A controlled trial of three methods for neonatal circumcision in Lusaka, Zambia.
OBJECTIVE
Neonatal male circumcision (NMC) is not routinely practiced in Zambia, but it is a promising long-term HIV prevention strategy. We studied the feasibility and safety of three different NMC methods.


METHODS
We enrolled healthy newborns in a controlled trial of the Mogen, Gomco, and Plastibell devices. Doctors, nurses, and clinical officers were trained to perform Mogen, Gomco, and Plastibell techniques. Each provider performed at least 10 circumcisions using each device. Neonates were reviewed at 1 and 6 weeks after circumcision for adverse events.


RESULTS
Between October 2009 and March 2011, 17 providers (5 physicians, 9 nurse midwives, and 3 clinical officers) without previous NMC experience were trained, and 640 circumcisions were performed. The median infant birth weight was 3.2 kg (interquartile range: 2.9-3.5 kg), and median age at the time of procedure was 11 days (interquartile range: 7-18 days); 149 babies (23.3%) were exposed to HIV. The overall adverse event rate was 4.9% (n = 31/630), and the moderate-severe adverse event rate was 4.1% (n = 26/630). Rates did not significantly differ by method. Most providers (65%) preferred Mogen clamp over Gomco and Plastibell.


CONCLUSIONS
Doctors, nurses, and clinical officers can be trained to safely provide NMC in a programmatic setting. The 3 studied techniques had comparable safety profiles. Mogen clamp was the preferred device for most providers.
Department of Surgery, Copperbelt University School of Medicine, Ndola, Zambia.
Kasonde
K
Bowa
Michelle S
MS
Li
Bridget
B
Mugisa
Emily
E
Waters
David M
DM
Linyama
Benjamin H
BH
Chi
Jeffrey S A
JS
Stringer
Elizabeth M
EM
Stringer
D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D055815:Young Adult; D015024:Zambia