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2010-2023 年撒哈拉以南非洲男性割礼流行率的估计值:系统评价和荟萃分析。

Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010-2023-A systematic review and meta-analysis.

机构信息

Department of Population Medicine, College of Medicine, QU Health, Qatar University, Qatar.

Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

出版信息

PLoS One. 2024 Mar 13;19(3):e0298387. doi: 10.1371/journal.pone.0298387. eCollection 2024.


DOI:10.1371/journal.pone.0298387
PMID:38478528
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10936832/
Abstract

BACKGROUND: Male circumcision (MC) is a key part of the package of interventions to prevent HIV, the biggest health challenge in sub-Saharan Africa. OBJECTIVE: To estimate the male circumcision prevalence and to evaluate the progress towards meeting WHO targets in sub-Saharan Africa during the period 2010-2023. METHODS: We carried out a systematic review and meta-analysis of studies published during the period 2010-2023. We searched PubMed, Scopus, Cochrane CENTRAL, Google Scholar, WHO and the Demographic and Health Survey for reports on MC prevalence in sub-Saharan Africa. MC prevalence was synthesized using inverse-variance heterogeneity models, heterogeneity using I2 statistics and publication bias using funnel plots. RESULTS: A total of 53 studies were included. The overall prevalence during the study period was 45.9% (95% CI 32.3-59.8), with a higher MC prevalence in Eastern (69.9%, 95%CI 49.9-86.8) compared to Southern African (33.3%, 95%CI 21.7-46.2). The overall prevalence was higher in urban (45.3%, 95%CI 27.7-63.4) compared to rural settings (42.6%, 95% 26.5-59.5). Male circumcision prevalence increased from 40.2% (95% CI 25.0-56.3) during 2010-2015 to 56.2% (95% CI 31.5-79.5) during 2016-2023. Three countries exceeded 80% MC coverage, namely, Ethiopia, Kenya and Tanzania. CONCLUSION: Overall, the current MC prevalence is below 50%, with higher prevalence in Eastern African countries and substantially lower prevalence in Southern Africa. Most of the priority countries need to do more to scale up medical male circumcision programs.

摘要

背景:男性割礼(MC)是预防艾滋病毒的干预措施组合中的关键部分,艾滋病毒是撒哈拉以南非洲地区面临的最大健康挑战。

目的:评估 2010 年至 2023 年期间,撒哈拉以南非洲地区男性割礼的流行率,并评估实现世界卫生组织目标的进展情况。

方法:我们对 2010 年至 2023 年期间发表的研究进行了系统回顾和荟萃分析。我们在 PubMed、Scopus、Cochrane 中心、谷歌学术、世界卫生组织和人口与健康调查中搜索了撒哈拉以南非洲地区男性割礼流行率的报告。使用逆方差异质性模型综合 MC 流行率,使用 I2 统计量评估异质性,使用漏斗图评估发表偏倚。

结果:共纳入 53 项研究。研究期间总体流行率为 45.9%(95%CI 32.3-59.8%),东部(69.9%,95%CI 49.9-86.8%)高于南部(33.3%,95%CI 21.7-46.2%)。城市(45.3%,95%CI 27.7-63.4%)高于农村(42.6%,95%CI 26.5-59.5%)的总体流行率更高。2010-2015 年期间,男性割礼流行率从 40.2%(95%CI 25.0-56.3%)上升至 2016-2023 年期间的 56.2%(95%CI 31.5-79.5%)。有三个国家的男性割礼覆盖率超过 80%,分别是埃塞俄比亚、肯尼亚和坦桑尼亚。

结论:总体而言,目前的男性割礼流行率低于 50%,东部非洲国家的流行率较高,南部非洲的流行率较低。大多数重点国家需要加大力度扩大男性割礼方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/6e14bf471a4a/pone.0298387.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/30fe66685834/pone.0298387.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/11d8039edbc9/pone.0298387.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/14f59d6065a2/pone.0298387.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/542679e6ccf1/pone.0298387.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/6e14bf471a4a/pone.0298387.g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/30fe66685834/pone.0298387.g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/11d8039edbc9/pone.0298387.g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/14f59d6065a2/pone.0298387.g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/542679e6ccf1/pone.0298387.g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e4f/10936832/6e14bf471a4a/pone.0298387.g005.jpg

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引用本文的文献

[1]
Retrospective analysis of clinical outcomes and early complications of conventional circumcision techniques and thermocautery-assisted circumcision.

Sci Rep. 2025-2-28

[2]
Acceptability, feasibility and appropriateness of intensified health education, SMS/phone tracing and transport reimbursement for uptake of voluntary medical male circumcision in a sexually transmitted infections clinic in Malawi: A mixed methods study.

PLoS One. 2025-1-24

本文引用的文献

[1]
Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study.

BMC Public Health. 2023-2-16

[2]
Is Circumcision "Necessary" in Islam? A Philosophical Argument Based on Peer Disagreement.

J Relig Health. 2022-12

[3]
The HIV Epidemic in South Africa: Key Findings from 2017 National Population-Based Survey.

Int J Environ Res Public Health. 2022-7-1

[4]
Male circumcision uptake during the Botswana Combination Prevention Project.

PLoS One. 2022

[5]
Prevalence of male circumcision in four culturally non-circumcising counties in western Kenya after 10 years of program implementation from 2008 to 2019.

PLoS One. 2021

[6]
Prevalence of Voluntary Medical Male Circumcision for HIV Infection Prevention - Chókwè District, Mozambique, 2014-2019.

MMWR Morb Mortal Wkly Rep. 2021-7-2

[7]
Factors Associated with Low Uptake of Voluntary Medical Male Circumcision as HIV-Prevention Strategy among Men Aged 18-49 Years from Nyanza District, Rwanda.

HIV AIDS (Auckl). 2021-4-1

[8]
The MethodologicAl STandards for Epidemiological Research (MASTER) scale demonstrated a unified framework for bias assessment.

J Clin Epidemiol. 2021-6

[9]
Male circumcision uptake and its predictors among sexually active men aged 15-59 years living in the highest HIV prevalence region of Ethiopia: evidence from 2016 Ethiopia demographic and health survey.

BMC Public Health. 2020-11-23

[10]
An assessment of sexual risk behaviours among circumcised and uncircumcised men before and after the implementation of the safe male circumcision programme in Botswana.

AIDS Care. 2020-12

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