impact of male circumcision in chitungwiza
TRANSCRIPT
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CHAPTER I: INTRODUCTION
1.1 Introduction
One of the possible answers to the global pandemic of HIV is male circumcision. Malecircumcision is the removal of the foreskin. It is one of the oldest and commonest
surgical procedures worldwide (Weiss, uigle! " Ha!es, #$$$, p. #%&', undertaken for
man! reasons including religious, cultural, social and medical ()rain, Halperin, Hughes,
*lausner " +aile!, #$$&, p.'#. In adult men, a four to si- weeks period is reuired to
full! heal the wound. Healing is usuall! complete after a week when circumcision is
performed in babies (/lank " Makhema, #$$0. 1emoving the foreskin is associated with
a number of health benefits that include better penile h!giene, prevention of balanitis and
prosthitis, lower risk of se-uall! transmitted diseases especiall! ulcerative diseases such
as chancroid and s!philis, reduced risk of penile cancer and reduced risk of cervical
cancer in female partners of circumcised men ()rain et al, #$$&.
Male circumcision reduces the risk of HIV transmission b! 2$3&$4 (WHO, #$''.
Higher levels of se-uall! transmitted infections, including HIV seen in uncircumcised
men is that the inner mucosal surface of the foreskin is onl! thinl! keratini5ed and
therefore susceptible to minor trauma and abrasions that facilitate entr! of pathogens
(Hussain " 6ehner, '007, p. 273282. 9he area under the foreskin is moist and warm,
providing a microenvironment that facilitates the multiplication of pathogens, especiall!
when penile h!giene is poor (Hussain " 6ehner, '007, p. 273282. :urther, the
increased risk of HIV infection in uncircumcised men is believed to be due to increased
risk of genital ulcer diseases as well as the superficial location of HIV ; ' target cells
(
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can occur. 9he surger! can lead to e-cessive bleeding, hematoma and other
complications in initial months after the procedure. In addition adverse reactions to the
anesthetic used during the circumcision ma! occur. 9hus trained personnel and correct
euipment and aseptic conditions are necessar! for proper circumcision (1ain39al>aard,
6agarde, 9al>aard,
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is &$ percenteffective in reducing HIV incidence. 9he trials were done at Orange :arm in
Bouth ?frica (semi3urban 1akai, @ganda (rural and *isumu, *en!a (urban. (?uvert,
9al>aard, 6agarde, Bobngwi39ambekou et al, #$$7F +aile!, Moses, /arker, ?got et al.,
#$$F Gra!, *igo5i, Berwadda, Makumbi et al, #$$ 9he removal of the foreskin
reduces ones susceptibilit! to HIV acuisition.
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have been erected. Mobile clinic and clinic in bo- have been purchasedF adeuate
supplies have been purchased. However, despite all these inputs the number of men
circumcised is lagging behind set targets.
In areas where circumcision is common, HIV prevalence tends to be lower, and
conversel! areas of higher HIV prevalence overlapped with region where M< is not
commonl! practiced (AI?)DAH #$$&.
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1.* #&eci%ic o'+ecti,e
9o assess the level of knowledge of both male and female in Beke district, ward % on
male circumcision as a strateg! of preventing HIV acuisition in males.
9o establish the acceptabilit! of male circumcision b! residence of ward %, Beke
)istrict
1.- Reearch uetion
How much knowledge do people have on circumcision as an HIV preventative
strateg!
What level of acceptance do people in Beke district ward % have on male circumcision
1./ #igni%icance o% tud!
?t a global level, the research contributes towards the achievement of Millennium
)evelopment Goal number si-, which seeks to combat HIV and ?I)B, malaria and other
epidemic diseases. Male circumcision reduces the chances of acuiring HIV through
vaginal se-ual intercourse. +esides this, it has other advantages, such as being h!gienic
and reducing the chances of cervical cancer in women with circumcised partners. It
appears there isnEt enough information about the knowledge, perceptions and
acceptabilit! of male circumcision b! residents of ward %, of Beke district and even other
groups of people in the countr! for the strateg! to give desirable results of eliminating
high levels of HIV prevalence rate. 9his stud! seeks to enrich the bank of information on
the sub>ect in the countr!. ?part from this, the results would also be useful to planning
agents, both governmental and non3governmental organi5ations since HIV and ?I)B has
become a developmental issue. Beke 1ural Home +ased
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9he researcher decided to carr! out the stud! in Beke district in ward % because the area
is semi3urban all rural and urban practices e-ists and therefore the stud! will be of use in
both set3ups and the research results would be representative of both set3ups also the area
is made up of diverse traditionsD cultures and practices at one place making a good
representation of the cultures that are practiced in the countr!. Information about peopleEs
understanding in the countr! could be obtained from ward % residents. +ased on the
above considerations the researcher thought it >ustified to conduct the stud! in ward %
where residents became participants.
Male circumcision is not onl! of obvious interest to polic! makers in view of the scale of
human, social and financial resources involved. It has also aroused considerable public
curiosit!, enthusiasm and concern as a result of the sheer si5e of the programmes to
promote male circumcision. 9he results from this stud! might also have a wider
application be!ond the immediate stud! area.
1.0 De(i$itation
9he stud! sample in this research was in Mashonaland ast province in Beke district
confined to *unaka and Marikopo villages in ward three. Males and females between the
age groups '7320 were the target population. 9he stud! focused mainl! on knowledge
and acceptabilit! of male circumcision as an HIV prevention strateg!. ? clinical
procedure of doing the male circumcision surger! was be!ond the scope of this research.
1. Organiation o% the tud!
9he organisation of the stud! is the structure of the research pro>ect. It outlines the steps
that are going to be taken b! the researcher in the stud!. 9he structure of the stud! will be
divided into five chapters as followsJ
ectives of the researchF research uestionsF
significance of stud! and delimitations of the stud!.
&
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Barrier to 4CJ
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Pre,a(ence rate: 9he total number of cases of a diseases e-isting in a population
divided b! the total population. Bo if a measurement of HIV
positive is taken in a population of 2$ $$$ people and ' #$$ were
recentl! diagnosed to be HIV positive and % 7$$ are living with
HIV, then the prevalence of HIV is $,''8 or '',7$ per '$$ $$$.
( Westercamp, Aelli and 1. +ailel! #$$
1.11 Conc(uion
9he chapter introduced the topic then discussed the background to the stud!, statement of
the problem, aim of the research, ob>ectives of the research, research uestions,
significance of the stud!, delimitations of the stud!, organi5ation of the stud! and
conclusion
0
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CHAPTER 2:7ITERATURE RE6IE8
2.1 Introduction
In this chapter the researcher reviews literature on studies conducted b! different authors
on knowledge of the benefits of male circumcision, peopleEs perception of male
circumcision and acceptabilit! of the procedure.
2.2 The Dee&9rooted Cu(ture o% 4a(e Circu$ciion
Male circumcision is a surgical procedure during which all or part of the foreskin (the
fold of skin covering the head of the penis is removed b! making a surgical cut around
the head of the penis (
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discuss its use to punish, hurt others, and to cure ailments and made3up diseases (#$$.
9he same review also describes male circumcision from a political perspective when it
was used during Aa5i German! and the ?rmenian genocide to impose power and social
order over others (?ggleton and 9homas, #$$. )uring these times, circumcision status
was often used as a means to determine if someone would be condemned to death or
allowed to live. Males of all ages were forcibl! circumcised during the ?rmenian
genocide while torture and death were often the conseuences for those who were
uncircumcised in Aa5i German! and during the Ottoman and Moorish mpires (?ggleton
and 9homas, #$$.
