title: Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya.
abstract: OBJECTIVE
  Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries.
  
  
  METHODS
  This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions.
  
  
  RESULTS
  Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities.
  
  
  CONCLUSIONS
  Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored.
authors.affiliation: Division of Epidemiology and Biostatistics, Chicago School of Public Health, University of Illinois, Chicago, IL, United States of America. rcbailey@uic.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.forename: Omar
authors.initials: O
authors.lastname: Egesah
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rosenberg
mesh_terms: D000293:Adolescent; D002648:Child; D002944:Circumcision, Male / Q000009:adverse effects* / Q000379:methods; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006920:Hygiene; D007630:Kenya / Q000453:epidemiology; D008297:Male; D016488:Medicine, African Traditional; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
references.citation: BJU Int. 2005 Nov;96(7):1109-13
references.pmid: 16225538
references.citation: BMC Urol. 2006 Aug 25;6:21
references.pmid: 16934157
references.citation: Lancet Infect Dis. 2001 Nov;1(4):223-31
references.pmid: 11871509
references.citation: AIDS. 2006 Jul 13;20(11):1491-5
references.pmid: 16847403
references.citation: PLoS Med. 2006 Dec;3(12):e517
references.pmid: 17194197
references.citation: Am J Clin Pathol. 2006 Mar;125(3):386-91
references.pmid: 16613341
references.citation: BJU Int. 2002 Mar;89 Suppl 1:31-6
references.pmid: 11876730
references.citation: Curationis. 1997 Sep;20(3):16-20
references.pmid: 9496032
references.citation: BMJ. 1996 Sep 14;313(7058):647
references.pmid: 8811755
references.citation: Ann Trop Paediatr. 1999 Mar;19(1):113-7
references.pmid: 10605531
references.citation: Trop Doct. 2000 Jan;30(1):52-3
references.pmid: 10842535
references.citation: Lancet. 2007 Feb 24;369(9562):643-56
references.pmid: 17321310
references.citation: Soc Sci Med. 1985;21(5):581-8
references.pmid: 4049025
references.citation: Ann Trop Paediatr. 2000 Jun;20(2):101-4
references.pmid: 10945058
references.citation: BMC Infect Dis. 2007 Mar 13;7:16
references.pmid: 17355625
references.citation: Br J Urol. 1997 Jul;80(1):136-9
references.pmid: 9240193
references.citation: Lancet. 2007 Feb 24;369(9562):657-66
references.pmid: 17321311
references.citation: East Afr Med J. 1999 Oct;76(10):583-6
references.pmid: 10734511
references.citation: PLoS Med. 2005 Nov;2(11):e298
references.pmid: 16231970
references.citation: PLoS Med. 2006 Jul;3(7):e262
references.pmid: 16822094
references.citation: West Indian Med J. 2004 Jan;53(1):23-6
references.pmid: 15114889
references.citation: Am J Pathol. 2002 Sep;161(3):867-73
references.pmid: 12213715
references.citation: AIDS. 2000 Oct 20;14(15):2361-70
references.pmid: 11089625
references.citation: Br J Urol. 1990 Sep;66(3):318-21
references.pmid: 2207550