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Current Views, Level of Acceptance, and Practice of Male Circumcision in Africa Subregion Osarumwense D

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Current Views, Level of Acceptance, and Practice of Male Circumcision in Africa Subregion Osarumwense D Annals of Pediatric Surgery Vol 5, No 4, October 2009, PP 254-260 Original Article Current Views, Level of Acceptance, and Practice of Male Circumcision in Africa Subregion Osarumwense D. Osifo, Mike E.Ovueni Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria Background/Purpose: Circumcision is one of the oldest and perhaps the most controversial surgical procedures. It is yet to be determined whether criticisms and/or campaigns against male circumcision have had effects on Africans with a possibility of stopping the practice. Here we report the current views, level of acceptance and extent of involvement in male circumcision in an African subregion. Materials & Methods: A questionnaire survey conducted between April-July 2009 in an African subregion using Benin City, Nigeria, as a base. Results: Of a total 1055 standardized questionnaires distributed, 1051 (99.6%) were successfully completed and returned by respondents who were parents/caregivers aged 18-75 (mean 39 ± 3.4) years, comprising 402 males and 649 females, 1046 (99.5%) were resident in Africa. Their occupation ranged from trading 287 (27.3%) to artisan 13 (1.2%); with 495 (47.1%) having tertiary, 277 (26.4%) having secondary, 173 (16.5%) having primary and 106 (10.1%) having no formal education. Awareness of male circumcision (99.5%), cultural acceptance (95.3%), personal acceptance (95.8%), participation (83.9%), and preference for circumcised male (98.7%) were very high, with the majority (96.4%) against a ban on the practice, even though 7.7% were unaware of the reason for male circumcision. Awareness of circumcision related complications was high (64.9 %). These responses were not influenced by age, sex, educational status, occupation, culture, and place of residence (P = 0.4261) . Conclusion: Support for male circumcision was overwhelming. Providing and educating people on modern circumcision methods and encouraging hospital circumcision may be adopted to eliminate associated complications. Index Word: Male circumcision, Views, Acceptance, Practice, Africa subregion. INTRODUCTION ircumcision is one of the oldest surgical technique, and age at which circumcision should be C procedures and perhaps also, one of the most performed 3,4. Before the advent of western controversial 1,2. There are worldwide civilization in Africa, both male and female conflicting opinions on the acceptance, surgical circumcisions were practiced 5-7. Although there were --------------------------------------------------------------------------------------------------------------------------------------------------------------------- Correspondence to: OSIFO O.D. Pediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. E-mail: [email protected] Tel: 234-8033380188. Osifo OD et al outcry against female circumcision by both in the subregion. Africans residing abroad but on visit governmental and nongovernmental organizations to Africa were also included in the study. that led to its being abolished in many cultures, male A total 1055 standardized questionnaires with 20 circumcision is still accepted and generally practiced questions generated to obtain biodata and elicit by Africans irrespective of culture, educational status responses on currents views, level of acceptance, and place of residence. Few decades ago, the practice and general disposition towards male uncircumcised in traditional African culture was circumcision were distributed with the help of regarded as taboo, uncultured and uncivilized and research assistants to volunteer respondents. The was, therefore, treated with contempt 1,5-7. This made questionnaires were answered directly by learned but male circumcision remains an accepted practice by the indirectly through interpreter by unlearned literates and illiterates even after the advent of respondents. Unreturned and incompletely answered western civilization. Consequently, male circumcision questionnaires were excluded from analysis. is the most common surgical procedure performed by Statistical analysis: The data obtained were analyzed both orthodox and unorthodox healthcare providers using SPSS version 13 software package (SPSS, in Africa 1,2. Chicago, IL, USA) and presented in simple tables and Like other surgical procedures, however, male figures with continuous data expressed as means/SD circumcision is associated with many complications 8- while categorical data were analyzed using X2 test 12. Whereas minor complications such as redundant and a p-value <0.05 regarded as statistically prepuce, scarred penis and glandulopenile adhesions significant. may be accepted