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Original Articles
Open Access

Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study

Vera Frajzyngier, George Odingo, Mark Barone, Paul Perchal and Melinda Pavin
Global Health: Science and Practice February 2014, 2(1):93-102; https://doi.org/10.9745/GHSP-D-13-00120
Vera Frajzyngier
aEngenderHealth, New York, NY, USA
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George Odingo
bEngenderHealth, Nairobi, Kenya
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Mark Barone
aEngenderHealth, New York, NY, USA
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Paul Perchal
aEngenderHealth, New York, NY, USA
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  • For correspondence: pperchal{at}engenderhealth.org
Melinda Pavin
aEngenderHealth, New York, NY, USA
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Figures & Tables

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    TABLE 1. Sociodemographic Characteristics of Study Participants (N = 2,244)
    Characteristics
    Age, y, n (%)
     13–17517 (23.0)
     18–251,137 (50.7)
     26–35440 (19.6)
     36–54150 (6.7)
    Age, y, mean (SD)22.7 (7.4)
    Ethnic group, n (%)
     Luo2,191 (97.6)
     Other53 (2.4)
    Religion, n (%)
     Christian2,151 (95.9)
     Muslim18 (0.8)
     Other75 (3.3)
    Marital status, n (%)
     Single1,618 (72.1)
     Married or living with partner606 (27.0)
     Unknown20 (0.9)
    Education, n (%)
     No secondary education656 (29.2)
     At least some secondary education1,588 (70.8)
    Employment status, n (%)
     Unemployed401 (17.8)
     Student950 (42.4)
     Employed883 (39.3)
     Unknown10 (0.4)
    Distance to clinic, km, mean (SD)5.5 (6.5)
    Mode of transportation to clinic, n (%)
     Walking1,274 (57.7)
     Car or bus389 (17.6)
     Motorcycle or bicycle482 (21.8)
     Other/unknown99 (4.4)
    HIV positive,a n (%)
     Self131 (5.8)
     Partner (primary or other)57 (2.5)
    • Abbreviations: SD, standard deviation.

    • ↵a Self-reported by participants.

    • View popup
    TABLE 2. Adverse Events at 7 Days and 60 Days Post-Circumcision, by Type of Provider and Severity
    7 days60 days
    Adverse EventClinical OfficerNurseTotalClinical OfficerNurseTotal
    (n = 807)(n = 1384)(n = 2191)(n = 694)(n = 1151)(n = 1845)
    Any moderate or severe AE15 (1.9)29 (2.1)44 (2.0)2 (0.29)1 (0.09)3 (0.16)
    Pain
     Moderate…………1 (0.07)1 (0.05)
     Severe1 (0.12)1 (0.07)2 (0.09)………
    Infection
     Moderate…4 (0.29)4 (0.18)………
     Severe………………
    Excess swelling
     Moderate8 (0.99)15 (1.1)23 (1.1)………
     Severe………………
    Bleeding
     Moderate1 (0.12)…1 (0.05)………
     Severe………………
    Problems with appearance
     Moderate2 (0.25)5 (0.36)7 (0.32)1 (0.12)…1 (0.05)
     Severe………………
    Hematoma
     Moderate2 (0.25)1 (0.07)3 (0.14)………
     Severe………………
    Delayed wound healing
     Moderate…3 (0.22)3 (0.14)………
     Severe………………
    Injury to penis
     Moderate………1 (0.12)…1 (0.05)
     Severe………………
    Insufficient skin removed
     Moderate1 (0.12)…1 (0.05)………
     Severe………………
    • Abbreviations: AE, adverse event.

    • Data are shown as n (%).

    • View popup
    TABLE 3. Risk Factors for Moderate/Severe Adverse Events at 7 Days Post-Circumcision
    No. of AEs/TotalUnadjusted ORa (95% CI)Adjusted ORb (95% CI)
    Provider Characteristics
    Sex
     Male30/1833Reference…
     Female4/3581.03 (0.40, 2.65)…
    Cadre
     Clinical officer13/807Reference…
     Nurse21/13841.04 (0.42, 2.60)…
    Professional experience, y
     < 621/808Reference…
     ≥ 613/13830.45 (0.17, 1.17)0.39c (0.17, 0.89)
    Procedure duration, min
     < 193/5260.22 (0.01, 5.9)…
     19–2313/6890.77 (0.36, 1.63)…
     > 2318/961Reference…
    No. of procedures conducted during the study
     < 10014/554Reference…
     ≥10020/16370.64 (0.31, 1.32)…
    Client Characteristics
    Age, y
     13–172/505Reference…
     18–5432/16865.59 (1.48, 21.1)3.75c (1.92, 7.33)
    Education
     No secondary education13/626Reference…
     At least some secondary education21/15500.63 (0.35, 1.12)0.61 (0.34,1.11)
    Employment status
     Unemployed4/395Reference…
     Employed21/8671.27 (0.86, 1.89)2.41c (1.06, 5.51)
     Student9/9190.65 (0.43, 0.97)1.34 (0.76, 2.53)
    Marital status
     Single22/1572Reference…
     Married or living with partner12/5991.38 (0.52 3.62)…
    Distance traveled, km
    ≤ 516/1143Reference…
    > 57/4911.05 (0.46, 2.38)…
    Mode of transportation to the facility
     Walking12/1246Reference…
     Car or bus10/3792.66 (0.98, 7.2)2.52 (0.94, 6.72)
     Motorcycle or bicycle9/4741.99 (0.86, 4.59)1.56 (0.78, 3.12)
     Other1/562.38 (0.62, 9.11)1.56 (0.37, 6.54)
    HIV status
     Negative26/1775Reference…
     Positive4/1302.09 (0.65, 6.65)…
    • Abbreviations: AE, adverse event; CI, confidence interval; OR, odds ratio.

    • ↵a Bivariate analysis.

    • ↵b Multivariate analysis; includes only those variables that were associated with AEs in unadjusted bivariate analysis at P < .20.

    • ↵c Significant at P < .05.

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Global Health: Science and Practice: 2 (1)
Global Health: Science and Practice
Vol. 2, No. 1
February 01, 2014
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Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
Vera Frajzyngier, George Odingo, Mark Barone, Paul Perchal, Melinda Pavin
Global Health: Science and Practice Feb 2014, 2 (1) 93-102; DOI: 10.9745/GHSP-D-13-00120

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Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
Vera Frajzyngier, George Odingo, Mark Barone, Paul Perchal, Melinda Pavin
Global Health: Science and Practice Feb 2014, 2 (1) 93-102; DOI: 10.9745/GHSP-D-13-00120
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