Abstract
BackgroundCircumcisions undertaken in non-clinical settings can have significant risks of serious adverse events, including death. The aim of this study was to test an intervention for safe traditional circumcision in the context of initiation into manhood among the Xhosa, Eastern Cape, South Africa.MethodsTraditional surgeons and nurses registered with the health department were trained over five days on ten modules including safe circumcision, infection control, anatomy, post-operative care, detection and early management of complications and sexual health education. Initiates from initiation schools of the trained surgeons and nurses were examined and interviewed on 2nd, 4th, 7th and 14th day after circumcision.ResultsFrom 192 initiates physically examined at the 14th day after circumcision by a trained clinical nurse high rates of complications were found: 40 (20.8%) had mild delayed wound healing, 31 (16.2%) had a mild wound infection, 22 (10.5%) mild pain and 20 (10.4%) had insufficient skin removed. Most traditional surgeons and nurses wore gloves during operation and care but did not use the recommended circumcision instrument. Only 12% of the initiates were circumcised before their sexual debut and they reported a great deal of sexual risk behaviour.ConclusionFindings show weak support for scaling up traditional male circumcision.
Highlights
Circumcisions undertaken in non-clinical settings can have significant risks of serious adverse events, including death
Adverse events following surgery From 192 initiates physically examined at the 14th day after circumcision by a trained clinical nurse 40 (20.8%) had mild delayed wound healing, 31 (16.2%) had a mild wound infection, 22 (10.5%) mild pain and 20 (10.4%) had insufficient skin removed
Using a pre-post intervention evaluation design, this study evaluated 192 initiates who had undergone a traditional male circumcision intervention with trained traditional surgeons and traditional nurses in the Eastern Cape, South Africa
Summary
Circumcisions undertaken in non-clinical settings can have significant risks of serious adverse events, including death. Accounts of serious complications or adverse events after adolescent and adult circumcision in traditional settings in Africa are legion. Among 50 patients admitted to hospital with post-circumcision complications in Nigeria and Kenya between 1981 and 1998, 80% had been circumcised by medically untrained traditional surgeons. One of these patients died from septicaemia,
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