1. Scaling-up male circumcision programmes in the Eastern and Southern Africa Region: Country update meeting Dr David Linyama UTH

2. CIRCUMCISION IN ZAMBIA Circumcision rate estimated to be 16 %. Most were done for religious and traditional reasons. Moslems, Jews and some Christians circumcise for religious reasons. Tribes in North Western part of the country do traditional circumcision. Procedure carried out by health personnel and traditional practitioners. Age at circumcision varies. Bowa et al 2006

3. History of Neonatal Male Circumcision (NMC) Small populations circumcise in Zambia No indigenous NMC CIDRZ and UTH circumcision unit started a NMC service at UTH in November 2008. Performed over 300 circumcisions in 18 months.

5. Acceptability of child circumcision, in Zambia

6. CIDRZ Centre for Infectious Disease Research in Zambia A collaboration between The University of Alabama at Birmingham and The Ministry of Health of Zambia. Mainly a research institution dealing in research such as ;maternal health, ART, Microbicides etc.

7. THE STUDY Title of study: Feasibility and acceptability of neonatal male circumcision at the University Teaching Hospital in Lusaka, Zambia and in the Lusaka District in Zambia using Gomco; Plastibell; and Mogen methods

8. A collaboration between CIDRZ and the Dept of Urology of the University Teaching Hospital. Sponsored by CDC.

9. OBJECTIVES PRIMARY OBJECTIVES: Evaluate knowledge and attitudes about neonatal male circumcision among parents of newborn boys. Determine the uptake of neonatal circumcision among parents of newborn boys who are offered the procedure. Among providers who participate in a structured training program, evaluate knowledge and attitudes about neonatal male circumcision, and assess skill development and preferences related to three different surgical techniques.

10. SECONDARY OBJECTIVES: Evaluate the number and severity of complications arising from the three different methods of neonatal male circumcision, comparing all methods to one another (assessed via documentation of adverse events). Evaluate and document logistical difficulties which would occur with scale up of neonatal services at a tertiary care institution as well as at the primary care level. Determine parental satisfaction with neonatal male circumcision.

11. STATUS Started enrolling in October 2009. Completed 1000 post partum questionnaires on parents knowledge and attitudes on NMC Have completed 15 Focus Group Discussions on NMC. Have trained 11 NMC providers (Diverse group) Performed 240 NMC’s

12. CHALLENGES Poor uptake by parents Babies Confinement period Some parents refuse to be randomized Parents refusal to bring baby for post op visits Poor uptake at large hospital as compared to local clinic Poor understanding of NMC by community.

13. PLANS To reach our target enrollment On completion of the study continue supporting training in NMC Support expansion of NMC services in Zambia. Work on a model for sustainable NMC in Zambia Advocate for NMC

14. Thank you