Gyan Thomas, McAuley Kimberley, Strobel Natalie A, Shannon Caitlin, Newton Sam, Tawiah-Agyemang Charlotte, Amenga-Etego Seeba, Owusu-Agyei Seth, Kirkwood Betty, Edmond Karen M
School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.
Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
Trop Med Int Health. 2017 Mar;22(3):312-322. doi: 10.1111/tmi.12829. Epub 2017 Jan 12.
Male circumcision services have expanded throughout Africa as part of a long-term HIV prevention strategy. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision-related morbidities in rural Ghana.
Population-based, cross-sectional study conducted between May and December 2012 involving 2850 circumcised infant males aged under 12 weeks. Multivariable logistic regression models were adjusted for maternal age, maternal education, income, birthweight and site of circumcision.
A total of 2850 (90.7%) infant males were circumcised. Overall, the risk of experiencing a morbidity (defined as complications occurring during or after the circumcision procedure as reported by the primary caregiver) was 8.1% (230). Risk was not significantly increased if the circumcision was performed by informal providers (121, 7.2%) vs. formal health service providers (109, 9.8%) [adjusted odds ratio (aOR) 1.11, 95% CI 0.80-1.47, P = 0.456]. Poor hygiene practices were associated with significantly increased risk of morbidity: no handwashing [148 (11.7%)] (aOR 1.78, 95% CI 1.27-2.52, P = 0.001); not cleaning circumcision instruments [174 (10.6%)] (aOR 1.80, 95% CI 1.27-2.54, P = 0.001); and uncleaned penile area [190 (10.0%)] (aOR 1.84, 95% CI 1.25-2.70, P = 0.002).
The risk of morbidity after infant male circumcision in rural Ghana is high, chiefly due to poor hygiene practices. Governmental and non-governmental organisations need to improve training of circumcision providers in hygiene practices in sub-Saharan Africa.
作为一项长期的艾滋病毒预防策略的一部分，男性包皮环切服务已在非洲各地得到推广。我们评估了服务提供者类型（正规和非正规）及卫生习惯对加纳农村地区包皮环切相关发病率的影响。
2012年5月至12月进行了一项基于人群的横断面研究，涉及2850名年龄在12周以下的接受包皮环切术的男婴。多变量逻辑回归模型针对母亲年龄、母亲教育程度、收入、出生体重和包皮环切部位进行了调整。
共有2850名（90.7%）男婴接受了包皮环切术。总体而言，出现发病情况（定义为主要照顾者报告的包皮环切手术期间或之后发生的并发症）的风险为8.1%（230例）。由非正规服务提供者进行包皮环切术（121例，7.2%）与由正规卫生服务提供者进行手术（109例，9.8%）相比，风险并未显著增加[调整后的优势比（aOR）为1.11，95%置信区间为0.80 - 1.47，P = 0.456]。卫生习惯不良与发病风险显著增加相关：未洗手[148例（11.7%）]（aOR为1.78，95%置信区间为1.27 - 2.52，P = 0.001）；未清洁包皮环切器械[174例（10.6%）]（aOR为1.80，95%置信区间为1.27 - 2.54，P = 0.001）；以及阴茎部位未清洁[190例（10.0%）]（aOR为1.84，95%置信区间为1.25 - 2.70，P = 0.002）。
加纳农村地区男婴包皮环切术后的发病风险很高，主要原因是卫生习惯不良。政府和非政府组织需要加强撒哈拉以南非洲地区包皮环切服务提供者的卫生习惯培训。