In Bub3Baharan ?frica, where #8 of 27 countries e-ceed 8$4 of male circumcision
prevalence, circumcision is carried out for cultural reasons (WHO, #$$0, &3'7. It can
s!mboli5e movement into manhood, masculinit!, initiation rites, a blood sacrifice to the
ancestors of the earth, or it ma! be used as a social construct to engage in relationships
with women (/aise, '08F WHO, #$$0, &3'7.
?ccording to Winkel (#$$7, the ?merican medical establishment has promoted male
circumcision as a preventative measure for an astonishing arra! of pathologies, ranging
from masturbator! insanit!, moral la-it!, aesthetics and h!giene, to headache,
tuberculosis, rheumatism, h!drocephalus, epileps!, paral!sis, alcoholism,
nearsightedness, rectal prolapse, hernia, gout, clubfoot, urinar! tract infection, and cancer
of the penis, cancer of the cervi-, s!philis and ?I)B. On medical grounds, male
circumcision can be recommended if one has in>ur! or anomalies of the foreskin and if
one continues to suffer from infections.
?cross different populations, the preferred age for circumcision varies with ethnicit! and
religious beliefs. In Kudaic societies, the ritual is performed on the eighth da! after birth,
but for Muslims, there is no clearl! prescribed age for circumcision (1i5vi et al., '000.
:or man! tribal cultures in ?frica, M< is performed in earl! adult life as a rite of
passageN or a shift to pubert!, adulthood or marriage ()o!le, #$$7F )unsmuir " Goldon,
''
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'000F Marck, '00. :or e-ample the hosa tribe of Bouth ?frica and the Masai tribe of
*en!a value M< practice as a wa! to show their attainment of manhood ()o!le, #$$7.
In areas where circumcision is common, HIV prevalence tends to be lower, conversel!,
areas of higher HIV prevalence overlapped with region where male circumcision is not
commonl! practiced (AI?)DAH #$$&.
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that occurred under coloni5ation. :or e-ample, in
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Mac6eod, dwards " +ouchier (#$$ argue that, male circumcision reduces the risk of
HIV infection as the removal of the foreskin reduces the abilit! of HIV to penetrate the
skin of the penis. On the underside of the foreskin are located man! special
immunological cells, such as 6angerhans cells which are prime targets for HIV.
6angerhans cells have been found at high densities in the inner but not the outer mucosal
surface of the foreskin (ibid, #$$. 6angerhans cells, which generall! aid in immune
responses to invading pathogens can bind HIV at a specific receptor site and deliver it to
the l!mph nodes. 9he HIV will then proliferate throughout the bod!. 9hese make the
inner surface of the foreskin highl! susceptible to HIV infection compared with the outer
keratini5ed surface of circumcised penis.
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ig 2.2: Ph!io(og! o% circu$cied and uncircu$cied &eni
#ource:www.healthinfotranslations.org
)uring heterose-ual se-ual intercourse, HIV has three main pathwa!s of crossing over
the mucosal epithelium. 9he first pathwa! involves the trans3epithelial migration of
langerhans cells that have >ust been infected with HIV. 9he virus ma! infect the host b! a
second pathwa! in which it penetrates across the epithelium into the lamina propria.
6astl!, the virus ma! undergo transc!tosis b! the epithelial cells that it comes into
contact with (*awamura, et al, #$$7. 9his can be illustrated in figure #.% below.
I
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?nother plus of M< is that it can be carried out over a wide age range and it is a one3off
intervention conferring lifelong reduced biological risk. One of the beauties of
circumcision is that it is a one3off operation which takes '&3#$ minutes but then has a
profound effect on the rest of a manEs life (+aile! #$$&. It seems biologicall! plausible
that, as long as it occurs before HIV e-posure and after full wound healing, circumcision
would offer the same degree of protection against HIV and B9Is regardless of the age
(+aile! et al, #$$'.
.
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getting genital ulcerative diseases and causing bacterial vaginosis in women (/opulation
services international, #$'#
2.* Diad,antage o% 4a(e Circu$ciion
9he following are some of the disadvantages of male circumcision as viewed b!
Mac6eod, dwards " +ouchier (#$$F Male circumcision can be seen as a violation of
human rights, particularl! if carried out on children or adolescents. Male circumcision
does not provide complete protection against HIV as it onl! offers between 7$ and &$
percent protection. Men can develop a false perception of complete protection against
HIV and engage in risk! se-ual behavior without protection.
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9he above cannot be compared with what happens in the developing world, especiall! in
?frica where there is a high number of traditional circumcisers who conduct the
procedure in unsafe conditions. +aile! et al (#$$& found that, traditional circumcision in
*en!a resulted in a complication rate of %74.
? stud! conducted in 9urke! b! +aile! et al in #$$' found out that circumcisions done
b! traditional circumcisers accounted for 874 of all those involving complications, and
004 of those that were >udged serious, which included profuse bleeding, serious
infection, secondar! phimosis, meatal stenosis, and even penile amputation.
In order to minimi5e the risks associated with male circumcision, WHO, @A:/?,
@AIoint
statement in which the! stated that, countries or health care institutions which decide to
offer male circumcision more widel! as an additional wa! to protect against HIV
infection must ensure that, it is performed safel! b! well3trained practitioners in sanitar!
settings under conditions of informed consent, confidentialit!, risk reduction counseling
and safet!. WHO produced a technical manual, Male circumcision under local
anesthesiaN, which addresses the provision of safe male circumcision services for
newborns, adolescents and adults and gives detailed technical information on the
different surgical approaches.
2.- =no;(edge o% $edica( 'ene%it o% $a(e circu$ciion
In studies of acceptabilit! of male circumcision conducted in *en!a and @ganda b!
+aile! and colleagues (#$$7, a sample of adult women reported that, the! would prefer a
circumcised partner for reasons of cleanliness and reduced chances of infection. ight!
eight percent of the same women said that the! would prefer to have their sons
circumcised. 9his shows that the women had knowledge of the benefits of male
circumcision, thus the! consented to the procedure to be done on their children and
preferred it on their partners.
'8
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In another stud! in Cambia entitled, ?cceptabilit! of male circumcision for prevention
of HIV infection in CambiaN the participants showed a lot of interest in more information
on the benefits of male circumcision. 9he author of the stud! wroteF :ocus group
discussion participants were interested in more informationN. Aearl! all of the
participants in non3circumcising districts reported that the! would take their sons to a
health facilit! to be circumcised, if the! were educated on the advantages and
disadvantages of male circumcision (+aile! " 6ukobo, #$$. 9his shows that, the
people did not have enough knowledge about male circumcision. 9heir acceptabilit! of
the procedure depended on their knowledge of the benefits of the procedure. 9here was
need for health promotion programmes on the benefits of male circumcision.
1oger Bhapiro et al (#$$' conducted a cross3sectional surve! stud! with &$7 men and
women aged '8!ears and above in various geographic and ethnicall! representative
location throughout +otswana. 9he surve! consisted of a baseline uestionnaire followed
b! an informational session on the potential risks and benefits of male circumcision. ?
second set of uestions was administered following the informational session. Aot all the
participants in the stud! knew about the medical benefits of male circumcision. Initiall!
some stated that the! would not favor circumcision for themselves or their children.
