Prevalence of complications of male circumcision in Anglophone Africa: a systematic review

Abstract

BackgroundThere is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent.MethodsA systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers.ResultsThere were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals.ConclusionThe available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision.

Male Circumcision and HIV Prevention: Is There Really Enough of the Right Kind of Evidence?

“…Most of this literature is about surgery undertaken in the developed world; there are far fewer data on medical circumcision in the developing world or traditional circumcision practices. 36 Beyond individual effects and consequent effects on partners and over the life course, there may be longer-term social impact, e.g. community expectations and understandings over time may change and affect compliance and participation in circumcision.…”

“…UNAIDS is clearly aware of these issues, 1 but there is not yet sufficient evidence on the extent of safety problems or the social complexity of traditional circumcision across sub-Saharan Africa (or elsewhere in the developing world for that matter), or on the level of adverse effects currently experienced, 44,36 and how these might be addressed at policy and programme level. There were programme successes reported in abstracts at the Toronto conference, 45 but these barely scratch the surface of what might be needed to go to scale on significantly improving safety in traditional circumcision.…”

Traditional male circumcision in eastern and southern Africa: a systematic review of prevalence and complications

“…[3][4][5] In these studies, complications following male circumcision ranged from 1.7% to 7.6% and were mostly of minor clinical significance. 6,7 However, serious complications and even deaths have been reported from traditional male circumcision carried out on adolescents. 8,9 While medical male circumcision is increasingly being incorporated in comprehensive strategies for the prevention of HIV infection 10 , traditional providers will continue to be an important source of circumcision for many males in eastern and southern Africa and will not easily be replaced by male circumcision performed in a clinical setting for reasons that are both cultural and linked to health service capacity.…”

Factors associated with the safety of voluntary medical male circumcision in Nyanza province, Kenya

“…5 Before the RCTs, outcomes in Africa for male circumcision among adults were poorly documented. In a review, 6 adverse event rates following African male circumcisions ranged from 0 to 24%. The RCTs, which provided services in a clinical trial setting, reported the following adverse event rates: 3.8% in Orange Farm, South Africa; 1.5% in Kisumu, Kenya; and 3.6% in Rakai, Uganda.…”