Background: As countries in sub-Saharan Africa scale up medical male circumcision (MMC), they are considering long term sustainable strategies, including early infant male circumcision (EIMC). This study tests two models of integrating EIMC with existing maternal child health structures in Kenya.
Methods: A standard delivery package (SDP) included training health providers in four health facilities to deliver safe EIMC and all health facility staff to educate, promote and mobilize mothers in antenatal, maternal child health and immunization clinics and surrounding communities. A SDP-PLUS model included all SDP activities in four facilities plus provision of EIMC services in the community by trained domiciliary midwives. A weighted random sample of mothers over age 15 years bringing sons to facilities for OPV-1 were interviewed and, with motherĀ“s consent, fathers were contacted and interviewed. Parents whose sons were circumcised and not circumcised were compared on demographic variables, reasons for choosing or declining EIMC, involvement of spouse in the decision, and circumcision status of the father in univariate and multivariate analyses.
Results: Among 987 mothers, 255 (26%) had their sons circumcised. There were no differences between mothers who had their sons circumcised and those who did not in age (median=24 yrs), ethnic origin (96% Luo), primary reason for circumcising the baby (HIV/STI prevention) nor HIV status (30% positive). Mothers with post-secondary education (PR=1.5; 95%CI:1.1-2.1), who were unmarried (PR=1.6; 95%CI:1.3-2.0), received prior information about EIMC (PR=10.6;95%CI:3.5-32.6), had a circumcised husband (PR=1.7;95%CI:1.4-2.1), and were in the SDP-PLUS community (PR=1.3;95%CI:1.1-1.6) were more likely to have their son circumcised. In multivariable analyses, unmarried mothers (PR=1.5), those with circumcised husbands (PR=1.3) and those in the SDP-PLUS community (PR=1.3) were significantly (p< 0.01) more likely to have their sons circumcised. Among 634 fathers, after adjustment for age, marital status and education, those who were circumcised (PR=2.3;95%CI:1.8-2.9) and in the SDP-PLUS community (PR=1.3;95%CI:1.1-1.6) were more likely to have their sons circumcised.
Conclusions: A community-based versus facility-based education and services model results in greater uptake of EIMC. Acceptance of EIMC is likely to increase as more adult men in a population become circumcised. These results contribute evidence needed as countries transition from adult toward infant circumcision.