However, some members in this cohort changed their minds after an informational
session on the benefits of male circumcision was conducted. +efore the informational
session, 2$8 (&84 responded that the! would definitel! or probabl! circumcise a male
child if circumcision was offered free of charge in a hospital settingF this number
increased to 72# (804 after the informational session. 9his shows that, some of the
stud! participants denied the procedure without full information on its medical benefits.
:ollowing an informational session about male circumcision, an even larger proportion of
participants stated that the! would definitel! or probabl! circumcise a male child, and a
greater number of women stated that the! would prefer to have a circumcised partner
(Bhapiro et al, #$$'. 9hus there is need to educate and re3educate people on the benefits
of male circumcision.
'0
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:rit5, Halperin " Woelk (#$$$, conducted a surve! in a Harare beer hall with #$$
randoml! selected men to assess the attitude regarding potential introduction of male
circumcision in Harare. ight! nine (80 men offered various health3related factors
associated with male circumcision. 9went! three mentioned that male circumcision is
considered h!gienic or smarter than un3circumcisedF while && said that it reduces the
likelihood of infections, including B9Is. Onl! & mentioned something on HIV that male
circumcision helps prevent B9IsDHIV infection, or that male circumcision can spread HIV
through the sharing of blades. 9his shows that ver! few men had knowledge of the
protective effect of male circumcision against HIV with si- men onl! mentioning
something on HIV. Aot all of the si- men had knowledge of the protective effect of male
circumcision against HIV sinceF some stated that there was a possibilit! of acuiring HIV
from the procedure if instruments are shared and not of the protective effect of the
procedure. 9his could be one reason wh! some people would not accept to be
circumcised.
)ube, Kanuar! " Bhamu (#$$& from the @niversit! of Cimbabwe Perce&tion on $a(e circu$ciion
+aile! " 6ukobo (#$$ conducted a stud! in Cambia, in which focus group discussion
were held with urban and rural men to assess male circumcision practices, opinions, and
acceptabilit! among married and unmarried men ages '8 to %0. 9he stud! sub>ect had
different perceptions of male circumcision. Aot being circumcised was associated with
uncleanness, premature e>aculation, and unfitness for marriage b! the traditional groups
practicing male circumcision. Male circumcision was viewed as a milestone for
manhood, protection from disease, and an enhancement for womenEs se-ual pleasure as
#$
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circumcised men are thought to be able to performN longer, thereb! increasing their
female partnerEs satisfaction (+aile! " 6ukobo, #$$
9he men among groups not practicing traditional male circumcision, e-pressed limited
interest in male circumcision although some said the! wished the! had been circumcised
because there was a common belief that women prefer circumcised men (+aile! "
6ukobo, #$$. 9his could be a problem that uncircumcised men could face especiall! in
circumcising communities. 9he! could end up undergoing the procedure not because the!
want to, but because the! would feel accepted b! their peers and females, thus avoid
stigmati5ation.
2.0 Acce&ta'i(it! o% $a(e circu$ciion
9he Cambia stud! found out that the ma>orit! of participants preferred the procedure to
be done b! a medicall! trained person in a health facilit! and should be free or at a
minimum cost. (+aile! " 6ukobo, #$$. 9his might suggest that people do not prefer
the traditional male circumcision procedure since the! stated that the! prefer it medicall!
done. 9he following were cited as reason not to circumciseJ cultural tradition, pain, and
safet!, as well as other barriers, such as cost and the concern that men would engage in
more se- if the! perceived themselves to be full! protected b! circumcisions (+aile! "
6ukobo, #$$. 9he stud! got the following reasons to circumcise, prevention of B9Is,
and h!giene. 9he participants had knowledge of the benefits of male circumcision
however, having the knowledge alone could not make them accept the procedure because
there were other factors, such as cost, place where the procedure would be done and the
e-pertiseDualification of the person carr!ing out the procedure that would make them
accept it.
Bcott et al (#$$% conducted a stud! in *waCulu Aatal, Bouth ?frica on acceptabilit! of
male circumcision as an HIV prevention method among a rural Culu population in which
he found out that about half the uncircumcised men surve!ed (7'4 said that, the! would
be circumcised if the procedure could be conducted safel! with little pain and at low cost.
Bi-t!3eight per cent of women said that the! would like their primar! partners to be
#'
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circumcised. 9here is some similarit! between the Cambian stud! and this Bouth ?frican
stud! in that the ma>orit! of the stud! sub>ect offered to be circumcised provided the
procedure is conducted in a health institution at low cost.
?ccording to Bhapiro et al (#$$', male circumcision was highl! acceptable in +otswana,
the! wroteF ?lthough the ma>orit! of males in +otswana are not circumcised, &84 of
participants in our stud! respond that the! would definitel! or probabl! circumcised a
male child if this service were offered for free in the hospitalN. 9he! cited the prevention
of se-uall! transmitted diseases, including HIV, for accepting male circumcision.
However, male circumcision was not acceptable to some people in the same stud! due to
various reasons. Of the 8& participants, who initiall! responded that the! would definitel!
not or probabl! not circumcise a male child, %74 listed pain, #&4 listed safet! concerns,
and ##4 listed religious or cultural reasons (Bhapiro et al #$$'. ?uvert et al (#$$7
found out that, culture was not a hindrance to male circumcision in a 1andomi5ed
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&$4 would accept male circumcision and enroll in a 1andomi5ed oen, #$$7 and had higher levels of education (Halperin et al., #$$7F
Bcott et al., #$$7. 9he reason being that, people living in urban areas and who are
educated are believed to be e-posed to circumcising tribes in schools and working areas,
thus thought to increase their acceptance of M< (Anko et al., #$$'. ?lso one of the
#%
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highest acceptabilit! levels of 8'4 in +otswana is that the participants agreed to a
procedure after information sessions were performed about the health benefits and the
risk associated with the procedure, compared to &'4 before the information sessions
(*ebaabetswe, 6ockman, Mogwe, Mandevu et al., #$$%.
In #$$0, the World Health Organi5ation estimated that %$4 of all males above the age of
'7 are circumcised globall! (WHO, #$$0, &
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CHARPTER ": RE#EARCH 4ETHODO7O
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"." Target &o&u(ation
?ccording to +abbie ('00, a population is an! group of individuals that have one more
characteristics in common that are of interest to the researcher. In this stud!, the target
population (#2% was appro-imatel! made up of residents of ward % Beke district in
*unaka and Marikopo village in the age groups '7320 !ears. ? resident is a permanent or
long3term dweller in Beke district ward %. Geographical spread of Beke district ward %
villages and the time frame of the stud! made it impossible to reach all residents of all the
villages in ward %. 9herefore a total of two focused groupsE discussions each constituting
'$ members each convenientl! selected from the two villages, %& uestionnaires and 2
purposivel! selected ke! informants were directl! interviewed b! the researcher. ? social
worker, village headmen, village health worker and a religious leader were involved
because the! were deemed knowledgeable about male circumcision and social issues in
their localit! affecting the uptake of male circumcision..
