyanza Province, Kenya between 2008 and 2010. Among 1437 participants, 46.7% attended follow-up. The median distance from residence to utilized facility was 2.98km (IQR 1.31-5.38). Nearly all participants (98.8%) lived within 5km from a facility, however, 26.3% visited a facility more than 5km away. Stratified results demonstrated that among those utilizing fixed facilities, greater distance was associated with higher odds of follow-up non-attendance (OR5.01-10km vs. 0-1km=1.71, 95% CI 1.08, 2.70, p=0.02; OR>10km vs. 0-1 km=2.80, 95% CI 1.26, 6.21, p=0.01), adjusting for age and district of residence. We found 5km marked the threshold distance beyond which follow-up attendance significantly dropped. These results demonstrate distance is an important predictor of attending follow-up, and this relationship appears to be modified by facility type.