title: Safety of task-shifting for male medical circumcision:  a systematic review and meta-analysis.
abstract: BACKGROUND
  Task-shifting for male medical circumcision is proposed as a strategy to overcome the lack of surgeons and doctors in high HIV prevalence settings. We undertook a systematic review and meta-analysis to review the safety of task-shifting for circumcision in Africa.
  
  
  METHODS
  We searched online databases and conference websites up to July 2011 without language restriction for studies reporting outcomes of task-shifting for circumcision in Africa. Information was extracted independently and in duplicate on study characteristics, quality, and outcome data. Case reports and case series were excluded.
  
  
  RESULTS
  Ten studies met our inclusion criteria, providing outcome data on 25119 circumcisions. The proportion of adverse events ranged from 0.70 [95% confidence interval (CI) 0.44-1.02%] to 37.36% (95% CI 27.54-47.72%), with an overall pooled proportion of 2.31% (95% CI 1.46-3.16%; τ  = 1.21; P < 0.001). Two studies reported outcomes separately for both doctors and non-physicians; there was no difference in the risk of adverse events by provider (pooled relative risk 1.18; 95% CI 0.78-1.78). The frequency of excessive bleeding ranged from 0.30 (0.09-0.65%) to 24.71% (16.27-34.26%) with an overall pooled prevalence of 0.55% (95% CI 0.13-0.97%). Infection occurred in 0.30 (0.14-1.47%) to 1.85% (0.07-5.96%) of cases, with an overall pooled proportion of 0.88% (95% CI 0.29-1.47%). All adverse events were reported to be non-severe.
  
  
  CONCLUSIONS
  Task-shifting of male medical circumcision to non-physician clinicians can be done safely, with reported rates of adverse events similar to doctors and specialists.
authors: Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa. Nathan.ford@msf.org
authors: Nathan
authors: N
authors: Ford
authors: Kathryn
authors: K
authors: Chu
authors: Edward J
authors: EJ
authors: Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D000078329:Workforce; D055815:Young Adult