{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:55:17Z","timestamp":1772160917877,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,1,12]],"date-time":"2017-01-12T00:00:00Z","timestamp":1484179200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009660","name":"London School of Hygiene and Tropical Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009660","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001801","name":"University of Western Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001801","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Male circumcision services have expanded throughout Africa as part of a long\u2010term\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      prevention strategy. We assessed the effect of type of service provider (formal and informal) and hygiene practices on circumcision\u2010related morbidities in rural Ghana.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Population\u2010based, cross\u2010sectional study conducted between May and December 2012 involving 2850 circumcised infant males aged under 12 weeks. Multivariable logistic regression models were adjusted for maternal age, maternal education, income, birthweight and site of circumcision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2850 (90.7%) infant males were circumcised. Overall, the risk of experiencing a morbidity (defined as complications occurring during or after the circumcision procedure as reported by the primary caregiver) was 8.1% (230). Risk was not significantly increased if the circumcision was performed by informal providers (121, 7.2%)\n                      <jats:italic>vs<\/jats:italic>\n                      . formal health service providers (109, 9.8%) [adjusted odds ratio (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      ) 1.11, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      0.80\u20131.47,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.456]. Poor hygiene practices were associated with significantly increased risk of morbidity: no handwashing [148 (11.7%)] (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      1.78, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.27\u20132.52,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001); not cleaning circumcision instruments [174 (10.6%)] (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      1.80, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.27\u20132.54,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001); and uncleaned penile area [190 (10.0%)] (\n                      <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\n                      1.84, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.25\u20132.70,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The risk of morbidity after infant male circumcision in rural Ghana is high, chiefly due to poor hygiene practices. Governmental and non\u2010governmental organisations need to improve training of circumcision providers in hygiene practices in sub\u2010Saharan Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.12829","type":"journal-article","created":{"date-parts":[[2016,12,19]],"date-time":"2016-12-19T01:36:39Z","timestamp":1482111399000},"page":"312-322","source":"Crossref","is-referenced-by-count":6,"title":["Determinants of morbidity associated with infant male circumcision: community\u2010level population\u2010based study in rural Ghana"],"prefix":"10.1111","volume":"22","author":[{"given":"Thomas","family":"Gyan","sequence":"first","affiliation":[{"name":"School of Paediatrics and Child Health University of Western Australia Perth Australia"},{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberley","family":"McAuley","sequence":"additional","affiliation":[{"name":"School of Paediatrics and Child Health University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie A.","family":"Strobel","sequence":"additional","affiliation":[{"name":"School of Paediatrics and Child Health University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Shannon","sequence":"additional","affiliation":[{"name":"Engender Health New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam","family":"Newton","sequence":"additional","affiliation":[{"name":"School of Public Health Kwame Nkrumah University of Science and Technology Kumasi Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Tawiah\u2010Agyemang","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seeba","family":"Amenga\u2010Etego","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seth","family":"Owusu\u2010Agyei","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"},{"name":"Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betty","family":"Kirkwood","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen M.","family":"Edmond","sequence":"additional","affiliation":[{"name":"School of Paediatrics and Child Health University of Western Australia Perth Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,1,12]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2490-10-2"},{"key":"e_1_2_6_3_1","volume-title":"Neonatal and child male circumcision: a global review","author":"Weiss H","year":"2010"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/28.2.263"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.4236\/ojpm.2014.49083"},{"key":"e_1_2_6_6_1","volume-title":"Report on Neonatal, Infant and Pre\u2010pubertal Male Circumcision Practices in Traditional and Clinical Settings in Ghana","author":"World Health Organisation","year":"2008"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000109"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001509"},{"key":"e_1_2_6_9_1","volume-title":"WHO\/UNAIDS Technical Consultation on Male Circumcision and HIV Prevention: Research Implications for Policy and Programming. 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