title: Health service provider education and/or training in infant male circumcision to improve short- and long-term morbidity outcomes: protocol for systematic review.
abstract: BACKGROUND
  There has been an expansion of circumcision services in Africa as part of a long-term HIV prevention strategy. However, the effect of infant male circumcision on morbidity and mortality still remains unclear. Acute morbidities associated with circumcision include pain, bleeding, swelling, infection, tetanus or inadequate skin removal. Scale-up of circumcision services could lead to a rise in these associated morbidities that could have significant impact on health service delivery and the safety of infants. Multidisciplinary training programmes have been developed to improve skills of health service providers, but very little is known about the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. This review aims to evaluate the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes.
  
  
  METHODS
  The review will include studies comparing health service providers who have received education and/or training to improve their skills for infant male circumcision with those who have not received education and/or training. Randomised controlled trials (RCTs) and cluster RCTs will be included. The outcomes of interest are short-term morbidities of the male infant including pain, infection, tetanus, bleeding, excess skin removal, glans amputation and fistula. Long-term morbidities include urinary tract infection (UTI), HIV infection and abnormalities of urination. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library (including CENTRAL and DARE), WHO databases and reference list of papers will be searched for relevant articles. Study selection, data extraction and synthesis and risk of bias assessment using the Cochrane risk of bias assessment tool will be conducted. We will calculate the pooled estimates of the difference in means and risk ratios using random effects models. If insufficient data are available, we will present results descriptively.
  
  
  CONCLUSIONS
  This review appears to be the first to be conducted in this area. The findings will have important implications for infant male circumcision programmes and policy.
  
  
  BACKGROUND
  PROSPERO CRD42015029345.
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. thomas.gyan@uwa.edu.au.|Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. thomas.gyan@uwa.edu.au.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gyan
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. natalie.strobel@uwa.edu.au.
authors.forename: Natalie
authors.initials: N
authors.lastname: Strobel
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. kimberley.mcauley@uwa.edu.au.
authors.forename: Kimberley
authors.initials: K
authors.lastname: McAuley
authors.affiliation: EngenderHealth Inc., Greater New York Area, USA. CShannon@engenderhealth.org.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Shannon
authors.affiliation: School of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. samkofinewton@yahoo.com.
authors.forename: Sam
authors.initials: S
authors.lastname: Newton
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. charlotte.tawiah@kintampo-hrc.org.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah-Agyemang
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. seeba.ae@kintampo-hrc.org.
authors.forename: Seeba
authors.initials: S
authors.lastname: Amenga-Etego
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. seth.owusu-agyei@kintampo-hrc.org.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. david.forbes@uwa.edu.au.
authors.forename: David
authors.initials: D
authors.lastname: Forbes
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Level 4, Administration Building Princess Margaret Hospital for Children, Roberts Road, Subiaco, 6008, Western Australia. karen.edmond@uwa.edu.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Edmond
mesh_terms: D000349:Africa; D002944:Circumcision, Male / Q000193:education*; D002983:Clinical Competence; D015658:HIV Infections / Q000517:prevention & control; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D000078202:Systematic Reviews as Topic