".) #a$&(e and #a$&(ing Procedure
?ccording to Baunders (#$$%, a sample si5e can be defined b! using at least '$3#$4 of
the targeted population. Aon3probabilit! convenience sampling method was used to
select two villages in ward % Beke district namel! Marikopo village and *unaka village
9he researcher live in Marikopo village and *unaka village is ver! close to the
researchersE homestead. 9he s!stematic sampling techniue was used to come up with a
sample population. In this case '74 (%& of the permanent residents (#2% was used due
to financial and resource shortage. Aon3probabilit! convenience sampling method was
used to select %& residents into the stud!. 9he researcher convenientl! selected residents
that were at home on the da!s of data collection. 9hose who were not at home due to
various reasons did not have the chance to participate in the stud!. 9he researcher could
have used probabilit! sampling but due to limitation of time, he was not able to do so.
/robabilit! sampling reuired a lot of time to come up with a complete sampling frame in
the stud! sites and then sample from it. On the other hand, non3probabilit! sampling is
#&
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limited in that all the residents were not given eual chance to be selected into the stud!
thus there was some selection bias.
:or the focused group discussions non3probabilit! convenience sampling was also used
to select 7 males 7 femalesE participants in each village from different interest groups
from the %& target population sample. )owd! #$$$ views that :G)s must not e-ceed '#
people for people to clearl! share their views and avoid it to act like a public meeting.
9he sampling method for interviews was purposive sampling. 9hose who had detailed
information on health and social issues were selectedF these included the village health
worker, a traditional healer, a religious leader and a village headman.
Ta'(e ".1Co$&oition o% the reearch a$&(e
Instrument Targeted population Atual
!opulation
"sample size
#omposition
uestionnaire #2% %& 1esidence male or female '73
20 !ears oldInterview
guide
'# 2 Bocial worker, 9raditional
leaders, village health workers,
1eligious leaders:G)s %& #$ /6H?,
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the phasing of if a woman would prefer a circumcised partner. In order to get more
information to the impact of motivation the uestionnaire had to be reconfigured to
accommodate more open ended narratives. ?fter the necessar! changes have been
effected, the uestionnaires were sent out into the field for a period of # da!s.
".- Data co((ection &rocedure
9he data collection procedure included self3introduction of the researcher to the
respondents followed b! assurance that the research was for academic purposes before
conducting an interview, focused group discussions or issuing out a uestionnaire.
?t each stud! village, the researcher moved on foot and distributed the uestionnaires to
the selected individuals. He made the respondents to sit as far awa! from each other as
possible so as to discourage an! undue influence among the participants during the
answering session. +efore the interviews and focused groups discussions the researcher
first e-plained to the participants about the stud!, its purpose and ob>ectives and how
the! would contribute to the stud!. 9he participants were given the opportunit! to ask
uestions about the stud! and other issues of interest to them. 9he researcher answered
all their uestions and then asked for their consent to participate in the stud!. 9he
researcher was taking down notes during interviews and focused groups discussions
"./ Reearch 4ethod
1esearch methods are tools used to gather data, such as uestionnaires and interviews
()awson, #$$0. 9hree methods were used and these are the :ocus Group )iscussions
guideline, interview guide and uestionnaires as discussed below.
uetionnaire
9he researcher used self3administered uestionnaires to collect information from stud!
participants. ?ccording to 6eed! " Ormand (#$$7, a uestionnaire is an instrument with
open or closed uestions or statements, to which a respondent must react. 9his was a
primar! source of data collection. 9he researcher designed two self3 administered
uestionnaires, one for males and the other for females. ach uestionnaire was
accompanied b! a covering letter e-plaining the purpose of the stud! to the prospective
#8
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respondent. General instructions on completing the uestionnaire and the importance of
completing all uestions were included. 9he covering letter e-plained wh! it was
important that the potential respondent personall! completed the uestionnaire.
?part from establishing rapport, it was also aimed at gathering as much information as
possible from them on their demographic characteristics, their knowledge and
perceptions of male circumcision and their acceptabilit! of the strateg!. 9he! were asked
to state how the! would want circumcision to be performed and whether the! think itEs
necessar! to embark on a massive campaign of male circumcision. :emales were asked if
it matters to them to have a circumcised partner or not. +oth females and males were
asked whether circumcision was of an! importance to them and whether the! would
accept to circumcise their male children. 9his techniue was chosen as it could be
completed at the respondents convenient. 9he researcher encountered >ust a few problems
using this techniue. 9he first was it was time consuming as it took two da!s to drop and
collect the uestionnaires. ?t times, the residents were not available when the researcher
visited the houses to collect the uestionnaires. Becondl! respondents did not seem to
appreciate the value of the research as the! did not answer some of the uestions. 6astl!
the responses can be biased, for e-ample respondents can lie about their circumcision
status.
Inter,ie; guide
9he interview techniue is a direct method of obtaining information in a face3to3face
situation which is a critical aspect of ualitative data collection ()awson, #$$0. 9he
researcher interviewed. 9he researcher wanted to find out peopleEs knowledge and
acceptance of M< as an HIV prevention procedure from ke! informantsF these included a
village health worker, pastor, traditional healer and a village headman. 9he same
uestions on the uestionnaires were used on interview. 9he researcher followed thebasic rules in an interview which are courtes!, tactful and acceptance, non3>udgmental
and confidentialit!. 9he researcher was formall! dressed.
9he researcherJ Initiated the interview, put the respondent at eas!. 9he researcher had the
skill of creating a rela-ed and natural atmosphere, was business3like and not long and
#0
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winding, and kept the interview situation as private as possible, avoid stereot!ping, was
thorough and familiar with the surve! instrument, asked the uestions in a proper
seuence, did not assume to an! uestion, spoke slowl! so as to be clearl! understood,
did not put answers in the respondentEs mouth, probed when need arise and recorded
responses.
9he merits of an interview included the fact that the response rate was high. 9here was
completeness as all uestions were answered. 9here was room to probe comple- and
emotionall! charged issues. 9he interviewer e-hibited fle-ibilit! as he repeated uestions
or probe henceF there was ma-imi5ation of trust between the interviewer and the
interviewees. Bome of the demerits of interviews were that interviews are length!. 9he
mood of the respondents affected responses. Bome respondents felt uneas! and adopted
avoidance tactics, when uestions were too personal and there was no opportunit! to
make research b! consulting records.
ocu
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uncomfortable in group setting and nervous about speaking in front of others, but the
researcher encourages them to speak freel! because the discussed issues were to remain
confidential.
".0 Data #ource
Mainl! primar! data was collected from interviews, uestionnaires and focus group
discussions which were guided b! respective research tools in the field. Becondar! data
was onl! used where the interviewees referred to their written documents relative to the
research uestions asked.
". Data Ana(!i Procedure
uantitative data from uestionnaires was anal!5ed using B/BB and ualitative data was
anal!5ed thematicall!. 9he following steps were taken to anal!5e ualitative data from
interviews and :G)sJ transcripts were coded using the participantsE own words and
phrases and without pre3conceived classificationF the participantsE language or phrases
were e-amined, categori5ed and recurrent themes were identified. 1ecurrent themes are
the similar and consistent wa!s people think about, and give accounts concerning
particular issues. -amples of repetition, e-planation, >ustification and vernacular terms
were highlighted. 9hese were then coded with a ke! word or phrase that captured the
essence of the content, and were taken to constitute emergent themes.
)ata from uestionnaires was anal!5ed using the Btatistical /ackage for Bocial Bciences
(B/BB and responses were coded using numbers according to the respondentsE answers.
:or e-ample, a LBN was coded as ' and a AON coded as #. :or open3ended uestions
all ideas were listed first, and then tallied to indicate how the respondents gave the same
response. ?ll data from uestionnaires was coded in B/BB for all the uestions before the
data was edited and then presented as tables, charts and graphs using Microsoft -cel.
