Bailey Robert C, Egesah Omar, Rosenberg Stephanie
Division of Epidemiology and Biostatistics, Chicago School of Public Health, University of Illinois, Chicago, IL, United States of America.
Bull World Health Organ. 2008 Sep;86(9):669-77. doi: 10.2471/blt.08.051482.
Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries.
This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions.
Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities.
Extensive training and resources will be necessary in sub-Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored.
男性包皮环切术可将感染艾滋病毒的风险降低约60%。目前，撒哈拉以南非洲部分人群正在引入男性包皮环切服务，并且正在规划进一步的干预措施。一个严重关切的问题是，在发展中国家能否安全地为大量成年男性实施包皮环切术。
这项前瞻性研究在肯尼亚布贡马区开展，当地普遍实施男性包皮环切术。通过两阶段整群抽样法确定打算接受传统或临床包皮环切术的年轻男性。在2004年7月至8月的包皮环切季节，对1007名男性在包皮环切术后30至89天进行了访谈。在包皮环切术期间以及术后3天、8天、30天和90天对24名男性进行了直接观察，298名男性在术后45至89天接受了临床检查。对21名传统从业者和20名临床从业者进行了访谈，以评估他们的经验和培训情况。对卫生设施进行了清点，以评估实施安全包皮环切术所需器械和用品的状况。
在443名接受传统包皮环切术的男性中，156名（35.2%）出现了不良事件，而在559名接受临床包皮环切术的男性中，有99名（17.7%）出现不良事件（比值比：2.53；95%置信区间：1.89 - 3.38）。出血和感染是最常见的不良反应，还观察到疼痛过度、撕裂伤、扭转和勃起功能障碍。参与者年龄在5至21岁之间，一半人在包皮环切术前有性行为。从业者缺乏知识和培训。大多数卫生设施缺乏合适的器械和用品。
在撒哈拉以南非洲大力推广男性包皮环切术以预防艾滋病毒之前，需要进行广泛的培训并提供资源。三分之二的非洲男性接受过包皮环切术，大多数是由传统或不合格的从业者在非正式场所进行的。在包皮环切术已广泛实施的社区，其安全性不容忽视。
