PT - JOURNAL ARTICLE AU - Kenu, Ernest AU - Sint, Tin Tin AU - Kamenga, Claude AU - Ekpini, Rene TI - Early Infant Male Circumcision in Cameroon and Senegal: Demand, Service Provision, and Cultural Context AID - 10.9745/GHSP-D-15-00185 DP - 2016 Jul 01 TA - Global Health: Science and Practice PG - S18--S28 VI - 4 IP - Supplement 1 4099 - http://www.ghspjournal.org/content/4/Supplement_1/S18.short 4100 - http://www.ghspjournal.org/content/4/Supplement_1/S18.full SO - GLOB HEALTH SCI PRACT2016 Jul 01; 4 AB - Despite the absence of national policies and strategies, early infant male circumcision is routinely offered at all levels of the health care system in Cameroon and Senegal, mainly because of community demand. Improving medical male circumcision will require service guidelines, preservice training, investigation of surgical and nonsurgical devices, supply chains, data collection tools, engaged communities to raise awareness, and communication strategies for men.Background: Male circumcision is almost universal in North and West Africa, and practiced for various reasons. Yet there is little documentation on service delivery, clinical procedures, policies, and programmatic strategies. The United Nations Children’s Fund (UNICEF) commissioned country program reviews in 2014 to shed light on the delivery of male circumcision services for infants in Cameroon and Senegal.Methods: We conducted a policy desk review, key informant interviews, and focus group discussions at health centers and in communities. Between December 2014 and January 2015, we conducted 21 key informant interviews (13 with regional and district officers, 5 with national officers, and 3 with UNICEF officials) and 36 focus group discussions (6 with men, 6 with women, 12 with adolescent boys, and 12 with service providers). Some of the men and women were parents of the adolescents who participated in the focus group discussions. In the French-speaking areas, the focus group discussions were conducted in French through an accredited translator, audio recorded, and transcribed into English.Results: All of the facilities we visited in Cameroon and Senegal offer medical male circumcision, with 10 out of 12 performing early infant male circumcision (EIMC) routinely. Neither country has policies, guidelines, or strategies for EIMC. The procedure is done mainly by untrained service providers, with some providers using modern circumcision devices. There are no key messages on EIMC for families; the increasing demand for EIMC is led by the community.Conclusion: Despite the absence of national policies and strategies, EIMC is routinely offered at all levels of the health care system in Cameroon and Senegal, mainly by untrained service providers. Improving circumcision services will require guidelines for EIMC and improvements in training, equipment, supply chains, recordkeeping, and demand creation.