A study of the outcome of neonatal male circumcision using Gomco, Mogen and Plastibell neonatal devices among trained providers in Zambia

Abstract

Background:Male circumcision (MC) is the surgical removal of the foreskin in males. Observational studies have shown a correlation between MC and HIV prevalence, such that in areas with high MC prevalence (> 80%), HIV prevalence is generally lower (<10%) (Bailey et al, 2007). Subsequently, three well-designed randomized controlled trials have found MC to have a vaccine-level protective benefit in preventing HIV transmission through heterosexual intercourse (50-60% reduction in risk among males) (Bailey et al2007). In view of these findings, WHO and UNAIDS estimate that over 5.7 million HIV infections could be prevented by 2026 with scale up of male circumcision. Thus, WHO has recommended MC as an important prevention strategy in high HIV prevalence settings, and services are being scaled up widely in Southern Africa (WHO/UNAIDS 2007). Neonatal male circumcision is seen as a cheaper and more cost effective method of circumcision and the Zambian government plans that by the year 2020, 80% of all new born boys will be circumcised (Zambia National Male Circumcision policy 2009).Zambia will be one of the few countries using doctors, nurses, midwives and clinical officers to offer services, and we attempted to ascertain, if they are all given the same training, will they all produce surgically acceptable circumcisions. WHO recommends 3 devices for performing NMC; we looked at these devices among the aforementioned cadres and see if they produce surgically acceptable procedures among them. Objectives: To determine whether an acceptable surgical outcome can be achieved by any trained service provider using three NMC devices (Gomco, Plastibell, and Mogen).Method: This was a descriptive prospective study conducted on infants who were circumcised by the “Feasibility and Acceptability of Neonatal male circumcision study”. They came for review at 6 weeks post op and were examined a scoring system; looking at exposure of coronal Sulcus, maintenance of penile symmetry, and distance of wound from corona. The results were then analyzed. Results: More than 75% of our sample size had surgically acceptable male circumcisions, according to our criteria. The Gomco produced the most acceptable circumcisions with 94.1%. There was no clear difference in outcome among the different types of providers. Conclusion: We conclude that NMC can produce a surgically acceptable outcome whichever device used, but more so with a Gomco device. The health care professionals trained to do not have to have any previous surgical training, as long as they are adequately trained and supervised; we determine that NMC, as implemented in a clinical setting in Zambia, is a safe procedure, resulting in a surgically acceptable outcome.