Circumcision in various Nigerian and Kenyan Hospitals

Department of Surgery, College of Health Sciences, University of Nairobi, Kenya.
East African medical journal 11/1999; 76(10):583-6.
Source: PubMed


To present and evaluate circumcision practices in Nigerian and Kenyan Africans.
Continuous prospective study involving:- two hundred and forty-nine consecutive circumcisions performed from 1981 to 1998 and; fifty patients with post circumcision complications referred for further management during the same period.
Lagos University Teaching Hospital, Duro-Soleye Hospital and First Foundation Medical Centre in Lagos, Nigeria; and Kenyatta National Hospital, Mater Misericordiae and Nairobi Hospital in Nairobi, Kenya.
Males of all ages presenting for circumcision and males of all ages referred with post circumcision complications.
One hundred and fifty-two (61.04%) of circumcisions performed were in adolescents and young adults for cultural initiation into 'manhood'. The remaining seventy-nine (31.73%) neonates were circumcised for religious, parental, cultural and medical reasons. Eighty per cent of the patients referred with circumcision complications were initially circumcised by unqualified traditional "surgeons". One patient (2%) died from septicaemia; two patients (4%) lost their penis from gangrene and five other patients (10%) remained with permanent disability from complete or partial amputation of the penis or glans.
This study shows that circumcision is a commonly performed operation but can have serious, life shattering and prolonged complications sometimes resulting in death. It should therefore be performed only in medical institutions under sterile conditions and by suitably trained surgeons for specific medical indications. Ritual circumcision whether mass or single for cultural or religious reasons remains controversial without medical benefit and should be discouraged.

