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