The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford.
BACKGROUND
Male circumcision for religious reasons is not available in the NHS. In this report, we present the results of an investigation conducted by the Thames Valley Health Protection Unit (TVHPU) at an unregulated circumcision 'camp' in Oxford in 2006.


METHODS
A detailed investigation was initiated following notification by a general practitioner of two children with circumcision-related complications at a 'camp'. Telephone interviews were conducted with the 'camp' organizers, the operating surgeon, GPs and paediatric surgeons. A field visit was carried out by TVHPU staff to assess implementation of infection control practices.


RESULTS
Thirty-two children were circumcised over a 3 day period in the library of an Islamic faith school by a single, medically qualified individual. Among the 29 children with follow-up information, 13 (44.8%) developed complications requiring medical intervention. Information obtained from interviews and the field visit confirmed the lack of implementation of standard infection control practices.


CONCLUSIONS
This incident highlights the harm associated with circumcision in young children by unregulated operators due to lack of compliance with best surgical and infection control guidance. There is an urgent need for commissioning circumcision services for religious reasons in the NHS.
Paranthaman
Karthikeyan
K
Oxford Deanery, Old Road Campus, Headington, Oxford OX3 7LG, UK. karthikeyan_doc@yahoo.co.uk
Bagaria
Jayshree
J
O'Moore
Eamonn
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000009:adverse effects* / Q000379:methods; D004739:England; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D007514:Islam; D008297:Male; D020380:Needs Assessment; D012068:Religion and Medicine; D013222:State Medicine; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents