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Proportion of Early Infant Male Circumcisions (EIMCs) Performed Compared to Male Deliveries in Eight Pilot Sites in Iringa, Tanzania Augustino Hellar, AIDSFree, Jhpiego, Dar es Salaam, Tanzania; Kanisiusy Ngonyani, AIDSFree, Jhpiego, Iringa, Tanzania; Alice Christensen AIDSFree, Jhpiego, Dar es Salaam, Tanzania; Michael Machaku, AIDSFree, Jhpiego, Dar es Salaam, Tanzania; Thomas Maokola, AIDSFree, Jhpiego, Dar Es Salaam, Tanzania; Mary Drake, AIDSFree, Jhpiego, Dar Es Salaam, Tanzania; Abdallah Maganga, AIDSFree, Jhpiego, Iringa, Tanzania; Zebedee Mwandi, AIDSFree, Jhpiego, Nairobi, Kenya; Mariam Mohamed, Regional Health Authority, Iringa, Tanzania; Robert Salim, Regional Health Authority, Iringa, Tanzania; Gissenge Lija, Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC); Jeremiah Mushy, MOHCDGEC; Erick Mlanga, USAID, Dar Es Salaam, Tanzania Poster #PEC231 Background • Prevalence of male circumcisions in regions supported by AIDSFree project in Tanzania has surpassed 80%. • AIDSFree project is being implemented in Iringa, Njombe, and Tabora Regions. – In 2013, the project initiated early infant male circumcision (EIMC) services as a pilot in the Iringa Region. – Now, EIMC services are offered in Njombe and Tabora Regions. – In fiscal year 2017, EIMC services expanded to Morogoro and Singida Regions. • The initial EIMC pilot started in four health facilities, then expanded to include eight health facilities. – Of these facilities, five are hospitals, two are health centers, and one is a dispensary. – All provide labor and delivery services. • Lessons learned from the pilot are informing the scale-up of EIMC services in other regions of the country. Map of AIDSFree-Supported Regions in Tanzania AIDSFree VMMC regions Partners’ VMMC regions Non-VMMC regions Iringa Mwanza Simiyu Geita Tabora Singida Shinyanga Mara Arusha Manyara Kilimanjaro Dodoma Morogoro Pemba Zanziba DSM Tanga Pwani Lindi Ruvuma Mbeya Rukwa Katavi Kigoma Mtwara Kagera Njombe Table 1. Number of MCs in infants by facility, January–December 2016 Note: male circumcision (MC) Figure 1. Average number of MCs performed in infants per month, January–December 2016 Note: male circumcision (MC) Objective of Study in Iringa Region • Is AIDSFree Tanzania missing an opportunity to reach more infants through EIMC in the first few days after birth? EIMC • Circumcisions are performed on male infants aged 24 hours to 60 days by trained providers (clinicians and nurses working in antenatal clinic, labor room, and postnatal ward). • EIMC is integrated into reproductive, maternal, newborn, and child health services. • Demand creation for EIMC services occurs in antenatal and postnatal care clinics. Methods • We conducted a retrospective review of EIMC data and facility-based infant delivery statistics for males. • For the eight pilot EIMC sites, we analyzed the following data collected from January to December 2016: – Average number of male circumcisions (MC) – Average number of MCs performed in each facility over the same period – Age distribution of infants during circumcision – Geographic location of facility in which child was delivered Results • MC rates did not differ significantly by a health facility’s geographic location (see Table 1). • Iringa Regional Hospital had an average of 190 males delivered per month, but it had an average of performing only nine MCs per month in male infants (see Figure 1). • Ipogolo Health Center had an average of 27 males delivered per month, and it performed an average of 29 MCs per month in male infants (see Figure 2). – The two extra MCs were probably performed in male infants delivered in other facilities or at home. • Only 23% of the male infants were circumcised within the first 7 days after birth (see Figure 3). • Just over one-half of the male infants in this study were circumcised at the facility in which they were delivered (see Figure 4). This poster is made possible by the generous support of the American people