Prevalence of complications of male circumcision in Anglophone Africa: a systematic review
1 Department of Community Health, University of Malawi, College of Medicine, Blantyre, Malawi
2 Department of Epidemiology, Denis and Joan Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
3 Department of Medicine, Health Sciences Faculty, University of Stellenbosch, Tygerberg, South Africa
4 Department of Global Health, School of Public Health, Loma Linda University, California, USA
5 Department of Obstetrics and Gynaecology, Faculty of Medicine, Mnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
BMC Urology 2007, 7:4 doi:10.1186/1471-2490-7-4Published: 2 March 2007
There is growing evidence that male circumcision (MC) prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent.
A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers.
There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals.
The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is need for standardized reporting of complications of male circumcision.