Makerere University School of Public Health, P.O Box 7072, Kampala, Uganda.
Rakai Health Science Program, Rakai, Uganda.
BMC Health Serv Res. 2022 Apr 14;22(1):505. doi: 10.1186/s12913-022-07842-5.
Women's support can improve uptake of voluntary medical male circumcision (VMMC). We assessed the level of women's support for VMMC and associated factors in fishing settlements on the shores of Lake Victoria in Uganda, to inform interventions aimed at increasing the uptake of safe male circumcision services in such high-risk populations.
We conducted a cross-sectional study, employing mixed methods of data collection, at Kasenyi and Kigungu landing sites in April 2018. We included women aged 18-49 years, who had stayed at the landing sites for ≥3 months. We obtained qualitative data using focus group discussions (FGDs), and interviewer-administered semi-structured questionnaires for quantitative data. The tool captured demographic characteristics, community factors including cultural norms and beliefs, women's experiences, and health facility-related factors. The dependent variable was derived from the response to the question: "Would you encourage your partner/husband to go for VMMC?", and used as a proxy for support of VMMC. We used modified Poisson regression to identify factors associated with women's support for VMMC. Qualitative data were analysed using thematic content analysis.
We enrolled 313 women with a mean age of 28 (SD±6.8) years. Of the 313 women, 230 (73.5%) supported VMMC. Belief that VMMC increases penile hygiene (Adjusted prevalence ratio [aPR]=1.9; CI: 1.8-3.2), performing VMMC for religious reasons (aPR=1.9; CI: 1.8-2.9), preference for a circumcised man (aPR=1.3; CI: 1.2-1.5), belief that vaginal fluids facilitate wound healing (aPR=1.9; CI: 1.3-2.7), and knowledge about when a man can resume sex (4 weeks) after circumcision (aPR=2.1; CI: 1.8-3.3) were associated with women's support for VMMC. FGDs revealed that women were not adequately involved in VMMC activities for decision making.
The support for VMMC was high among women in the fishing communities. However, women perceived they were not involved in decision-making for VMMC and had several misconceptions, including a belief that vaginal fluids facilitate wound healing. The Ministry of Health and VMMC implementing partners should devise strategies to increase sensitization and involvement of women in VMMC decision-making without slowing service uptake.
妇女的支持可以提高自愿男性包皮环切术（VMMC）的普及率。我们评估了乌干达维多利亚湖沿岸渔村妇女对 VMMC 的支持程度及其相关因素，以便为旨在提高高危人群安全男性割礼服务普及率的干预措施提供信息。
我们于 2018 年 4 月在卡森伊和基根古着陆点进行了一项横断面研究，采用定性和定量数据相结合的混合方法。我们纳入了年龄在 18-49 岁之间、在着陆点居住时间≥3 个月的妇女。我们使用焦点小组讨论（FGD）获取定性数据，并使用访谈者管理的半结构式问卷获取定量数据。该工具收集了人口统计学特征、社区因素（包括文化规范和信仰）、妇女的经历以及与卫生机构相关的因素。因变量来自对以下问题的回答：“你会鼓励你的伴侣/丈夫去做 VMMC 吗？”，并用作对 VMMC 支持的替代指标。我们使用修正泊松回归来确定与妇女支持 VMMC 相关的因素。定性数据采用主题内容分析进行分析。
我们共招募了 313 名平均年龄为 28（SD±6.8）岁的妇女。在 313 名妇女中，230 名（73.5%）支持 VMMC。相信 VMMC 可以提高阴茎卫生（调整后的患病率比[aPR]=1.9；CI：1.8-3.2）、出于宗教原因进行 VMMC（aPR=1.9；CI：1.8-2.9）、更喜欢割礼的男人（aPR=1.3；CI：1.2-1.5）、相信阴道分泌物有助于伤口愈合（aPR=1.9；CI：1.3-2.7）以及知道男性在割礼后 4 周可以恢复性生活（aPR=2.1；CI：1.8-3.3）与妇女对 VMMC 的支持相关。FGD 表明，妇女在 VMMC 活动中没有充分参与决策。
在渔村社区，妇女对 VMMC 的支持率很高。然而，妇女认为她们没有参与 VMMC 的决策，并且存在一些误解，包括相信阴道分泌物有助于伤口愈合。卫生部和 VMMC 实施伙伴应制定战略，提高妇女对 VMMC 决策的认识和参与度，而不会减缓服务的普及速度。
