A review of the cases done in the first six months of the male circumcision programme in Harare: An HIV intervention measure

Abstract

Background: Voluntary Medical Male Circumcision (VMMC) was embarked on in Zimbabwe as a public health intervention measure after it was realised that it significantly reduces the rate of Human  Immunodeficiency Virus (HIV) transmission from an infected female to an uninfected male during heterosexual intercourse. Objectives: The main aim of the study was to determine the complication rate and type of complications occurring during and after Male Circumcision (MC) at Spilhaus Clinic, Harare. Design: Retrospective cross sectional study. Setting: Spilhaus Family Planning Clinic, Harare Central Hospital, Zimbabwe. Results: Five hundred and eight records of VMMC were retrieved and analysed. The median age of the MC clients was 28 years (Q 1 = 24 years, Q 3 = 33 years). The complication rate of male circumcision during  surgery and up to 48 hours post- surgery was 1.8%. After one month post surgery the complication rate was 1.4%. Nearly 90% of patients had VMMC for the purposes of HIV prevention. About 66% of the patients had been referred to the VMMC centre from Voluntary Counselling and Testing (VCT) centres. Ninety percent of clients seeking male circumcision were sexually active. Close to 11% of VMMC clients had had a Sexually Transmitted Infection (STI) in the three months preceding VMMC. Almost 70% of the VMMC clients had not used a condom during their last sexual encounter. Slightly above 1% of the patients were HIV positive. The median operating time for each circumcision was 23 minutes (Q 1 = 18 minutes, Q 3 = 29 minutes).  Excessive bleeding was the most common intra- operative complication (1.2%). Wound infection was the most frequent cause of morbidity (12.6%) from 48 hours post MC to one month post- op. An ASA score of 2 (p< 0.01) was associated with a greater number of complications. Conclusion: The complication rate of MC in the peri- operative period was relatively high. Wound (12.6%) infection was the most common cause of morbidity. This rate could be significantly reduced by improving the aseptic technique and possibly training of doctors. However, on final review the complication rate was only 1.4%. Effort needs to be concentrated on circumcising populations which have a high incidence of HIV infection. Most clients were circumcised in a bid to prevent HIV infection. The HIV contracting risk profile of VMMC- seeking clients is relatively low.