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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Evaluation of the safety and efficiency of the dorsal slit and sleeve methods of male circumcision provided by physicians and clinical officers in Rakai, Uganda
BJU International, Volume 109, No. 1, Year 2012
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Description
Objective: • To assess the safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers (COs). Patients and Methods: • We evaluated the time required for the MC procedure (efficiency) and moderate/severe adverse events (AEs) for MC (safety) by trained physicians and COs using the sleeve and dorsal slit MC methods in a service programme. • Univariate and multiple regressions with robust variance estimation were used to assess factors associated with operative duration (linear) and AEs (logistic). Results: • Six physicians and eight COs conducted 1934 and 3218 MCs, respectively; there were 2471 dorsal slit and 2681 sleeve MC procedures. The overall mean operative duration was 33 min for newly trained providers, whichdecreased to ≈20 min after ≈100 MCs. • The adjusted mean operative duration for dorsal slit MC was significantly shorter than that for the sleeve MC method (Δ- 2.7 min, P < 0.001). • The operative duration was longer for COs than physicians for the sleeve procedure, but not the dorsal slit procedure; however this difference reduced with increasing numbers of MCs completed. • The unadjusted AE rates were 0.6% for dorsal slit MC and 1.4% for the sleeve method (P= 0.006) and 1.5% for physicians and 0.68% for COs (P= 0.003); however, there were no significant differences after multivariate adjustment. • Use of bipolar cautery significantly reduced operative duration (Δ- 4.0 min, P= 0.008), but was associated with higher AE rates (adjusted odds ratio 2.13, 95% confidence interval 1.26-3.61, P= 0.005). Conclusion • The dorsal slit MC method is faster than sleeve resection, and can be safely performed by non-physicians; however, use of bipolar cautery may be inadvisable in this setting. © 2011 The Authors.
Authors & Co-Authors
Buwembo, Dennis Rogers
Uganda, Kalisizo
Rakai Health Sciences Program
Musoke, Richard M.
Uganda, Kalisizo
Rakai Health Sciences Program
Kigozi, Godfrey G.
Uganda, Kalisizo
Rakai Health Sciences Program
Ssempijja, Victor
Uganda, Kalisizo
Rakai Health Sciences Program
Serwadda, David Musoke
Uganda, Kampala
Makerere University
Makumbi, Fredrick Edward
Uganda, Kampala
Makerere University
Watya, Stephen
Uganda, Kampala
Mulago Hospital
Uganda, Kampala
School of Medicine
Namuguzi, Dan
Uganda, Kalisizo
Rakai Health Sciences Program
Nalugoda, Fred Kakaire
Uganda, Kampala
Makerere University
Kiwanuka, Noah
Uganda, Kampala
School of Medicine
Sewankambo, Nelson K.
Uganda, Kampala
School of Medicine
Wabwire-Mangen, Fred
Uganda, Kampala
Makerere University
Kiggundu, Valerian L.
Uganda, Kalisizo
Rakai Health Sciences Program
Wawer, Maria J.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Gray, Ronald H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Statistics
Citations: 31
Authors: 15
Affiliations: 5
Identifiers
Doi:
10.1111/j.1464-410X.2011.10259.x
ISSN:
14644096
e-ISSN:
1464410X
Research Areas
Mental Health
Study Design
Case-Control Study
Study Locations
Uganda
Participants Gender
Male