Good Shepherd Catholic Hospital
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Male Circumcision

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Male Circumcision At GSH

AT Good Shepherd Mission Hospital male medical circumcision is voluntary (VMMC)

Service given is divided into two groups:

  1. Early Infant Male Circumcision (EIMC) from 1 day old to 8 weeks old
  2. Adult male circumcision from 10 years old upward.

EIMCIs is the surgical removal of the foreskin of the baby‘s penis.

ADVANTAGES OF EIMC

  • Faster healing
  • Less complications
  • Baby blood vessel smaller
  • Penis is less developed
  • Foreskin thinner
  • No sutures needed
  • Not complicated by erections
  • EIMC also avoids lost days from school and work, associated with circumcision done at later ages.
  • Active IEMC maximizes the benefits of circumcision by providing the procedure before the male becomes sexually active.

SCREENING

The screening procedure is done by a professional health (EIMC provider) for ensuring that if there is any doubt the baby is referred to a specialist.

HEALTH EDUCATION AND COUNSELLING

Before the  procedure parent are educated on the benefits and risks, how the procedure is done, health care after the procedure, follow up schedule and given an emergency number to call in case of need.

CONSENT

 Informed consent must be obtained before the procedure from the parents ( mother or father above 18 years)

EIMC will be only undertaken if the infant is healthy.

PHYSICAL EXAMINATION

A thoroughly health history from the parent and a thoroughly physical assessment will be done with a health care professional.

Who can be circumcised?

  • Were pregnancy and delivery normal
  • Not born premature (before 37 weeks)
  • Birth weight of 2,5 kg or more ( infant bellow 2,5 kg is not eligible for circumcision)
  • Infant should be in good health (eg: with no sign of Sepsis, Jaundice or Illness)
  • No family history of blood disorders.
  • Current age should be less than 8 weeks from birth.

BENEFITS OF EIMC

  • Reduced risk of HIV infection (60%) in the future
  • Easier to clean the penis
  • Reduced risk of some STIs (ulcerative)
  • Reduced risk of the penile cancer in the future
  • Reduced risk of urinary infection during childhood
  • Prevent risk of phimosis and paraphimosis
  • Reduced risk of cervical cancer among future female sexual partners.

 RISKS

  • Pain which can be minimized with the use of anaesthesia which is given local
  • Bleeding which is very rare with infant.

VMMC FOR ADORECSENT AND ADULT (FROM 10 YEARS AND ABOVE)

NB: VMMC SERVISE IS FREE OF CHARGE

ON ARRIVAL REGISTRATION IS DONE

CLIENT DEMOGRAPHICS; Name and Surname, ID number, date of birth and Age, cellphone number. Physical Address, and your relationship status.

MC GROUP EDUCATION

  • After registration clients if they are more than one a group counseling is done.
  • Group education is done on
  • Definition of male circumcision
  • Benefits and risks
  • The need for HIV counseling and testing
  • The need for screening for STIs
  • Need for TB screening using the national TB screening tool
  • Surgical procedure
  • Partial protection nature, need to maintain other HIV prevention practices
  • 6 weeks post operation abstinence period and post procedure care and management.
  • Client are grouped according to their age.

INDIVIDUAL COUNSELLING

  • A group counseling is followed by an individual counseling which is done in privacy where you discuss the importance of HIV testing and other personal concern.
  • CONSENT FOR VMMC AND HTC; Informed consent is obtained from those who are eligible to consent for themselves ( from 18 years and above) those under 18 years parent or legal guardian can sign for them.
  • After consenting HIV test is conducted.

IF NEGATIVE RESULT

  • Provide and explain result
  • Check for window period
  • Retest date after 2 months
  • Test partner
  • Abstinence / condom /reduce partners
  • Balanced Diet
  • Stress Reduction /Exercise /Rest
  • Avoid Alcohol and Drugs
  • Return anytime when there is a need to talk about.
  • IN CASE OF POSITIVE RESURT
  • Provide and explain result
  • Living with HIV
  • Disclosure
  • Blood test for CD4
  • Talk about ARV
  • Test partner
  • Treat OI’s
  • Drug Adherence
  • Test Partner and Children (Index clients)
  • Abstinence / condom/ Reduce Partners
  • Balanced Diet
  • Stress Reduction / Exercise /Rest
  • Avoid Alcohol and Drugs

Return anytime when there is a need to talk about.

NB: HIV testing and VMMC are both voluntary.

SCREENING FOR ELIGIBILITY

PHYSICAL EXAMINATION

Physical examination is done to rule out any condition which may interfere with   MC procedure so to be referred to a specialist.

 Example of things which are screened: Blood pressure, Temperature, Weight, Phimosis Penile Ulcers, Paraphimosis, Allergies, STI and many more.

Once discovered with a problem a client is referred to care specific to the problem he has for further management.

MC PROCEDURE

A local Anaesthesia is given to stop the pain, then the surgeon perform the procedure. Normal it takes 15 to 20 minutes.

After the procedure a client is observed for few minutes in a recovery place. Pain medication are given to take home and a free phone number is given to call in case of any abnormality observed at home.

FOLLOW UP

On the second day of the procedure the client has to come to the facility for removal of the bandage and review the progress of the healing. In case of need a transport is arranged. This is also done on the 7th day after the procedure.

ADVERSE EVENT

In case for any reason adverse event happens, a client will come to the hospital for management.  To those who are unable to come they will call the free number given and transport will be arranged.

CURRENTLY SINCE MARCH 2020 UP TO THIS JUNE 2020   DUE TO THE COVID-19 PRECAUTIONS, THE SERVICE IS ONLY GIVEN TO INFANT. SPECIAL FOR THOSE WHO’S MOTHERS COMES FOR DELIVERY AT GSH AND WISH TO CIRCUMCISE THEIR BABY BEFORE DISCHARGED, AND TO THOSE WHO COME FOR IMMUNATION.