African health workers need more training and better tools to circumcise men and boys safely for HIV prevention, according to a World Health Organisation (WHO) study chronicling "shocking" rates of complications.
As many as 35% of males circumcised by traditional practitioners in Kenya's Bungoma district suffered complications such as bleeding, infection, excessive pain and erectile dysfunction from the procedure, the WHO researchers found.
"Other common adverse effects reported were pain upon urination, incomplete circumcision requiring re-circumcision, and laceration," they wrote, estimating 6% of patients had life-long problems as a result.
Although male circumcision is universally practiced in Bungoma, the study said many clinicians there lacked sharp and clean instruments and few were formally trained. Even in public clinics, the complication rate was 18%.
The findings, published in the WHO Bulletin, raised questions about whether the availability of male circumcision should be extended quickly as part of a strategy to fight HIV backed by the WHO and its sister UN agency UNAIDS.
Circumcision can be 70% effective
"Extensive training and resources will be necessary to build the capacity of health facilities in sub-Saharan Africa before safe circumcision services can be aggressively promoted for HIV prevention," the authors wrote.
"Our results showing 35% of traditional circumcisions resulting in adverse events, many of them serious and permanent, should also serve as an alarm to ministries of health and the international health community that focus cannot only be on areas where circumcision prevalence is low."
Studies have shown male circumcision could be 70% effective in protecting men against HIV infection. Africa is the centre of the Aids epidemic and countries such as Uganda are looking to increase their male circumcision rates to stem the spread of the disease.
The authors of the WHO study, Kenyan expert Omar Egesah, and Robert Bailey and Stephanie Rosenberg of the United States, physically examined 298 of the 1 007 participants in their study, and intervened when they observed complications.
The WHO study concluded that health workers should be trained in sterilisation techniques, surgical procedures, pain management, post-operative care and counselling about wound care before male circumcision is pursued on a large scale. – (Reuters Health, September 2008)
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