An assessment of the training and practice of circumcision by medical circumcisers in Ghana

Abstract

Background: Circumcision is a common procedure in most parts of sub-Saharan Africa with an estimated prevalence of 95% in Ghana. It has been documented that most circumcision related injuries in Ghana occur after circumcision by health care professionals who perform these circumcisions in hospitals and other healthcare facilities. In spite of the high rates of circumcision in Ghana, the expertise of circumcision providers and the safety of their practice has not been assessed. This study evaluates the training and practice of circumcision by health care professionals from across the country. Methods: This is a questionnaire-based study of health care professionals who perform circumcision in Ghana. Data was extracted from pre-conference evaluation questionnaire completed by participants attending a circumcision training workshop from January to October 2019. These participants included responses on their training and practice of circumcision. Data was captured using the Epi-data software and analyzed with PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc. Results: There were 378 participants seen over the study period who already performed circumcision. The majority of them were midwives 281 (74.3%), followed by general nurses 89 (23.5%). The duration of practice of circumcision ranged from 4 months to 23 years and one-third of them (33.3%) had practiced circumcision for less than 1 year. The forceps guided technique was the most common (53.2%) circumcision technique used followed by the dorsal slit technique (24.1%). None of these participants who performed circumcision had any formal training on the procedure and all of them had experienced at least one adverse event such as excessive bleeding, insufficient skin coverage or redundant foreskin. Six (6) of them had seen patients who reported later with urethrocutaneous fistula and two of them had caused glans amputations. Only 102 (27%) of these participants offered anesthesia for circumcision. Conclusion: The majority of medical circumcisers in Ghana have no formal training for circumcision. They require formal circumcision training and certification to improve the practice of circumcision in Ghana.