Uganda tests new method of circumcision for infants

Saturday May 16 2015

By EVELYN LIRRI, TEA Special Correspondent

A non-surgical circumcision method for infants using a Gomco clamp is being tested under a pilot project in Uganda and will be available nationwide by the end of the year.

A Gomco clamp is a metal device with a bell-shaped end. During circumcision, the baby’s foreskin is stretched over the bell and the clamp is tightened over his skin. The skin cuts away and the clamp is removed a few minutes later.

The pilot project, funded by the Bill and Melinda Gates Foundation, is being undertaken in Rakai district in central Uganda. At least 200 infants between the age of 1and 59 days have already been circumcised, with an additional 300 expected to undergo the procedure by the end of July.

Currently, only adults are being circumcised using a non-surgical method called prepex, a medial device used to carry out non-surgical medical male circumcision for adults. The device comprises two rubber rings.

During circumcision, one ring is fixed inside the foreskin and the other outside to block blood from flowing to the foreskin. Gradually, this process removes the foreskin and the rings are removed after seven days. Infants and young children have to use the surgical method.

Dr Barbara Nanteza, the co-ordinator of the National Safe Male Circumcision Programme at Uganda’s Ministry of Health, said the non-surgical method for both infants and adults is cost-effective because it takes a short time to carry out, requires less expertise and manpower and uses minimum anaesthesia.

The Gomco clamp procedure, according to Dr Nanteza, takes between five and seven days to heal.

“We want to ensure every newborn baby boy is circumcised early in life as this will be a cheaper option in the long run,” said Dr Nanteza.

She added: “No donor wants to put money into circumcising children. So, at the moment, we are looking for a child-friendly donor who will take on the programme at the end of the pilot project,” she said.

Uganda’s medical male circumcision programme is largely funded under the US President’s Emergency Plan for Aids Relief.

Although the country’s Safe Male Circumcision Policy of 2010 states that children and adults can all benefit from the government’s free circumcision programme, the focus has largely been on those between the ages of 15 and 45. This is also the age group considered most at risk of HIV infection.

But Dr Nanteza said uptake of circumcision in the targeted age group remains low. “Our target was men who are between the ages of 15 and 40. Then we found that it was people younger than 15 who were coming for circumcision, so we decided to lower the age,” said Dr Nanteza.

Under the policy, the government set a target to circumcise up to 4.2 million men between 2010 and 2015. Figures from the Ministry of Health show that about 2.1 million have undergone the cut so far. At least 878,109 mostly young adolescents were circumcised in 2014 alone.

Circumcision has been widely favoured for the prevention of HIV/Aids in countries with generalised epidemics and where uptake remains low. This follows studies conducted in Uganda, South Africa and Kenya that showed that circumcision could reduce a man’s risk of contracting the HIV virus by about 60 per cent.

Health experts also say circumcision has a lot more benefits beyond reducing the risk of men contracting HIV/Aids. These include improved genital hygiene and reduced risk of cancers such as penile in men and cervical cancer in women.