title: The Relationship Between Distance and Post-operative Visit Attendance Following Medical Male Circumcision in Nyanza Province, Kenya.
abstract: To date, there is no research on voluntary medical male circumcision (VMMC) catchment areas or the relationship between distance to a VMMC facility and attendance at a post-operative follow-up visit. We analyzed data from a randomly selected subset of males self-seeking circumcision at one of 16 participating facilities in Nyanza Province, Kenya between 2008 and 2010. Among 1437 participants, 46.7 % attended follow-up. The median distance from residence to utilized facility was 2.98 km (IQR 1.31-5.38). Nearly all participants (98.8 %) lived within 5 km from a facility, however, 26.3 % visited a facility more than 5 km away. Stratified results demonstrated that among those utilizing fixed facilities, greater distance was associated with higher odds of follow-up non-attendance (OR5.01-10km vs. 0-1km= 1.71, 95 % CI 1.08, 2.70, p = 0.02; OR>10km vs. 0-1 km= 2.80, 95 % CI 1.26, 6.21, p = 0.01), adjusting for age and district of residence. We found 5 km marked the threshold distance beyond which follow-up attendance significantly dropped. These results demonstrate distance is an important predictor of attending follow-up, and this relationship appears to be modified by facility type.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. gingermariegolub@gmail.com.
authors.forename: Ginger
authors.identifier: 0000-0002-0669-4758
authors.initials: G
authors.lastname: Golub
authors.affiliation: Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.|Nyanza Reproductive Health Society, Kisumu, Kenya.
authors.forename: Amy
authors.initials: A
authors.lastname: Herman-Roloff
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.|HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, NY, USA.
authors.forename: Susie
authors.initials: S
authors.lastname: Hoffman
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.affiliation: Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.|Nyanza Reproductive Health Society, Kisumu, Kenya.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000523:psychology / Q000706:statistics & numerical data*; D002944:Circumcision, Male / Q000523:psychology* / Q000706:statistics & numerical data; D015658:HIV Infections / Q000517:prevention & control; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Facility attendance; Kenya; Post-operative follow-up; Spatial analysis of catchment; Voluntary medical male circumcision