dr. e. odoyo-june early infant male circumcision in nyanza province, kenya unim project nyanza...
TRANSCRIPT
Dr. E. Odoyo-June
Early Infant male circumcision in Nyanza Province, Kenya
UNIM ProjectNyanza Reproductive Health Society
Kenya’s VMMC program is expanding towards initiating MC services for infants aged 0-60 days
A pilot infant MC project was initiated in Sep 2009 by NRHS under the auspices of the MCC –Mtoto Msafi
Service providers in public health facilities are trained and supported to provide infant MC using Mogen clamp
Uptake and safety are monitored through an inbuilt operational research to inform future roll out
Introduction
Why emphasize Early Infant Male Circumcision ?
Less technically challenging (no routine suturing)
Minimal bleeding Faster Less expensive Intervention before the
onset of sexual activity Rapid healing Lower complication rate
(studies from North America)
“Mtoto Msafi” Early infant MC Research
“Mtoto Msafi” Early infant MC Research?
Goals:
(1) Evaluate demand
(2) Learn about parental decision making around EIMC
(3) Assess safety
Parents (mothers and fathers) of 600 infants eligible for IMC -- 300 accepting and 300 refusing
Administer questionnaire Those in the circumcising group return for
review
Comparison of demographic characteristics among parents who choose and those who decline EIMC
Comparison of beliefs and attitudes about circumcision between the two groups
Frequency, severity and type of AEs encountered
Comparison of circumcision preferences of mothers to those of fathers
Outcomes of interest
Current status
•2 EIMC trainers certified
•33 Nurses and RCOs trained in EIMC and 11 certified
•Service provided at 1 Provincial and 3 District Hospitals
•Expansion to two additional health facilities planned
Summary data
Site Start Date EIMC’s Done Uptake (%)
NYANZA PGH Sep, 2009 253 14.6
KISUMU DH Oct, 2009 82 11.3
KOMBEWA DH
Nov, 2009 32 21.3
SIAYA DH Feb, 2010 11 6.8
381 Procedures performed by Mid May 2010
Total AEs= 5 (1.3%); 4 classified as mild intra operative bleeding and 1 involved post-operative bleeding
Infants seen for follow-up = 207 (54.3%)
Challenges
Relatively low uptake
Turn away infants aged greater than 60 days
Concerns regarding the timing and feasibility of rituals for infant MC
Poor compliance with instructions on follow up visit
desire for compensation by MOH staff for additional work
Mtoto Msafi research team led by Marisa YoungMale Circumcision consortiumNyanza provincial MC task forceMtoto Msafi Project StaffNyanza Provincial HospitalKisumu District HospitalKombewa District HospitalSiaya District HospitalStudy participants
Acknowledgements
Citations
EIMC is not widely practiced in Eastern and Southern Africa
IMC could be an acceptable HIV prevention strategy1
Factors influencing decision making around IMC and true acceptability of IMC in Sub-Saharan Africa not Known
AE rates reported in the literature vary widely (e.g. 3% and 20.2% from 2 separate studies in Nigeria alone)2,3
1Westercamp, N and RC Bailey. 2007. Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review. AIDS Behav 11:341–55
2Ahmed, A, NH Mbibi, D Dawan, et al. 1999. Complications of traditional male circumcision. Ann Trop Paediatr 19:113-17.
3Okeke, LI, AA Asinobi, OS Ikuerowo. 2006. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 6:21