Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen clamp in Rakai, Uganda.
OBJECTIVE
To assess the safety and acceptability of early infant circumcision (EIC) provided by trained clinical officers (COs) and registered nurse midwives (RNMWs) in rural Uganda.


METHODS
We conducted a randomised trial of EIC using the Mogen clamp provided by newly trained COs and RNMWs in four health centres in rural Rakai, Uganda. The trial was registered with clinicaltrials.gov # NCT02596282. In all, 501 healthy neonates aged 1-28 days with normal birth weight and gestational age were randomised to COs (n = 256) and RNMWs (n = 245) for EIC, and were followed-up at 1, 7 and 28 days.


RESULTS
In all, 701 mothers were directly invited to participate in the trial, 525 consented to circumcision (74.9%) and 23 were found ineligible on screening (4.4%). The procedure took an average of 10.5 min. Adherence to follow-up was >90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% for COs and 1.6% for RNMWs (P = 0.9). All wounds were healed by 28 days after circumcision. Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs.


CONCLUSIONS
EIC was acceptable in this rural Ugandan population and can be safely performed by RNMWs who have direct contact with the mothers during pregnancy and delivery. EIC services should be made available to parents who are interested in the service.
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Edward N
EN
Kankaka
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Teddy
T
Murungi
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Godfrey
G
Kigozi
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.|College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda.
Frederick
F
Makumbi
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Dorean
D
Nabukalu
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Stephen
S
Watya
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Nehemiah
N
Kighoma
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Resty
R
Nampijja
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Daniel
D
Kayiwa
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.
Fred
F
Nalugoda
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.|College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda.
David
D
Serwadda
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.|Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Maria
M
Wawer
Rakai Health Sciences Program, Kalisizo, Rakai, Uganda.|Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Ronald H
RH
Gray
D002944:Circumcision, Male / Q000295:instrumentation*; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009721:Nurse Midwives; D009726:Nurses; D014454:Uganda
Mogen clamp; Rakai; Uganda; early infant circumcision; non-physicians