Notat om omskæring af drenge - Sundhedsstyrelsen

Weiss et al. BMC Urology 2010, 10:2http://www.biomedcentral.com/1471-2490/10/2Page 11 of 13underway in some settings where male circumcision servicesare being expanded for HIV prevention. A set ofguidelines on expansion of male circumcision have beenproduced by WHO/UNAIDS, and include operationalguidance for scaling up male circumcision for HIV prevention,a surgical manual for male circumcision underlocal anaesthesia, guidance for decision-makers onhuman rights, ethical and legal considerations protocolsfor monitoring and evaluation [70].There is a clear need to improve safety of male circumcisionat all ages through improved training or retrainingfor both traditional and medically trained providers,and to ensure that providers have adequate suppliesof necessary equipment and instruments for safecircumcision. Strategies for training and quality assuranceare needed and will be context specific. In Swaziland,“Operation AB” demonstrated a comprehensivemodel of training teams of medical providers in safe andswift adolescent and adult circumcisions, with improvedsterilization equipment and clients’ education, at community-levelclinics [71] In Ghana, where neonatal circumcisionis almost universal, the formal Health Serviceprovides training to traditional providers in Accra, withtraining on basic hygiene and provision of necessaryequipment, such as sterile gloves and dressings [72]. InSouth Africa it has been suggested that communityhealth nurses create opportunities to educate traditionalcircumcisers of adolescents and adults on basic hygienerequirements to be met before, during and after circumcision[72], USAID/PATH/MSH have designed a trainingprogram in the Eastern Cape for training traditionalproviders about safe circumcision practices [73]. Linksbetween the formal and informal health sectors shouldbe explored elsewhere to institute quality standard practicesfor both traditional and medical circumcisers, forexample wearing sterile gloves, using sterile instrumentsand appropriate aftercare, and creating a formal structurethrough which to monitor and regulate the conductof circumcision. Through these steps, it is likely that thesafety of this common procedure can be substantiallyimproved.AbbreviationsGP: General Practitioner; RCT: Randomised controlled trials; UK: UnitedKingdom; UNAIDS: The Joint United Nations Programme on HIV/AIDS; USA:United States of America; WHO: World Health Organisation.AcknowledgementsWe are grateful to the Bill & Melinda Gates Foundation for funding thisresearch and providing funding for NL. HW was funded by the UK MedicalResearch Council.Author details1 MRC Tropical Epidemiology Group, Department of Epidemiology andPopulation Health, London School of Hygiene & Tropical Medicine, KeppelStreet, London WC1E 7HT, UK.2 Dept of Global Health and Population,Harvard School of Public Health, 665 Huntington St, Boston, MA, USA.3 TheJerusalem AIDS Project, 4 Eliezer Hagadol Street, Jerusalem 91072, Israel.Authors’ contributionsThe review was designed and conducted by HW and NL. The first draft ofthe paper was written by HW. IS and DH critically reviewed the manuscriptand approved the final version. All authors read and approved the finalversion of the paper.Competing interestsThe authors declare that they have no competing interests.Received: 13 July 2009Accepted: 16 February 2010 Published: 16 February 2010References1. WHO/UNAIDS: Male circumcision: global trends and determinants ofprevalence, safety and acceptability. World Health Organization 2008.2. Kaplan GW: Complications of circumcision. Urol Clin North Am 1983,10:543-549.3. Lerman SE, Liao JC: Neonatal circumcision. Pediatr Clin North Am 2001,48:1539-1557.4. Williams N, Kapila L: Complications of circumcision. Br J Surg 1993,80:1231-1236.5. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA: Newborn penile glansamputation during circumcision and successful reattachment. J Urol1995, 153:778-779.6. Shenfeld OZ, Ad-El D: [Penile reconstruction after complete glansamputation during ritual circumcision]. Harefuah 2000, 139:352-354, 407..7. Ahmed A, Mbibi NH, Dawam D, Kalayi GD: Complications of traditionalmale circumcision. Ann Trop Paediatr 1999, 19:113-117.8. Strimling BS: Partial amputation of glans penis during Mogen clampcircumcision. Pediatrics 1996, 97:906-907.9. Ben Chaim J, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y:Complications of circumcision in Israel: a one year multicenter survey. IsrMed Assoc J 2005, 7:368-370.10. Okeke LI, Asinobi AA, Ikuerowo OS: Epidemiology of complications ofmale circumcision in Ibadan, Nigeria. BMC Urol 2006, 6:21.11. al-Samarrai AY, Mofti AB, Crankson SJ, Jawad A, Haque K, al-Meshari A: Areview of a Plastibell device in neonatal circumcision in 2,000 instances.Surg Gynecol Obstet 1988, 167:341-343.12. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F,Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, et al: Malecircumcision for HIV prevention in men in Rakai, Uganda: a randomisedtrial. Lancet 2007, 369:657-666.13. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF,Campbell RT, Ndinya-Achola JO: Male circumcision for HIV prevention inyoung men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007,369:643-656.14. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A:Randomized, controlled intervention trial of male circumcision forreduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005, 2:e298.15. Hankins C: Implementation of male circumcision: what is the wayforward?. International Union Against Tuberculosis and Lung Disease 39thUnion World Conference on Lung Health Paris 2008.16. WHO/UNAIDS: New data on male circumcision and HIV prevention:Policy and programme implications: conclusions and recommendations.UNAIDS 2007.17. Muula AS, Prozesky HW, Mataya RH, Ikechebelu JI: Prevalence ofcomplications of male circumcision in Anglophone Africa: a systematicreview. BMC Urol 2007, 7:4.18. Wiswell TE, Tencer HL, Welch CA, Chamberlain JL: Circumcision in childrenbeyond the neonatal period. Pediatrics 1993, 92:791-793.19. Wiswell TE, Geschke DW: Risks from circumcision during the first monthof life compared with those for uncircumcised boys. Pediatrics 1989,83:1011-1015.20. Shittu OB, Shokunbi WA: Circumcision in haemophiliacs: the Nigerianexperience. Haemophilia 2001, 7:534-536.