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".13 4a& and Decri&tion o% the #tud! Area
ig ". *: #eke ditrict $a&
#ource: 'e(e )ural Home *ased #are, 20+0
4a& o% the tudied area
ig ". -: 4a& o% #eke co$$una( area@ ;ard "
? boundar! in fig %.& below within Beke communal area indicate the area the researcher
did his research, that is Marikopo and *unaka village
%#
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#ource:!rimar% data
".11 Decri&tion o% the #tud! Area
Beke district is in Mashonaland east. In Beke district the main source of livelihoods is
farming. +ecause of its pro-imit! to the capital cit!, a notable section of the populationwork in Harare and
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Marikopo and *unaka villages are dominated b! market gardeningF people sell their
agricultural produce to nearb! markets such as Makoni, Mbare and Harare. 9he nearest
hospital is *unaka hospital appro-imatel! #.7km from the distant homesteads. Beke
Home +ased or role in educating the local people about male
circumcision. Marikopo primar! and secondar! school is located within Marikopo village
".11 #u$$ar! o% cha&ter
9he methodolog! that sought to guide this research has been discussed in this chapter.
*e! areas discussed were the research design, population sample and sampling
procedures, research instruments, data collection, presentation and anal!sis procedures.
9his >ustified the research posture, in terms of validit! and reliabilit!. 9he ne-t chapter
presents, anal!ses, interprets and discusses the data.
%2
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CHAPTER ): DATA PRE#ENTATION ANA7?#I# INTERPRETATION AND
DI#CU##ION
).1 Introduction
In this chapter, the researcher interprets, anal!5e, present and discuss the results obtained
from the two villages in ward % Beke district. 9he results are categori5ed into five main
sections namel! demographic characteristics of respondents, knowledge of benefits of
male circumcision, perceptions of respondents on male circumcision, acceptabilit! of the
procedure and suggestions on how male circumcision can be promoted to become one of
the HIV prevention methods.
).1.1 Re&one Rate
9he response rate was high because of the follow3ups on the part of the researcher and
support from the respondents
Ta'(e ).1Re&one rate(Bource$ !rimar% data
Intru$ent ued Targeted
re&ondent T
Actua(
re&ondentA
Re&one rate
AT133F
uestionnaire guide %& %# 0F
Interview guide 2 % /*F:G) guide #$ '8 3F
Tota( -3 *" 00F
9he adoption of an action research approach on motivated volunteers ensured a strict
follow up of respondents to honor appointments for meetings. 9he high response rate of
884 gives confidence that the results are valid for the purposes of this stud!. It actuall!
surpasses that of 9erthu *utupu Agod>i, #$'$ which had which makes the research
results more valid and possibl! fill the gap that was left out. 9he reason for the '#4shortfall can be attributed to situations be!ond the researcher and the respondentsE control
such as misplacement of the papers, sicknesses and absenteeism. :rom the uestionnaires
the researcher managed to get %# respondentsF '7 (284 males and ' (7#4 females.
9his was 804 of the e-pected (calculated sample si5e. :rom interview guides the
respondents were one man (%%4 and two women (&4. 9his was 74 of the e-pected
%7
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calculated sample si5e. ight (224 and ten (7&4 women participated in focused groups
discussions. 9his was 0$4 of the e-pected calculated sample. 9heir ages ranged between
'7 and 20 and their average age was #2.7 !ears. ?ll were residents in ward %, Beke
district. )etailed information about the respondents can be shown below
Ta'(e ).2: #tud! &artici&ant %or Guetionnaire &er tud! center N"2 133F
Name of villages Number of males - Number of females % Total %
*unaka 22 0 20 1- *3Marikopo 8 2* 8 2* 1- *3TOTA7 1* )/ 1/ *" "2 133
#ource:!rimar% data
Ta'(e ).": #tud! &artici&ant %or %ocued grou& dicuion &er tud! center N 10133F
Name of village Number of males % Number of females % Total %
*unaka % 1/ 2 22 / "
Marikopo 7 20 & "" 11 -1TOTA7 0 )* 13 ** 10 133
#ourceJ /rimar! data
Ta'(e ).): #tud! &artici&ant %or the inter,ie; N "
Occupation Sex Village Allocated time Time taken
Village health worker :emale Marikopo &$ minutes 2' minutesVillage headmen Male Marikopo &$ minutes ## minutes/astor :emale *unaka &$ minutes %0minutes
#ource:!rimar% data
9he tables 2.2 above show that village health worker took more time that is 2'minutes
because she knows a lot about male circumcision. 9he pastor followed with %0minutes he
know the biblical aspect a lot than the medical benefits of male circumcision. 9he village
headmen knew limited information about male circumcision. 9he researcher deduced thathaving access to information about male circumcision makes people knowledgeable and
for e-ample a village health worker knew a lot about male circumcision because of
access to information.
).2 De$ogra&hic characteritic o% the re&ondent
%&
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9he ma>orit! of the respondents '0 (70.24Q were married while '% (2$.&4 were single.
ver! respondent did specif! their marital status. 9he respondents had #2 (2.'4 male
children and the rest had # (7#.04 female children.
Ta'(e ).*: #ocio9de$ogra&hic characteritic o% tud! &artici&ant
Characteristics Study sample N !" #ercentage
Age $&'"( #$.7
"'") '$ %2.'
"*'!+ 7 '.'
!&'+" 2 ''.2
+!'+, 2 ''.2
$+- # 7.
Number of children .ales #2 2.'
/emales # 7#.0
.arital status 0nmarried '% 2$.&
.arried '0 70.2
1eligion Christianity #8 8.2
African Tradition # &.%
0nspecified # &.%
#ource:!rimar% data
9went!3eight (8.24 of the respondents were
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shown from fig 2.' One respondent who finished at primar! school knew nothing about
male circumcision on the other hand # respondents who were degree holders knew a lot
of information about male circumcision. Generall! ordinar! level, advanced level and
diploma holders knew basic information about male circumcision.
igure ).1: Educationa( (e,e( o% the re&ondent
#ource:!rimar% data
:rom the research findings level of education affected oneEs knowledge and perception
about male circumcision. 9his can be so because higher levels of education e-pose
people to various literatures and social contact with a broader mi- of different ethnic and
religious groups. 9his in turn increases the likelihood of access to information about male
circumcision as purported b! @rassa, 9odd, +oerma, Ha!es et al., '00.
9wo men who were circumcised one was a diploma holder and the other one doing
advanced level this showed that higher levels of education are associated with higher
rates of circumcision among non3circumcising societies. 9he findings concurs with
studies in traditionall! non3circumcised societies in 9an5ania and Bouth ?frica which
indicated that higher levels of education were associated with higher rates of
circumcision among non3circumcising societies (Halperin et al., #$$7F 1ain3 9al>aard et
al., #$$%.
)." =no;(edge o% $edica( 'ene%it o% $a(e circu$ciion
%8
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9he ma>orit! of the respondents #% ('.74 stated that male circumcision was not
practiced in their cultureDtradition or their religion. 9his result concur with those of other
studies in ?frica where circumcision is not a traditional practice including +otswana
(*ebaabetswe et al., #$$%, Bouth ?frica (6agarde, #$$%F 1ain39al>aard et al., #$$%F
Bcott et al., #$$7 and *en!a (Mattson et al., #$$7. :our ('#.74 stated it was practiced
in their tradition while 7 ('&4 respondents had no idea whether it was practiced or not.