as normal because they do not interfere with sexual performance, glandular amputation, urethrocutaneous fistula, transmission of RESULTS infections and uncontrolled hemorrhage are unacceptable complications that brought into Of a total 1055 questionnaires distributed, 1051 questioning the rationale for male circumcision. (99.6%) were successfully completed and returned in Operative complications resulted in a tilt towards reasonably short time by very cooperative uncircumcision in many cultures, particularly in respondents. The respondents were parents and Europe where male circumcision is highly condemned caregivers of age range 18-75 (mean 39 ± 3.4) years, 3,8-10,13 . Whether criticisms and/or campaigns against comprising 402 males and 649 females, 1046 male circumcision has had effects on Africans respondents (99.5%) were resident in Africa while 5 resulting in a possibility of putting a stop to the (0.5%) were African visitors from Europe who practice is yet to be determined even though reports brought their male children home for circumcision 11,12,14-17 of associated complications abound . during the period. As shown in the bar and pie charts This survey was conducted to obtain current views (Figs. 1&2), all lawful occupations in African setting on male circumcision in a subregion of Africa and to ranging from trading 287 (27.3%) to artisan 13 (1.2%) determine the level of acceptance and extent of were represented, with 495 (47.1%) of the respondents involvement in the practice by the people. having tertiary, 277 (26.4%) having secondary, 173 (16.5%) having primary and 106 (10.1%) having no PATIENTS AND METHODS formal education. Table 1 shows the level of awareness (1046 respondents, 99.5%), participation This survey on male circumcision in Africa was (882 respondents, 83.9%), acceptance (1007 conducted between April and July 2009 using Benin respondents , 95.8%), and preference for circumcised City, Nigeria, as a reference base. Ethical approval male (1037 respondents , 98.7%) that were very high was granted by the University of Benin Teaching with no statistically significant differences observed in Hospital Local Ethics Committee and consent that met the responses elicited between sex, age groups, WHO-Helsinki declaration standard was duly educational status, occupation, culture, and place of obtained from respondents before commencement of residence of the respondents (P = 0.4261). survey. Only African caregivers and parents aged 18 Although the majority (682 respondents, 64.9%) were years and above were randomly selected across aware complications might be associated with male various tiers of educational level and lawful vocations circumcision and 911 respondents (86.7%) confirmed 255 Vol 5, No 4, October 2009 Osifo OD et al the need for post circumcision care, 1013 respondents healthcare providers 302 (28.7%). Similarly, more (96.4%) objected to a ban on male circumcision in circumcisions were performed in orthodox clinics and Africa because they saw it as part of life. A significant hospital 703 (66.9%) than homes and traditional proportion (81 respondents , 7.7%), even among those clinics 348 (33.1%). Respondents’ experience with post with tertiary education, were unaware of the reason circumcision complications was low, as 159 (15.1%) for male circumcision. Ritual, rite and initiation which have neither seen nor heard of it, but 505 Respondents still occur only among the rural dwellers were rare (48%) admitted to have heard of bleeding as a indications accounting for only 62 (5.9%) reason for common complication. Poor cosmetic results and male circumcision. Religious indication (in 532 glandular injuries were rarely admitted (2.1% and responces,50.6%) was the highest reason given, 1.2% respectively). Although 96 respondents (9.1%) followed by cultural 282 (26.8%) and medical 156 do not give any form of post circumcision care, (14.8%) reasons, as depicted in table 2. Neonatal 635 application of petroleum jelly was very common (60.4%) and infantile 370 (35.2%) circumcisions were (43.4%), followed by use of antibiotics (including commonly practiced while late childhood and topical application, 21.3%), dressing (17.8%) and other adulthood circumcisions were very rare. cares as shown in table 3. Doctors and nurses performed more circumcision 749 (71.3%) than paramedical staff and traditional Table 1: Level of awareness, acceptance, performance, and preference for male circumcision Variables Yes (%) No (%) Aware of circumcision? 1046 (99.5) 5 (0.5) Cultural acceptance? 1002 (95.3) 49 (4.7) Personal acceptance? 1007 (95.8) 40 (4.2) Personal Participation? 882 (83.9) 169 (16.1) Circumcision as part of rites/rituals? 62 (5.9) 989 (94.1) Aware of complications? 682 (64.9) 369 (35.1) Aware of post circumcision care? 911 (86.7) 140 (13.3) Preferred circumcised male? 1037 (98.7) 14 (1.3)
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