Evaluation of neonatal circumcision training for resident doctors in a developing country

Ekenze, Sebastian O.; Ugwu, JideoforOkechukwu; Onumaegbu, O.O.

doi:10.1016/j.jpurol.2015.03.017

Cited by 6 publications

(4 citation statements)

References 16 publications

(23 reference statements)

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“…This trend of nurses performing most of the circumcisions causing UCF and using the freehand technique to do so has been reported in previous studies. [ 5 , 6 , 9 , 10 , 12 ] Nurses in private hospitals, maternity homes and general hospitals performed most of the circumcisions. Osuigwe et al .…”

Section: Discussionmentioning

confidence: 99%

“…[ 11 , 13 ] Training in circumcision amongst doctors in residency training in South-East Nigeria, has been found to be suboptimal; in spite of this, majority of these doctors plan to perform circumcision in future. [ 12 ] The scenario in the training of nurses and paramedics may be poorer in our environment even when they provide the highest number of this service.…”

Section: Discussionmentioning

confidence: 99%

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Post-Circumcision Urethrocutaneous Fistulae

Ugwu¹,

Ekwunife²,

Modekwe³

et al. 2023

African Journal of Paediatric Surgery

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Background: Circumcision is regarded as the most common surgical procedure world over. It is also perceived to be a simple and safe procedure; however, it could be fraught with major urological complications such as urethrocutaneous fistula (UCF). Repair of these fistulae poses a great reconstructive challenge to the paediatric surgeon/urologist with varied outcomes. Aim: We seek to review the presentations, repair and outcome of post-circumcision UCFs managed in a tertiary centre. Patients and Methods: This is a retrospective review of all the consecutive cases of repaired post-circumcision UCFs in Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria, over a period of 9 years (January 2012–December 2020). Data on demography, size of fistula, type of repair and outcome were retrieved from the Records Department and patients’ case notes and were analysed using SPSS (version 22, Chicago, Illinois). Results: A total of 22 boys had post-circumcision UCF repair within the period, and they were aged between 2 weeks and 108 months with a median age of 4 months at presentation and aged between 8 months and 144 months with a median age of 24 months at the time of surgery. Circumcisions were by freehand technique in 21 (95.5%). Nurses performed most of the circumcisions in 19 (86.4%), and most of the circumcisions were performed in private hospitals 7 (31.8%), maternity homes 3 (13.6%) and general hospitals in 10 (45.5%) each, respectively. Most 17 (77.3%) fistulae were coronal, and the size of defect ranged from 1 mm to 10 mm. The most commonly employed technique of repair was simple closure in 16 (72.2%). Meatal stenosis and re-fistulation occurred in 2 (9.1%) and 4 (18.2%), respectively. Only two (12.5%) required reoperation. There was no relationship between the size of defect and re-fistulation, P = 0.377. Conclusion: Majority of the Post-circumcision urethrocutaneous fistulae were from free hand technique of circumcisions . These were performed mostly by nurses in general, private hospitals and maternity homes. Hence, there is a need to ramp up training of providers of neonatal circumcision in our environment. Most UCF in children could be repaired with simple closure technique reinforced with dartos flap.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Post-Circumcision Urethrocutaneous Fistulae

Ugwu¹,

Ekwunife²,

Modekwe³

et al. 2023

African Journal of Paediatric Surgery

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“…Despite this burden of responsibility for managing post circumcision complications placed on doctors, it has been reported that training of doctors in circumcision is suboptimal in our environment. [ 27 ] As a corollary training in the management of post-circumcision complications may also be inadequate. Hence, we highly recommend adequate training of nurses to reduce post-circumcision complications and upgrading the skills of doctors in managing post-circumcision complications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Maternal Preferences for Neonatal Male Circumcision in Enugu Nigeria

Ezomike

Chinawa

Enebe

et al. 2022

African Journal of Paediatric Surgery

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Background: Although circumcision in male neonates is one of the most common procedures performed in neonatal surgery, mothers’ preferences concerning the aspects of circumcision are not well-known. Since mother is the likely parent to present child for circumcision, her preferences should be given adequate consideration. Objectives: The objective of this study is to evaluate maternal preferences for neonatal male circumcision in Enugu. Methodology: A cross-sectional study where questionnaire was distributed by the researchers to consenting pregnant women attending antenatal clinics in two teaching hospitals in Enugu. Data analysis was performed using the SPSS. The results presented as means, percentages and tables. Test for significance was done using the Chi-square test. Results: Four hundred and sixty-one pregnant women participated in the study. Ninety-five percent (438/461) wanted circumcision and 83.5% (385/461) wanted it on or before the 8 th day of life. The reasons were cultural/religious in 69% (302/447). Fifty-four percent (250/461) had no preferences as to methods, but for those who had, Plastibell was most preferred method in 28% (129/461) while 76% (235/309) preferred circumcision to be done in hospital. In 49.2% (227/461) preferred personnel were nurses but 79.6% (367/461) wanted doctors to attend to post-circumcision complications. In 79.2% (365/461), mothers will not insist on the use of anaesthesia for circumcision. Mothers with circumcised husbands were significantly more willing to circumcise a male child ( P = 0.0018). Higher educational status of mother was significantly related to willingness to insist on the use of anaesthesia ( P = 0.046) and use of analgesics after circumcision ( P = 0.001). Conclusions: Most mothers prefer neonatal male circumcision by nurses, while preferring doctors for post-circumcision complications. These choices are not affected by parents' educational status. Mothers with circumcised husbands accepted circumcision more than those with uncircumcised husbands. Higher maternal education encourages anaesthesia during circumcision and post-circumcision analgesia.

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“…Sub‐Saharan African countries have low physician coverage, but comparatively higher coverage of non‐physicians who could facilitate roll out of circumcision for HIV prevention. The major concern has been safety of the procedure and complications can be mitigated by adequate training using a structured curriculum with a didactic and supervised practicum, step‐by‐step checklists, and immediate feedback from mentors. Anatomical models have also been shown to enhance trainee learning .…”

Section: Introductionmentioning

confidence: 99%