through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) with the U.S. Agency for International Development (USAID) under the Cooperative Agreement Strengthening High Impact Interventions for an AIDS-free Generation, number AID-OAA-A-14-00046. The information provided does not necessarily reflect the views of USAID, PEPFAR, or the U.S. Government. Facility name Geographical location Number of MCs Proportion of MCs Frelimo Hospital Urban 128 10.0% Igumbilo Dispensary Urban 101 7.9% Ilula District Hospital Semiurban 232 18.1% Ipogolo Health Centre Urban 344 26.8% Iringa Referral Hospital Urban 105 8.2% Kidabaga Heath Centre Rural 95 7.4% Mafinga Hospital Urban 151 11.8% Tosamaganga District Hospital Urban 126 9.8% Total 1,282 100% 28% 25% 24% 23% = 7 days 8–21 days 22–36 days 37–60 days Figure 2. Average number of male deliveries per month, January– December 2016 Figure 3. Number of days old at circumcision Note: male circumcision (MC) Figure 4. Place of delivery Note: male circumcision (MC) Conclusion • There is a potential to increase uptake of EIMC in Iringa, especially in sites with a high volume of male births. • This analysis shows the need to improve demand creation efforts for EIMC services during antenatal and immediate postnatal care. • Geographic location or the care level of the facility in which the male was delivered may not affect the number of MCs performed. • There is a potential to reach more infants delivered in these facilities within the first week of birth. • EIMC services may represent a pathway to access health services for male infants delivered at home. 18% 55% 2% 25% Facility other than where MC occurred Facility where MC occurred Not indicated Home Parents receive education about EIMC services through the continuum of antenatal to postnatal care, thereby allowing them to make informed decisions for their sons. Photo by Alice Christensen and Hawa Mziray. 0 5 10 15 20 25 30 Frelimo Hospital Igumbilo Dispensary Ilula District Hospital Ipogolo Health Centre Iringa Referral Hospital Kidabaga Health Center Mafinga Hospital Tosamaganga District Hospital 11 8 19 29 9 8 13 11 Number of male deliveries Facility name 0 50 100 150 200 Frelimo Hospital Igumbilo Dispensary Ilula District Hospital Ipogolo Health Centre Iringa Referral Hospital Kidabaga Health Center Mafinga Hospital Tosamaganga District Hospital 43 7 96 27 190 5 76 42 Number of MCs Facility name
Transcript of 0(1&2342&5&'5(6*./157(!0)#408(1#4$+08(%#(/+,0(90,&:0&05...
Proportion of Early Infant Male Circumcisions (EIMCs) Performed Compared to Male Deliveries in Eight Pilot Sites in Iringa, Tanzania
Augustino Hellar, AIDSFree, Jhpiego, Dar es Salaam, Tanzania; Kanisiusy Ngonyani, AIDSFree, Jhpiego, Iringa, Tanzania; Alice Christensen AIDSFree, Jhpiego, Dar es Salaam, Tanzania; Michael Machaku, AIDSFree, Jhpiego, Dar es Salaam, Tanzania; Thomas Maokola, AIDSFree, Jhpiego, Dar Es Salaam, Tanzania; Mary Drake, AIDSFree, Jhpiego, Dar Es Salaam, Tanzania; Abdallah Maganga, AIDSFree, Jhpiego, Iringa, Tanzania; Zebedee Mwandi, AIDSFree, Jhpiego, Nairobi, Kenya; Mariam Mohamed, Regional Health Authority, Iringa, Tanzania; Robert Salim, Regional Health Authority, Iringa, Tanzania; Gissenge Lija, Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC); Jeremiah Mushy, MOHCDGEC; Erick Mlanga, USAID, Dar Es Salaam, Tanzania
Poster #PEC231
Background• Prevalence of male circumcisions in regions supported by AIDSFree
project in Tanzania has surpassed 80%.• AIDSFree project is being implemented in Iringa, Njombe, and Tabora
Regions.– In 2013, the project initiated early infant male circumcision (EIMC)
services as a pilot in the Iringa Region.– Now, EIMC services are offered in Njombe and Tabora Regions.– In fiscal year 2017, EIMC services expanded to Morogoro and Singida
Regions.• The initial EIMC pilot started in four health facilities, then expanded to
include eight health facilities.– Of these facilities, five are hospitals, two are health centers, and one is
a dispensary.– All provide labor and delivery services.
