Factors Associated With Postoperative Adverse Events Following Voluntary Medical Male Circumcision among Clients in Migori County Hospital

Abstract

Male circumcision is one of the oldest surgical procedures in human history. Scientists predicted the medical benefit of this procedure as early as mid-19th century. Results from three clinical trials conducted in Kenya, Uganda and South Africa between 2005 and 2007 confirmed male circumcision reduced the incidence of HIV acquisition by approximately 50-60%. This evidence led the World Health Organization (WHO) to recommend male circumcision as an additional strategy for prevention of HIV acquisition. Consequently, sub- Saharan Africa countries implemented and rapidly scaled up male circumcision from 2008. WHO has reported an increase in infection related AEs in sub-Saharan Africa. These include cases of postoperative wound infection. In VMMC, occurrence of adverse events like excessive bleeding or serious infection affects safety of men receiving these services, leads to loss in man hours and put a strain of the health care delivery system. There is a need to continuously monitor the incidences and determinants of AEs in the current VMMC activities to improve safety and quality of the service. There also a need to ensure that the quality and effectiveness of care is delivered to the highest standard to improve and foster acceptability of VMMC. This study set out to determine the risk factors of adverse events (mild, moderate and severe) following voluntary medical male circumcision among clients within the Family AIDS Care and Education Services (FACES) program in Migori sub county hospital. This was a quantitative cross sectional study design involving 138 men attending their follow up visits at Migori Sub-County Hospital. The participants were recruited via systematic sampling and interviewed and examined to obtain information on adverse events. The mean age of the participants was 22 years while the mode was 18 years. (Range: 18-48). At least half 70(50.7%) were between 18- 20 years. Most participants 97(70.3%) were circumcised using the surgical method while 41(29.7%) opted for the Pre-pex method. The prevalence of mild adverse events following male circumcision were 58% while the prevalence of moderate adverse events was 2.9 %. Results showed infrequent bathing after circumcision (P=0.001) and washing of underpants (P<0.001) significantly increased the chance having moderate adverse event. Most participants (72%) were aware of possible Adverse Events of VMMC Almost all (99%) of the participants were highly satisfied with the circumcision procedure and the post-operative care services they received. The findings imply that VMMC services offered within FACES program are perceived as safe and that VMMC can be delivered safely and effectively in a program setting within those communities where circumcision is not carried out for cultural reasons. More effort should be directed towards ensuring adherence to instructions including good hygiene practices post circumcision.