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    • "In addition, circumcision and its changing significances has been widely studied in relation to factors that link it to health complications, adverse health effects, socio-economic effects, pain, safety and lately the HIV threat (Crowley and Masner 1990, Aldeeb 1994, Mayatula and Mavundla 1997, Ahmed et al. 1999, Magoha 1999, Khalifa 2000, Bailey and Halperin 2000, USAIDS 2003, Mattelaer 2003, Darby 2003, Auvert 2005, Bailey and Egesah 2006, Westercamp and Bailey 2006, Bailey 2007, Gray 2007, WHO/UNAIDS 2007, Bailey, Egesah and Rosenberg 2008) among others. Further, studies indicate that religiosity is a key influence to the significance and function of circumcision (Aldeeb 1994, UNAIDS/CAPRISA 2007, Egesah 2009). "
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    ABSTRACT: Male circumcision is a common practice in many cultures. In Sub-Saharan Africa, it is practiced as a rite of passage performed around adolescence. In clinical settings, it is normally done as a quick outpatient procedure using local anaesthesia (USAID 2003). Despite some controversy, circumcision has been widely practiced in modern times and in most parts of Africa, Asia, Europe and America (Columbia Encyclopaedia 2004). In Sub-Saharan Africa, about two-thirds of men circumcise, while in Kenya male circumcision is practiced by over 80% of men including young Babukusu men in Western Kenya where this study was conducted (M.O.H Kenya 2007). This paper explores the significance of male circumcision and its redefinition in modern times positing that Babukusu have practiced male circumcision over time because its significances withstand modernity influences. The objective of the paper is to describe the relevance and significance this intangible cultural heritage plays in initiating Babukusu young men into adulthood despite challenges of modernity. The authors posit that the institution of male circumcision is highly regarded amongst Babukusu because it is stalked in initiating young males into adulthood, reason why it is practiced to date. What is the significance of male circumcision as its practice transforms from traditional to modern? A triangulated source of data was utilized from in-depth interviews, focus group discussions and semi structured questionnaire with Babukusu parents and boys before and soon after circumcisions. Both qualitative and quantitative data were obtained and analysed complementarily to provide the results of this study. The paper reports the ubiquity and significance of Babukusu male circumcision in initiating young boys into adulthood regardless of whether the process is traditional or clinical. In addition, it argues that modernity depicted by education, cost, health and religiosity do not vary the plethora of functions and importances assigned to male circumcision, but they influence shift in its practice from traditional to clinical processes. We conclude that male circumcision among Babukusu is an important, relevant and significant institution and we recommend cogent synergy between its traditional roles and modern influences.
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    • "When this happens, a portion of the glans may be excised with the ventral penile and frenular skin attached to it. This is the proposed mechanism of injury for the majority of our patients " [10] [13] [17]. The importance of releasing these adhesions dates to ancient times, including Old Testament citations. "
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    ABSTRACT: Objective: Glans injury during circumcision is an uncommon yet potentially devastating complication. Its mechanism remains poorly understood. Herein we critically evaluate a case series and, based on common characteristics, hypothesize the mechanism of injury as well as means to prevent it. Methods: Retrospective review of circumcision-related glans amputation cases referred for evaluation and management, focusing on detection of common history and presentation patterns in order to evaluate possible underlying mechanisms. Results: A neonatal elective circumcision was conducted using a Mogen clamp and an oblique injury to the ventro-lateral aspect of the glans was noted in 6 cases referred over a 5-year period, suggesting a similar trauma pattern. The urethra was consistently involved. The amputated segments were reattached as free composite grafts in 2/6 cases. Three patients underwent delayed glansplasty months after the trauma in an attempt to restore natural symmetry and cosmesis. In one case a buccal mucosa graft was employed to rebuild the ventral coronal sulcus. Conclusions: Trauma pattern suggests that the ventral glans is at high risk for injury by traction on incompletely released ventral preputial adhesions with subsequent glans entrapment. Practitioners performing neonatal circumcisions, particularly with a Mogen clamp, should exercise adequate release of ventral adhesions to prevent this complication.
    Journal of pediatric urology 11/2012; 9(6). DOI:10.1016/j.jpurol.2012.09.012 · 0.90 Impact Factor
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    • "Numerous accounts of complications from traditional male circumcision and initiation into manhood are available, but the rate of adverse events cannot be calculated because none of the reports include a denominator (Bailey et al., 2008). Research indicates many complications and even deaths due to traditional male circumcision (Mayatula and Mavundla, 1997; Magoha, 1999). Examples of these problems include: mutilations as a consequence of botched surgery, infection of circumcision wounds, gangrene of the penis, severe hemorrhage, respiratory infection, dehydration, penile amputation, delayed wound healing, insufficient skin removal, torture and assault resulting in serious injuries, disability or even deaths, and one circumcision instrument may be used for several initiates, leading to speculation that cases of wound sepsis, viral hepatitis B and HIV transmissions occur (Bailey et al., 2008; Crowley and Kesner, 1990; Du Toit and Villet, 1979; Gounden, 1990; Kanta, 2003; Marck, 1997; Mayatula and Mavundla, 1997; Mogotlane et al., 2004; Ngqaza, 1997; Peltzer, et al., 2008b). "
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    ABSTRACT: The aim of this study was to assess the safety of traditional male circumcision practices among Ndebele traditional surgeons following a five days training by direct observation of circumcision procedures. The sample included eight Ndebele traditional surgeons and traditional nurses and 86 initiates (abakhwetwa) from two districts in Gauteng province in South Africa. A structured observations tool was administered by a trained research doctor during circumcisions and (wound) care of the initiates of the trained traditional surgeons. Results indicate that from the observations of 86 traditional male circumcisions a high number (37%) of adverse events were recorded (excessive bleeding, excessive skin removed and damage to the penis) and in six cases the use of one instrument for the circumcision was observed. Before scaling up and/or considering integration traditional male circumcision services into medical male circumcision services in South Africa, a careful strategy to minimize unnecessary morbidity, and fundamental improvements on current traditional male circumcision techniques, are required. In addition, legislation and control of traditional male circumcision in Gauteng province, where the study took place, are recommended to make traditional male circumcision safer and to prevent adverse events to happen.
    African Journal of Traditional, Complementary and Alternative Medicines 01/2009; 7(2):153-9. DOI:10.4314/ajtcam.v7i2.50876 · 0.56 Impact Factor
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