Dr. E. Odoyo-June

Early Infant male circumcision in Nyanza Province, Kenya

UNIM ProjectNyanza Reproductive Health Society

Kenya’s VMMC program is expanding towards initiating MC services for infants aged 0-60 days

A pilot infant MC project was initiated in Sep 2009 by NRHS under the auspices of the MCC –Mtoto Msafi

Service providers in public health facilities are trained and supported to provide infant MC using Mogen clamp

Uptake and safety are monitored through an inbuilt operational research to inform future roll out

Introduction

Why emphasize Early Infant Male Circumcision ?

Less technically challenging (no routine suturing)

Minimal bleeding Faster Less expensive Intervention before the

onset of sexual activity Rapid healing Lower complication rate

(studies from North America)

“Mtoto Msafi” Early infant MC Research

“Mtoto Msafi” Early infant MC Research?

Goals:

(1) Evaluate demand

(2) Learn about parental decision making around EIMC

(3) Assess safety

Parents (mothers and fathers) of 600 infants eligible for IMC -- 300 accepting and 300 refusing

Administer questionnaire Those in the circumcising group return for

review

Comparison of demographic characteristics among parents who choose and those who decline EIMC

Comparison of beliefs and attitudes about circumcision between the two groups

Frequency, severity and type of AEs encountered

Comparison of circumcision preferences of mothers to those of fathers

Outcomes of interest

Current status

•2 EIMC trainers certified

•33 Nurses and RCOs trained in EIMC and 11 certified

•Service provided at 1 Provincial and 3 District Hospitals

•Expansion to two additional health facilities planned

Summary data

Site Start Date EIMC’s Done Uptake (%)

NYANZA PGH Sep, 2009 253 14.6

KISUMU DH Oct, 2009 82 11.3

KOMBEWA DH

Nov, 2009 32 21.3

SIAYA DH Feb, 2010 11 6.8

381 Procedures performed by Mid May 2010

Total AEs= 5 (1.3%); 4 classified as mild intra operative bleeding and 1 involved post-operative bleeding

Infants seen for follow-up = 207 (54.3%)

Challenges

Relatively low uptake

Turn away infants aged greater than 60 days

Concerns regarding the timing and feasibility of rituals for infant MC

Poor compliance with instructions on follow up visit

desire for compensation by MOH staff for additional work

Mtoto Msafi research team led by Marisa YoungMale Circumcision consortiumNyanza provincial MC task forceMtoto Msafi Project StaffNyanza Provincial HospitalKisumu District HospitalKombewa District HospitalSiaya District HospitalStudy participants

Acknowledgements

Citations

EIMC is not widely practiced in Eastern and Southern Africa

IMC could be an acceptable HIV prevention strategy1

Factors influencing decision making around IMC and true acceptability of IMC in Sub-Saharan Africa not Known

AE rates reported in the literature vary widely (e.g. 3% and 20.2% from 2 separate studies in Nigeria alone)2,3

1Westercamp, N and RC Bailey. 2007. Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review. AIDS Behav 11:341–55

2Ahmed, A, NH Mbibi, D Dawan, et al. 1999. Complications of traditional male circumcision. Ann Trop Paediatr 19:113-17.

3Okeke, LI, AA Asinobi, OS Ikuerowo. 2006. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 6:21