Dr David Linyama UTH

1. Scaling-up male circumcision programmes in the Eastern and Southern Africa Region: Country update meeting Dr David Linyama UTH

2. CIRCUMCISION IN ZAMBIA • Circumcision rate estimated to be 16 %. • Most were done for religious and traditional reasons. • Moslems, Jews and some Christians circumcise for religious reasons. • Tribes in North Western part of the country do traditional circumcision. • Procedure carried out by health personnel and traditional practitioners. • Age at circumcision varies. Bowa et al 2006

3. History of Neonatal Male Circumcision (NMC) • Small populations circumcise in Zambia • No indigenous NMC • CIDRZ and UTH circumcision unit started a NMC service at UTH in November 2008. • Performed over 300 circumcisions in 18 months.

5. Acceptability of child circumcision, in Zambia

6. CIDRZ Centre for Infectious Disease Research in Zambia A collaboration between The University of Alabama at Birmingham and The Ministry of Health of Zambia. Mainly a research institution dealing in research such as ;maternal health, ART , Microbicides etc.

7. THE STUDY Title of study: Feasibility and acceptability of neonatal male circumcision at the University Teaching Hospital in Lusaka, Zambia and in the Lusaka District in Zambia using Gomco; Plastibell; and Mogen methods

8. A collaboration between CIDRZ and the Dept of Urology of the University Teaching Hospital. • Sponsored by CDC.

9. OBJECTIVES PRIMARY OBJECTIVES:  • Evaluate knowledge and attitudes about neonatal male circumcision among parents of newborn boys. • Determine the uptake of neonatal circumcision among parents of newborn boys who are offered the procedure . • Among providers who participate in a structured training program, evaluate knowledge and attitudes about neonatal male circumcision , and assess skill development and preferences related to three different surgical techniques.

10. SECONDARY OBJECTIVES: • Evaluate the number and severity of complications arising from the three different methods of neonatal male circumcision, comparing all methods to one another (assessed via documentation of adverse events). • Evaluate and document logistical difficulties which would occur with scale up of neonatal services at a tertiary care institution as well as at the primary care level. • Determine parental satisfaction with neonatal male circumcision.

11. STATUS • Started enrolling in October 2009. • Completed 1000 post partum questionnaires on parents knowledge and attitudes on NMC • Have completed 15 Focus Group Discussions on NMC. • Have trained 11 NMC providers (Diverse group) • Performed 240 NMC’s

12. CHALLENGES • Poor uptake by parents • Babies Confinement period • Some parents refuse to be randomized • Parents refusal to bring baby for post op visits • Poor uptake at large hospital as compared to local clinic • Poor understanding of NMC by community.

13. PLANS • To reach our target enrollment • On completion of the study continue supporting training in NMC • Support expansion of NMC services in Zambia. • Work on a model for sustainable NMC in Zambia • Advocate for NMC

14. Thank you