Bevent!3three percent of the respondents correctl! defined male circumcision.
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No idea % (
Tota( "2 ((
#ource:!rimar% data
In contrast :rit5 et al (#$$$ found out that, & (&.4 of the 80 men who knew about the
benefits of male circumcision mentioned something on HIV and h!giene in their stud!.
9he percentage of respondents with information in this current stud! was higher than in
:rit5 et al (#$$' stud!. 9his could be attributed to difference in time when the studies
were conducted. Aowada!s people are having more information about HIV and male
circumcision than the! had in #$$'. 9he difference could also be attributed to the
characteristics of the respondents. :rit5 et al (#$$' used males from a beer hall, while
this stud! incorporated residents of ward %, Beke district in a peri3 urban area with access
to the information.
Ta'(e )./: Aociation 'et;een =no;(edge and Re(igion n"3 133F
123454ON 6no7ledge of benefits
Had
kno;(edge
F No
kno;(edge
F TOTA7 F
?frican
9radition
' " ' " # -
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#e5ua( ineniti,it! # Poi'i(it! o% getting HI6 i% intru$ent are
hared
% '$
Death ' %8ound take (ong to hea( 7 '
Da$age to the &eni 2 '2E5cei,e '(eeding 7 'Can caue eriou in%ection 8 #0TOTA7 2 133
#ource:!rimar% data
9went!3nine (0'4 of the respondents stated a variet! of complications of male
circumcision which are summari5ed in the table 2.8 above. 9en percent of the
respondents stated that one could end up contracting HIV if instruments are shared during
the procedure. 9he common complication was serious infections. However, three (04 of
the total respondents of %# had no idea of an! complication of the procedure. 9he finding
gives >ustification wh! male circumcision is not well accepted as an HIV prevention
strateg!. 9he complications correspond with those from studies carried out in Bouth
?frican (Bcott et al., #$$7 and *en!a (Mattson et al., #$$7.
Bcott et al (#$$% found out that, more than half the uncircumcised men surve! 7'4 said
that the! would be circumcised if the procedure could be conducted safel! with little pain
and at low cost. 9he respondents in this current stud! also opted for safe conditions
which were found when the procedure is medicall! conducted.
Ta'(e ).: Circu$ciion tatu ,eru Bene%it o% Circu$ciion N1* 133F
Circu$ciion
tatu
Conideration o% $a(e circu$ciion
'ene%icia( F Non9
'ene%icia(
F Tota( F
Aot circumcised 8 7% 7 %% 1" 00
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9able 2.0 above shows that, there appears to be an association between being circumcised
and consideration of the procedure as beneficial to oneself. 9his ma! suggest that if men
are well informed about the benefit of male circumcision the! will probabl! get
circumcised. :rom the narratives on whether circumcision was of an! benefit to the
males, '$ (&4 stated that it was of beneficial to them and # were circumcised on the
other hand 7 (%%4 of the '7 males stated that it was not beneficial to them and no3one
was circumcised. 9he benefits include protection against B9Is and HIV and improved
h!giene. 9wo of the '7 respondents did not state an! benefits even though the! had
indicated that circumcision was beneficial to them.
ig ).2: Percentage o% $en ;ho ;ere circu$cied and uncircu$cied
#ource:!rimar% soure
:rom the fig above # ('#4 of men were circumcised and the rest ('% 884 were not.
9his showed low levels of circumcision rates amongst the male respondents. 9his stud!
concurs with the :rit5 et al.s (#$$$ stud! in terms of high rate of non3circumcision
which was 8&4. 9his also concurs with the #$$0F World Health Organi5ation which also
estimated low levels of circumcision rate of %$4 globall!.
2#
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9en (&$4 of the ' women stated that, male circumcision was beneficial to them while
(2$4 stated that, it was not beneficial to them. Bome of the benefits listed b! women
included reduced chances of B9I infection including HIV, protection from cervical cancer
and improved h!giene as shown on the table below
Ta'(e ).13 Bene%it o% 4a(e Circu$ciion 4entioned '! e$a(e. N13
Bene%it reGuenc! Percentage
/rotection from cervical
cancer
# 23
/rotection from B9Is and
HIV
& -3
Improve general h!giene # 23TOTA7 13 133
#ource:!rimar% soure
When the researcher compared results from focused groupsE discussions, uestionnaires
and interviews on the benefits of M< to men and women he concluded that respondents
are knowledgeable about the benefits of male circumcision.
).) Perce&tion on 4a(e Circu$ciion
9o find out about the perception of the respondents on male circumcision all the three
data sources were used. 9o get an in3depth understanding of perceptions in the area in3
depth interviews were held with village health workers, headmen and a pastor. :rom the
research findings generall! more respondents (&$4 viewed male circumcision as good.
9went!3three percent of the participants stated that, male circumcision was bad while
'4 of the respondents did not state their perception the figure below is a summar! of
the respondentsE perceptions. 9here is a knowledge gap within the respondents that can
onl! be bridged b! health promotion strategies. Most of the males with a negative
perception of male circumcision were not circumcised. However this is not surprising as
those alread! circumcised would have an overt appreciation of the procedure.
2%
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However after information sessions of the benefits of male circumcision some people
began to have positive perceptions of the procedure and four men accepted to be
circumcised. 9welve percent of the women who initiall! had a negative perception on
male circumcision changed their view to accepting that male circumcision should be
practiced. Btriking were the male respondents who did not change their negative
perception on male circumcision.
9his is comparable to what was found b! Bhapiro et al (#$$' when some respondents
changed their perception and accepted to be circumcised. ?mong #%8 uncircumcised
men, '0# (8'4 after the informational session changed their perceptions and some
voluntaril! accepted to be circumcised (Bhapiro et al, #$$'. 9his further demonstrates
the fact that, there is an association between knowledge and perceptions increasing oneEs
knowledge can possibl! influence oneEs perception in the positive or negative sense
depending on the advantages or benefits one would stand to gain
ig ).". Perce&tion on $a(e circu$ciion
#ource$ !rimar% soure
22
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9able 2.'' below shows the association between knowledge of medical benefits of male
circumcision and the respondentsE perception.
Ta'(e ).11: Aociation 'et;een =no;(edge and Perce&tion on 4a(e Circu$ciion
n"2
=no;(edge o% 'ene%it Perce&tion
Aegative /ositive 9otal
)id not have the knowledge 2 # -
Had the information 8 '8 2-
9otal 12 23 "2
#ource:!rimar% soure
:rom the table above twent!3si- (8'4 respondents had the knowledge on male
circumcision and si- ('04 did not have the information. 9here was a significant
association between knowledge of respondents on benefits of male circumcision and their
perception of the procedure. 9he negative perceptions in most of the respondents could
have been a result of lack of knowledge or limited information of medical benefits of
male circumcision. 9he stud! found a significant association between the two. Having theknowledge of the benefits of male circumcision is paramount in building a positive
perception of the procedure as those who were circumcised or knew of its benefits had a
positive view of the procedure. It would be logical to have a handful of the respondents
with a negative perception of the procedure since some of them did not have enough
information on the medical benefits of male circumcision. It is difficult for people to have
a positive perception when the! are not full! informed about the benefits of the
procedure. *nowledge is power as it can influence oneEs perception
27
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Ta'(e ).12: Aociation 'et;een Re(igion and Re&ondent &erce&tion n "3
RE7I
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!ears and above age3group was ver! low. :igure 2.2 below shows the willingness to be
circumcised amongst the uncircumcised male respondents. 9here was a significant
association between willingness to be circumcised and consideration of the procedure as
of benefit to the respondents.
ig ).) Acce&ta'i(it! o% $a(e circu$ciion a$ongt the uncircu$cied $a(e
#ource$ !rimar% soure
:rom the fig above the ma>orit! of the uncircumcised males were not willing to becircumcised. 9his was lower than those who were willing to undergo the procedure in
:rit5 et al.s (#$$$ stud!. 9his was close to half of those who were to undergo the same
procedure in Bhapiro et al (#$$', which had acceptabilit! level of &84.
