Center for Essential Surgical and Acute Care, Global Health Directorate, Indus Health Network, 5th Floor Woodcraft Building, Plot 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan.
Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Bull World Health Organ. 2021 Apr 1;99(4):250-258. doi: 10.2471/BLT.19.249656. Epub 2021 Feb 3.
To retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.
Based on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1-92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing adverse events with infants facing no complications using multivariate logistic regression.
Between August 2016 and August 2018, 2822 circumcised male infants with mean age 22.8 days were eligible for the study. Of these, 2617 infants (92.7%) were followed up by telephone interviews of caretakers. Older infants were more likely to experience adverse events than infants circumcised between 1-30 days of age: 31-60 days: adjusted odds ratio, aOR: 2.03; 95% confidence interval, CI: 1.31-3.15; 61-92 days: aOR: 2.14; 95% CI: 1.13-4.05. Minor adverse events (100 infants; 3.8%) included failure of the bell to shed (90 infants) and minimal bleeding (10 infants). Major adverse events (eight infants; 0.3%) included bleeding that required intervention (four infants), infection (three infants) and skin tear (one infant).
Standardized training protocols and close monitoring enabled nonphysician health providers to perform safe circumcisions on infants aged three months or younger.
回顾巴基斯坦由医疗服务提供者主导的婴儿割礼项目的结果。
根据世界卫生组织的指导方针，我们培训了外科技术员和助产士，使用 Plastibell 设备在两个 Indus 健康网络设施进行割礼。该项目的工具包括医疗服务提供者培训手册、家庭信息手册、登记表格和记录程序细节和结果的标准化表格。年龄在 1-92 天的婴儿有资格参加该研究。卫生工作者在手术后的第 1 天和第 7 天联系家庭，记录任何不良事件。我们使用多变量逻辑回归比较了发生不良事件的婴儿和无并发症的婴儿的特征。
2016 年 8 月至 2018 年 8 月，2822 名平均年龄为 22.8 天的男性割礼婴儿符合研究条件。其中，2617 名婴儿（92.7%）通过电话采访了照顾者。与年龄在 1-30 天之间接受割礼的婴儿相比，年龄较大的婴儿更有可能发生不良事件：31-60 天：调整后的优势比，aOR：2.03；95%置信区间，CI：1.31-3.15；61-92 天：aOR：2.14；95%CI：1.13-4.05。轻微不良事件（100 名婴儿；3.8%）包括铃未脱落（90 名婴儿）和轻微出血（10 名婴儿）。严重不良事件（8 名婴儿；0.3%）包括需要干预的出血（4 名婴儿）、感染（3 名婴儿）和皮肤撕裂（1 名婴儿）。
标准化的培训方案和密切监测使非医师医疗服务提供者能够对三个月或更小的婴儿进行安全的割礼。
