Quick expansion of medical circumcision brings challenges – study

As South Africa vastly expanded male medical circumcision services since 2010, surgical efficiency and record-keeping improved but the quality of surgical care, such as tracking complications, declined, a study released on Tuesday found.

The study, by the Centre for HIV and Aids Prevention Studies (Chaps) and the Johns Hopkins School of Public Health, was published in the open access journal of PLOS Medicine journal.

Researchers assessed 40 government medical male circumcision sites in six South African provinces in 2012, following a first assessment in 2011.

Previous studies have shown that medical male circumcision – the full removal of the foreskin of a penis – can reduce a heterosexual man’s risk of contracting HIV through sex by about 60%.

The national health department aims to medically circumcise 4.3-million men by 2016. Health department figures show about 1.3-million circumcisions have been performed since April 2010 and sites have expanded from one in 2010 to 80 in 2012.


According to World Health Organisation figures, South Africa has the fastest scale-up among African countries offering medical male circumcision services to prevent HIV.

Declines vs improvements 
But the PLOS study found that the scaleup of medical male circumcision services had “diluted human resources”, as experienced staff was redeployed to train staff in new clinics. “Declines in quality far outnumbered improvements,” study authors reported.

These included a quality decline in the monitoring of complications, post-operative counselling and some infection control issues, such as hand washing between clients, using sterile gloves and protective eyewear, disposal of medical waste and disinfection of surgical beds between clients.

“Medical male circumcision is a complex mass medical intervention involving many elements in the service chain,” co-author Dino Rech from the Chaps told Bhekisisa. “Initially South Africa’s focus was on making the surgery safe. It then shifted to post-operative care and counselling on which we’re still working.”

Rech pointed out that the quality of surgical care has started to improve since the collection of the study’s data. “Throughout the research period, we regularly met with the South African government to plug the gaps and found them to be open to improvement.”

On the plus side, South Africa has adopted three best practices for surgical efficiency – use of multiple surgical bays, electrocautery (the process of heating tissue with electricity to stop bleeding) instead of sutures, and ready-made kits with disposable instruments.

Manual or computerised record-keeping of circumcisions performed was also excellent but the South Africa system failed in tracking adverse events. 

According to the study, the rapid scaling up of medical male circumcision services should go hand in hand with a plan to maintain quality.

“We must ensure that the urgency of scaling up does not hinder the quality of existing services,” said Larissa Jennings, from the Johns Hopkins Bloomberg School of Public Health.

Subscribe to the M&G

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years, and we’ve survived right from day one thanks to the support of readers who value fiercely independent journalism that is beholden to no-one. To help us continue for another 35 future years with the same proud values, please consider taking out a subscription.

Mercedes Sayagues
Mercedes Sayagues works from Pretoria, South Africa. Journalist, editor, media trainer Mercedes Sayagues has over 121 followers on Twitter.

Related stories

Happiness is restored manhood

To understand the miracle of correcting a botched circumcision, just speak to one of the survivors

Justice failed, says initiates’ father

Two traditional nurses found guilty of mutilating a man’s two sons were given an ‘insulting’ sentence

Hope for victims of botched circumcisions

Young men who have lost their penises during initiation may be in line for free reconstruction

Wonder where SA’s medically circumcised men are? Now there’s a map for that

When new technology and an old tradition meet, they could help avert more than a million new HIV infections.

Do medically circumcised men take more risks in the bedroom?

New research may have finally answered an old question.

​Slice of Life: ‘I was afraid but ah, me, I’m now a man’

'Circumcision school can be a dangerous place but after I went everyone was happy, I joined the elders’ discussions and felt I could face anything.'
Advertising

Subscribers only

Q&A Sessions: Frank Chikane on the rainbow where colours never...

Reverend Frank Chikane has just completed six years as the chairperson of the Kagiso Trust. He speaks about corruption, his children’s views and how churches can be mobilised

ANC: ‘We’re operating under conditions of anarchy’

In its latest policy documents, the ANC is self-critical and wants ‘consequence management’, yet it’s letting its members off the hook again

More top stories

Shabnim Ismail bowls her way into the record books Down...

The night before Australia’s Women’s Big Bash League (WBBL) final, fiery South African fast bowler Shabnim Ismail lay awake pondering how...

Hawks make arrest in matric maths paper leak

Themba Daniel Shikwambana, who works at a printing company, was granted bail and is due to return to court in January

Andile Lungisa: Early parole for the house of truth

Disgraced Nelson Mandela Bay councillor Andile Lungisa calls for a change of leadership in the ANC immediately after being released on parole

War of words at Zondo commission: ‘Grow up Mr Gordhan,...

The cross-examination of the public enterprises minister by Tom Moyane’s lawyers at the state capture inquiry went on well into overtime on Monday evening
Advertising

press releases

Loading latest Press Releases…