Factors associated with the safety of voluntary medical male circumcision in Nyanza province, Kenya
Amy Herman-Roloff, Robert C Bailey & Kawango Agot
Volume 90, Number 10, October 2012, 773-781
Table 4. Factors associated with an adverse event following medical male circumcision, by surveillance system, Nyanza province, Kenya, 2008–2010
| Factor | Clinic system (n = 1 672) |
Active system (n = 1 449) |
|||||
|---|---|---|---|---|---|---|---|
| No. (%) | OR (95% CI) | aOR (95% CI) | No. (%) | OR (95% CI) | aOR (95% CI) | ||
| Age (years) | |||||||
| < 18 | 76 (4.6) | Ref | 1.1 (0.36–3.2) | 105 (7.3) | Ref | 0.88 (0.36–2.1) | |
| 18–24 | 1133 (67.8) | 0.9 (0.3–2.5) | Ref | 976 (67.4) | 1.4 (0.6–3.4) | Ref | |
| 25–34 | 345 (20.6) | 1.0 (0.3–3.2) | 289 (19.9) | 1.2 (0.5–3.1) | |||
| ≥ 35 | 118 (7.0) | 0.5 (0.1–2.2) | 79 (5.4) | 0.9 (0.2–3.2) | |||
| HIV status | |||||||
| Positive | 49 (2.9) | 1.3 (0.41–4.4) | – | 42 (2.9) | 0.61 (0.15–2.6) | – | |
| Negative and unknown | 1623 (97.1) | Ref | – | 1407 (97.1) | Ref | – | |
| Comorbidity at screening | |||||||
| Yes | 504 (30.1) | 1.2 (0.7–1.9) | – | 398 (27.5) | 1.1 (0.7–1.7) | – | |
| No | 1168 (69.9) | Ref | – | 1051 (72.5) | Ref | – | |
| MMC during high-volume month | |||||||
| Yes | 962 (57.5) | 1.2 (0.7–1.9) | 1.1 (0.67–1.8) | 791 (54.6) | 0.7 (0.5–1.1) | 0.62 (0.41–0.93) | |
| No | 710 (42.5) | Ref | Ref | 658 (45.4) | Ref | Ref | |
| Duration of procedure | |||||||
| Less than 25% IQR (< 14 minute) | 224 (13.4) | 0.3 (0.1–0.9) | 0.50 (0.17–1.4) | 290 (20.0) | 0.7 (0.4–1.2) | 0.96 (0.53–1.7) | |
| IQR (14–23 minute) | 976 (58.4) | Ref | Ref | 811 (56.0) | Ref | Ref | |
| More than 75% IQR (> 23 minute) | 472 (28.2) | 1.8 (1.1–2.9) | 1.3 (0.75–2.1) | 348 (24.0) | 1.4 (0.9–2.1) | 0.83 (0.51–1.4) | |
| Dose of local anaesthesia | |||||||
| ≥ 10 ml | 1083 (64.8) | 1.0 (0.6–1.7) | 0.86 (0.51–1.4) | 721 (49.8) | 2.0 (1.4–3.1) | 2.1 (1.4–3.4) | |
| ≤ 10 ml | 589 (35.2) | Ref | Ref | 728 (50.2) | Ref | Ref | |
| Cadre of MMC provider | |||||||
| Clinician (CO or MO) | 1178 (70.5) | 0.4 (0.3–0.7) | 0.60 (0.37–0.98) | 1010 (69.7) | 0.7 (0.5–1.0) | 0.75 (0.48–1.2) | |
| Nurse | 494 (29.5) | Ref | Ref | 439 (30.3) | Ref | Ref | |
| Employer of MMC provider | |||||||
| Government of Kenya | 198 (11.8) | 2.0 (1.1–3.5) | 1.1 (0.54–2.2) | 138 (9.5) | 2.2 (1.3–3.7) | 1.5 (0.81–2.9) | |
| Nyanza Reproductive Health Society | 1474 (88.2) | Ref | Ref | 1311 (90.5) | Ref | Ref | |
| Premature sexual activity (< 42 days after procedure) | |||||||
| Yes | – | – | – | 415 (28.6) | 1.0 (0.7–1.5) | – | |
| No | – | – | – | 1034 (71.4) | Ref | – | |
| Provider experience (No. of MMCs performed) | |||||||
| Level 1: 0–20 (Ref) | 497 (29.7) | Ref | Ref | 390 (26.9) | Ref | Ref | |
| Level 2: 21–100 | 649 (38.8) | 0.71 (0.43–1.16) | 0.89 (0.50–1.6) | 469 (32.4) | 0.58 (0.36–0.93) | 0.64 (0.37–1.1) | |
| Levels 3 & 4: 101–302 | 526 (31.5) | 0.26 (0.13–0.52) | 0.37 (0.17–0.81) | 590 (40.7) | 0.45 (0.28–0.73) | 0.61 (0.34–1.1) | |
aOR, adjusted odds ratio; CI, confidence interval; CO, clinical officer; IQR, interquartile range; HIV, human immunodeficiency virus; MMC, medical male circumcision; MO, medical officer; OR, odds ratio; Ref, reference.