With the high level of knowledge of benefits of male circumcision, people would have
positive perception, and would opt for the procedure but this is not the case. :our (%%4
of the respondents who were willing to undergo the procedure had a positive perception
of the procedure. 9his was a good indicator b! possible of the earl! adopters of male
circumcision should the innovation be made to diffuse into the members of the stud!
area. 9hirt!3three percent of the males who were willing to be circumcised were
significant suggesting that an! promotion of this procedure should target these
respondents as peer educators. 9he males stated the following reasons for accepting to be
2
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circumcisedF protection from B9Is and HIV, improved h!giene since circumcised men
were considered to be more h!gienic than uncircumcised men and se-ual pleasure
because of dela!ed e>aculation. On the other hand reasons for den!ing circumcision
included, it being too painful and torturous, possibilit! of getting HIV if contaminated
instruments were shared during the procedure, fear of damage of the penis leading to
infertilit!, it being not necessar! at all to others while others believed that circumcision
was against what God wanted men to look like at creation, so the! did not accept to be
circumcised.
9hirteen (0%4 of the fourteen parents stated that their male children were not
circumcised this implies that parents were not circumcising their male children. 9he
results concurs with )emographic and Health Burve! results of Aamibia #$$&, which
indicated that M< prevalence in children was ''4 (MOHBB, #$$8 leven (&'4 of the
'8 respondents that currentl! did not a male child stated that the! would accept to
circumcise their children, (%04 stated that the! would not circumcise their children.
While one was not sure. ?fter parents were told of the benefits of male circumcision
acceptabilit! to circumcise their male child increased from &24 to 8%4. It was difficult
to accept male circumcision when the parents were not informed and convinced of the
benefits of the procedure. 6ack of knowledge would lead to negative perception which
would ultimatel! lead to low acceptabilit!. ?s mentioned on Bhapiro et al (#$$',
acceptabilit! of the procedure increased after an informational session on the benefits of
male circumcision was offered to the stud! participants.
One of the main findings of this stud! is that most of the participants prefer M< to be
performed during the infanc! period (less than ' !ear. Bimilar results were found from
the stud! in non3circumcising communit! in +otswana (*ebaabetswe et al., #$$%.
28
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Ta'(e ).1": Reaon %or Circu$ciing 4a(e Chi(dren n"2
Reaon %or circu$ciing $a(e chi(dren reGuenc! Percent
Be-ual satisfaction of future partner 1 ":ollowing culture and traditions "
H!giene 0 2*
/rotection against HIV and B9Is 23 -"
TOTA7 "2 133
'oure$ !rimar% soure
9he reasons for circumcising children included protection against B9Is and HIV,
improved general h!giene, following cultureDtradition and se-ual satisfaction of their
future female partners and the table 2.'% above summari5es the general reasons. 9hirt!3
nine percent of the respondents who had a male child were willing to circumcise their
male children. 9his is dissimilar to the research findings of +otswana Havard ?I)B
Institute /artnership #$$' (*ebaabetswe, et al, #$$% which found out that &84 of the
respondents were willing to circumcise a male child. ?lso Westercamp and +aile! found
out that '4 (7$30$4 of men and 8'4 ($30$4 of women would circumcise their sons
if given the chance. However more specific reasons against circumcision of children are
summari5ed in the 9able 2.'2 below.
Most of the parents stated that their children were not circumcised, echoing the high
rates of non3circumcision among the respondents. 9his could be due to lack of
information on the benefits of male circumcision or due to the rarit! of the procedure in
hospitals and clinics. With the fear that clinicall! performed circumcision could result in
complications and looming possibilit! of contracting HIV through sharing instruments,
man! people would not be willing to be circumcised.
20
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Ta'(e ).1): Reaon againt circu$ciion o% chi(dren n"2
Reaon %or not circu$ciing a $a(e chi(d reGuenc! Percentage
6ack of knowledge of benefits of the procedure # &
It is outdated ' %?gainst what God created man like # &
Aot necessar! 2 '%
Bhould be personal choice & '0
Aot wanting to see a child suffering because of pain % 0
Aot believing in male circumcision # &
:ear of complications '# %8
Tota( "2 133
#ource:!rimar% soure
:rom the table above the highest freuenc! was fear of complications followed b!
personal choice.
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the traditional conducted one for themselves for the reasons that circumcision was a
traditional practice that should be done traditionall!. 9he! also said that, the traditional
circumcisers were more e-perienced than the medical ones since the practice is done
more traditionall! than medicall!. 9hose who opted for medical circumcision stated that,
it was conducted under h!gienic conditions and the chances of getting an infection or
complications were less since there would be ualified personnel to deal with an!
challenging situation that ma! arise during and after carr!ing out the procedure.
ig ).*: PrereGuiite %or Undergoing Circu$ciion n"2
#ource:!rimar% soure
ighteen (7&4 of the %# respondents stated that, the! would consider the benefits of
undergoing procedure, '$ (%'4 considered h!gienic conditions, while 2 ('%4
considered the e-perience and ualifications of the practitioner. :rom the research
findings people consider the benefits of undergoing the procedure more than h!giene
conditions and e-perience and ualifications of the practitioners when the! want to be
circumcised.
7'
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ig ).-: 8o$en &re%erence on 4an Circu$ciion tate N 1/
#ource:!rimar% soure
:ig 2.7 shows that & (%74 of the ' women stated that, the! would accept an! man
whether circumcised or uncircumcised. 9he ma>orit! of these women stated that, the! did
not have enough knowledge on the difference between these two conditions to warrant
them to make a choice between the two. 9o them a male was a male whether circumcised
or not, while 8 (2&4 stated that the! preferred circumcised men for cleanliness, less
chances of getting B9Is and se-ual satisfaction especiall! dela!ed e>aculation. On the
other hand '04 preferred uncircumcised men for the reasons that the! en>o!ed pla!ing
with the foreskin of the penis and that the uncircumcised head of the penis is se-uall!
sensitive as the! regarded the circumcised penis as insensitive. However, according to
Gra! (#$$, male circumcision does not reduce levels of se-ual desire, satisfaction or
performance.
).- #uggetion on &ro$otion o% $a(e circu$ciion
7#
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9he ma>orit! of the respondents #' (&4 out of %# were of the opinion that there was a
need to embark on a nationwide programme to circumcise males, while %%4 of the
respondents were indifferent.
1espondents also came up with suggested age groups to conduct male circumcision, the
most suggested groups were at infanc! and under3fives. 9he most common suggestion
was carr!ing out awareness campaigns on the benefits of male circumcision to all the
people, parents and !outh included in a bid to create awareness to ever!one. 9his was
suggested b! 884 of the total respondents. Other suggestions included offering male
circumcision at ever! maternit! clinic and hospital free of charge and making it
compulsor! to ever! male.
