More training, improved tools needed for African health workers performing male circumcisions, study finds

African health workers performing male circumcision in an effort to curb the spread of HIV need better tools and more training to avoid high rates of complications, according to a World Health Organization study published Monday in the WHO Bulletin, Reuters Health reports.

The authors conducted the study among 1,007 participants, 298 of whom were physically examined by the authors. The researchers also intervened when they observed complications. According to the study, complications such as bleeding, infection, excessive pain and erectile dysfunction occurred in as many as 35% of males circumcised in Kenya's Bungoma district by traditional practitioners, with an estimated 6% of patients experiencing lifelong problems.

Although male circumcision is practiced universally in Bungoma, the study said many clinicians in Bungoma were not trained formally and lacked clean and sharp instruments. The study also found that the rate of complications in public clinics was 18%. The study's findings have "raised questions" about how quickly male circumcision should be included as part of HIV prevention strategies supported by WHO and UNAIDS, according to Reuters Health. The study authors said extensive training and resources are needed to "build the capacity of health facilities in sub-Saharan Africa" before male circumcision can be included in prevention strategies. They added that the high rate of complications "should also serve as an alarm to ministries of health and the international health community that focus cannot only be on areas where circumcision prevalence is low." The authors concluded that health workers should be provided with training in sterilization techniques, surgical procedures, pain management, post-operative care and counseling about wound care before male circumcision is implemented on a wide scale (MacInnis, Reuters Health, 9/1).

The study is available online.