Rakai Study Recommends Early Childhood Circumcision Top story


In short
Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen Clamp. It says early infant male circumcision services should be made available to parents who are interested in the service.

A new study by researchers at Rakai Health Sciences projects says Early Infant Male Circumcision (EIC), which helps to prevent HIV transmission later in life, can be safely performed in rural Uganda.
The trial was conducted in four health centres in the rural Rakai district of southwestern Uganda.

Dr. Edward Nelson Kankaka one of the researchers in a study published the BJU International says their  findings suggest registered nurse midwives could be a useful untapped resource for early infant circumcision in Uganda and similar settings.
Dr. Kankaka says the trials involved over five hundred infants who were circumcised by either trained clinical officers or registered nurse midwives following their mothers consent.
The rates of moderate/severe adverse events were 2.4 percent with surgeries by clinical officers and 1.6 percent with surgeries by registered nurse midwives.
All wounds according to Dr. Kankana were healed by four weeks post-circumcision. Maternal satisfaction with the procedure was 99.6 percent for infants circumcised by clinical officers and 100 percent among infants circumcised by registered nurse midwives.
One of the conclusions of the study is that Early Infant Male Circumcision was acceptable in Rakai and can be safely performed by registered nurses midwives who have direct contact with the mothers during pregnancy and delivery.
Ministry of Health's Safe Male Medical Male Circumcision Coordinator, Dr. Barbra Nanteza did not answer her phone when contacted about the latest findings.
She in May this year indicated that with support from UN Children's Fund (UNICEF), her ministry was piloting the roll out infant circumcision.
Dr. Nanteza said Early Infant Circumcision using the Mogen clamp had been tested in a number of districts and found acceptable. She said early infant circumcision would replace the current campaign targeting male adults for male circumcision as part of HIV prevention.   
Early Infant Male Circumcision according to health experts avoids the risk of premature resumption of sexual activity before complete wound healing observed in men after circumcision. They say it also provides protection from infant male urinary tract infections among others.
Early Infant Male Circumcision according to the Rakai study is technically simpler, safer, and less expensive compared to medical circumcision performed in older children or adults.
Although HIV prevention has been achieved through scale up of Medical Circumcision in adolescents and adults, long-term sustainability will likely be achieved through early infant circumcision.
Medical circumcision (MC) reduced HIV incidence in men by 50 - 60% in three randomised trials, and observational studies of men circumcised in infancy or childhood show long-term protection from HIV acquisition in adulthood.
Medical circumcision has been recommended by the Joint United Nations Programme on HIV/AIDS (UNAIDS), as a major component of HIV prevention strategies in 14 priority countries in East and Southern Africa with high rates of HIV and low prevalence of medical circumcision.