• Lessons learned from the pilot are informing the scale-up of EIMC services in other regions of the country.
Map of AIDSFree-Supported Regions in Tanzania
AIDSFree VMMC regions
Partners’ VMMC regions
Non-VMMC regions
Iringa
Mwanza
SimiyuGeita
Tabora
Singida
Shinyanga
Mara
Arusha
Manyara
Kilimanjaro
Dodoma
Morogoro
Pemba
Zanzibar
DSM
Tanga
Pwani
Lindi
Ruvuma
Mbeya
Rukwa
Katavi
Kigoma
Mtwara
Kagera
Njombe
Table 1. Number of MCs in infants by facility, January–December 2016
Note: male circumcision (MC)
Figure 1. Average number of MCs performed in infants per month, January–December 2016
Note: male circumcision (MC)
Objective of Study in Iringa Region• Is AIDSFree Tanzania missing an opportunity to reach more infants
through EIMC in the first few days after birth?
EIMC• Circumcisions are performed on male infants aged 24 hours to 60 days
by trained providers (clinicians and nurses working in antenatal clinic, labor room, and postnatal ward).
• EIMC is integrated into reproductive, maternal, newborn, and child health services.
• Demand creation for EIMC services occurs in antenatal and postnatal care clinics.
Methods• We conducted a retrospective review of EIMC data and facility-based
infant delivery statistics for males.• For the eight pilot EIMC sites, we analyzed the following data collected
from January to December 2016:– Average number of male circumcisions (MC)– Average number of MCs performed in each facility over the same
period– Age distribution of infants during circumcision– Geographic location of facility in which child was delivered
Results• MC rates did not differ significantly by a health facility’s geographic
location (see Table 1).• Iringa Regional Hospital had an average of 190 males delivered per
month, but it had an average of performing only nine MCs per month in male infants (see Figure 1).
• Ipogolo Health Center had an average of 27 males delivered per month, and it performed an average of 29 MCs per month in male infants (see Figure 2). – The two extra MCs were probably performed in male infants delivered
in other facilities or at home.• Only 23% of the male infants were circumcised within the first 7 days
after birth (see Figure 3).• Just over one-half of the male infants in this study were circumcised at
the facility in which they were delivered (see Figure 4).
This poster is made possible by the generous support of the American people through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) with the U.S. Agency for International Development (USAID) under the Cooperative Agreement Strengthening High Impact Interventions for an AIDS-free Generation, number AID-OAA-A-14-00046. The information provided does not necessarily reflect the views of USAID, PEPFAR, or the U.S. Government.
Facility name Geographical location
Number of MCs
Proportion of MCs
Frelimo Hospital Urban 128 10.0%Igumbilo Dispensary Urban 101 7.9%Ilula District Hospital Semiurban 232 18.1%Ipogolo Health Centre Urban 344 26.8%Iringa Referral Hospital Urban 105 8.2%Kidabaga Heath Centre Rural 95 7.4%Mafinga Hospital Urban 151 11.8%Tosamaganga District Hospital Urban 126 9.8%
Total 1,282 100%
28%
25% 24%
23%
= 7 days 8–21 days 22–36 days 37–60 days
Figure 2. Average number of male deliveries per month, January–December 2016
Figure 3. Number of days old at circumcision
Note: male circumcision (MC)
Figure 4. Place of delivery
Note: male circumcision (MC)
Conclusion• There is a potential to increase uptake of EIMC in Iringa, especially in sites
with a high volume of male births.• This analysis shows the need to improve demand creation efforts for EIMC
services during antenatal and immediate postnatal care.• Geographic location or the care level of the facility in which the male was
delivered may not affect the number of MCs performed.• There is a potential to reach more infants delivered in these facilities
within the first week of birth.• EIMC services may represent a pathway to access health services for male
infants delivered at home.
18%
55%
2%
25%
Facility other than where MC occurred
Facility where MC occurred
Not indicatedHome
Parents receive education about EIMC services through the continuum of antenatal to postnatal care, thereby allowing them to make informed decisions for their sons. Photo by Alice Christensen and Hawa Mziray.
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