Community Engagement to Reduce Tragic Circumcision Related Complications in the North Rift Region Kenya

BY

• Elijah Koros BSN, MSN-SADN Surgical Services MTRH
• Patrick Kimutai BSN-Nurse Manager Specialized Surgeries MTRH.
• Francis Kosgei BSN,KRPON-Clinical Nurse Educators MTRH Theatres.

​

Male Circumcision

• Circumcision is one of the most common non therapeutic surgeries performed among men globally.
• In Rift valley Kenya, nearly all boys undergo circumcision at the age of 13-19 years as a cultural rite of passage to adulthood.
• Like any other surgical procedure, it has been associated with several complications

Background

• In the last three years between November to January- increased incidence of post circumcision complications in the North Rift Counties of Uasin Gishu, Nandi and Elgeyo Marakwet.
• High number of hospitalizations of otherwise healthy young boys

(at the time of the project-35 admissions and 5 mortalities).

​

Trends of Post Circumcision cases admitted at MTRH

Age distribution for 2023 cases

Distribution per community (2023 cases)

Distribution per county/subcounty (2023 cases)

Common Clinical presentations

• Sepsis
• Cellulitis
• Respiratory distress
• Death
• Bleeding
• Hyperglycemia

​

Clinical presentations ct…

• Glans trauma
• Penile shaft trauma
• Tetany
• Trauma of lower limbs
• Scrotal cellulitis
• AKI
• IO, Anemia, Urethrocuteneous fistula, Iliopsoas abscess etc

​

NB: Some required critical care while others were even brought to the hospital dead. This necessitated the hospital to select a team to engage the community in possible mitigation measures to avert this crisis

​

Aim of the Project

• The project was aimed at reducing incidents of tragic complications of circumcision through community engagement:
• Through creating awareness across the two levels of Government on the post circumcision crisis
• By drumming up support in the counties on ending preventable deaths associated with post circumcision complications.
• By visiting the initiates at the seclusion sites and evaluating their health status and undertaking immediate appropriate intervention on the health concerns identified.
• To assess the perspectives of the community on the cultural practices of rite of passage vis a vis integration of safe medical procedures in both pre- and post-circumcision practices with regard to safety concerns of the initiate.

​

Methodology

• A team of culturally acceptable Healthcare workers was selected to undertake the assignment.
• The team held focussed group discussions with the County Government Health Leadership, National Government officers, Community opinion leaders and Initiates at the seclusion sites in three North Rift Counties.
• Observation

​

Findings on seclusion sites

• Young caretakers
• IPC during surgery ???
• Surgical instruments and consumables, sterility ???
• Potency of TT injected, ???
• Obvious physically and psychologically traumatized initiates

​

Findings ct..

• Many of the initiates needed urgent medical attention
• Minimal medical follow up Care after circumcision
• Delayed intervention in most cases
• Indiscriminate use of solutions; surgical spirit, povidone iodine, hydrogen peroxide, Dettol.
• Crowded seclusion sites

Findings ct…

• No investigation/screening at all before surgery
• Most of the surgeries were done by health workers , safe for few cases by traditional circumcisers.

General consensus by stakeholders

• Acceptance across the two levels of government on the post circumcision crisis in the region
• County and community support to end preventable deaths associated with post circumcision complications
• Close to 50% of initiates at the seclusion sites required medical attention due to varied health needs with most having septic surgical sites.
• Initiate community driven change on safe rites of passage and post circumcision safety.
• Acknowledgement by the community that they have a crisis and they need help.
• This ought not to be happening at such a time.

​

Recommendations

1. County Governments to formulate and implement a policy and legislative framework to govern circumcision practices.
2. Training and licensing of culturally acceptable circumcision practitioners
3. The attending circumcision practitioner to make regular review of initiates
4. Link each seclusion site to a healthcare worker in the nearest facility
5. Pre-circumcision screening for all candidates
6. Tetanus Toxoid must be administered in a health facility
7. Infection prevention and control
8. Further research on community practices leading to increased post circumcision complications

​

.

​

​

​

THANK YOU