)./ Conc(uion
9he researcher presented results obtained from the stud! participants. Most of the
respondents had information on the benefits of male circumcision. On perceptions, the
ma>orit! had a positive view of male circumcision however low acceptabilit! of the
procedure was noticed as the respondents are afraid of complications. 9he chapter ended
b! compiling suggestions made b! respondents on how male circumcision could be
promoted to be one of HIV prevention methods.
).0 #u$$ar!
9his chapter presented results of the research stud!. It looked at knowledge, perceptions
and attitudes of participants, on the ma>or issues surrounding the male circumcision in
Beke district. 9he findings showed that, most people knew about male circumcision and
had knowledge of the protective effect of the procedure against HIV acuisition and
transmission. However few people are willing to be circumcised. 9he ne-t chapter gives
a summar!, conclusions and recommendations of the research stud!.
CHAPTER *
7%
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#U44AR?@ CONC7U#ION# AND RECO44ENDATION#
*.1 Introduction.
9his chapter consists of three sections, which wind up this research report. 9hese are the
summar!, research conclusions and recommendations.
*.2 #u$$ar!
9he stud! set out to establish the level of knowledge and acceptabilit! of male
circumcision with the hope of using the information to develop health promotion
programmes on the strateg! in Beke district and in the countr! at large in an effort to
reduce the transmission of HIV. +esides the above, male circumcision it has other
advantages, such as being h!gienic and reducing the chances of cervical cancer in women
with circumcised partners. In addressing what appeared to be lack of enough information
about the knowledge, perceptions and acceptabilit! of male circumcision in ward %, Beke
district and even other districts in the countr! for the strateg! to produce fruits. 9his stud!
set to enrich the bank of information on the sub>ect in the countr!.
9he research findings would assist in the strategic evaluation of current HIVD?I)B
prevention strategies, so as to enable the formulation and improvement of the multi3
sectorial and multi3methodical approaches to the disease prevention. In order to
accomplish the assessment, a sample of %# residents from # villages of ward %, Beke
district were involved in the stud!. 9he methodolog! was based on the viewpoint that,
knowledge of HIVD?I)B prevention in Beke district is relative and cannot be amendable
to an! form of classification, hence there was need to come up with first3 hand
information using ualitative and uantitative techniues in a descriptive surve!. 9he
researcher used purposive sampling techniue and non3probabilit! convenience sampling
to come out with an optimal sample si5e.
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9he stud! then used uestionnaires, focused groups discussions and interviews to get
information on knowledge and acceptabilit! of male circumcision as an HIV prevention
strateg!. 9he stud! wanted to solve the problem where it appears that low level of male
circumcision countries coincidentall! have the highest burden of HIVD?I)B in the world.
Aevertheless, male circumcision has been perceived as a culturalDtraditional act that is
backward and not necessar!.
In carr!ing out this stud!, a handful of the respondents had problems in answering the
uestionnaire owing to the levels of their literac!. 9he researcher trained research
assistants to help those who were to complete the uestionnaire. )ue to limitation of time
the researcher carried out non3probabilit! convenience sampling which could have
caused biasness also the researcher could not reall! check whether those who claimed to
be circumcised were not l!ing. Most respondents managed to fill in their uestionnaires.
)espite the above constrains the following conclusions could be made.
*." Conc(uion
Most respondents knew about male circumcision at least most of them had knowledge of
the protective effect of the procedure against HIV acuisition and transmissionF some few
respondents had information of other benefits, such as cleanlinessDimproved h!giene and
reduced chances of getting other se-uall! transmitted diseases.
Bi-t! percent of the respondents had positive perception of the procedure whilst #%4 of
the respondents perceived male circumcision as bad and were of the opinion that, the
procedure was supposed to have been stopped long ago, and '4 of the respondents did
not state their perceptions. 9he stud! found out that, there was a significant association
between knowledge of medical benefits of male circumcision and oneEs perception of the
procedure. 9hus, increasing oneEs knowledge on the medical benefits of the procedure is
paramount in creating a positive perception of male circumcision.
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9welve percent of men were circumcised this showed low levels of circumcision rates
amongst the male respondents. Most of the parents stated that their children were not
circumcised, echoing the high rates of non3circumcision in the studied area. 9he
procedure was lowl! accepted b! the respondents with a percentage acceptabilit! of %%4
b! the male respondents, while %04 of all the respondents e-pressed their willingness to
circumcise their male children. ?lmost all the respondents preferred medicall! performed
circumcision. Medicall! performed circumcisions were preferred because of the e-pertise
and professionalism of the people conducting the procedure and reduction of chances of
complications.
?cceptabilit! of male circumcision was affected b! people uestioning the procedure and
peopleEs knowledge of its benefits as these aspects had a significant association with each
other. 1aising peopleEs knowledge of the benefits of male circumcision could influence
positive perceptions in them which could lead to increased willingness to undergo the
procedure.
9he stud! concluded that the respondents have information on the medical benefits of
male circumcision as a strateg! against acuisition of HIV infection. 9he ma>orit! of the
respondents had a positive perception of the procedure while the acceptabilit! to undergo
the procedure was generall! low.
*.) Reco$$endation
9he researcher made the following recommendations in3order to make male circumcision
an HIV preventive method that is accepted b! man! peopleF
9he heads of institutions and communit! bodies should make information on male
circumcision and other HIV prevention methods available to residents so as to increase
awareness on the role of male circumcision in preventing HIV acuisition and
transmission. 9his could be achieved b! inviting speakers on the sub>ect and through
7&
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sourcing literature on the sub>ect. 9his can also change some of negative perceptions
mentioned in this stud!.
9o promote the uptake of M
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?irhahenbuwa,
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+him>i ?. M.), #$$$, In%ant $a(e circu$ciion A 6io(ation o% the Canadian Charter
o% Right and reedo$, Health 6aw #$$$,
www.cirp.orgDlibrar!DlegalD#$'$D'#D'# D
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Halperian ).9, :rit5 *, Mc:arland W, Woelk G, #$$7, Acce&ta'i(it! o% adu(t $a(e
circu$ciion %or e5ua((! tran$itted dieae and HI6 &re,ention in
i$'a';e. Be- 9ransm )is %#J#%83#%0
Hargrove KW " Mahomva ?, et.al, #$$7. Dec(ining Pre,a(ence and incidence in
;o$en attending $aternit! c(inic in
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6eed! /) and Ormand.K, (#$$7. Practica( Reearch: P(anning and Deign. /erson
/rentice Hall, Aew Kerse!
6ukobo M.), +aile! 1
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A!amuda, /. (#$$#. Organiationa( (eaderhi& in 4ater o% Buine Ad$initration
7#%. Cimbabwe Open @niversit! Harare.
Bcott, +., Weiss H. ? and Vil>oen K. I, #$$7, The acce&ta'i(it! o% $a(e circu$ciion
a an HI6 &re,ention a$ong a rura( u(u &o&u(ation@ =;au(u9Nata(@
#outh A%rica@?I)B
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Westercamp, Aelli and 1obert +aile!. #$$. Acce&ta'i(it! o% $a(e circu$ciion %or
&re,ention o% HI6AID# in #u'9#aharan A%ricaJ ? review. ?I)B
+ehavior,
Winkel 1. #$$7, 4a(e Circu$ciion in the U#AJ ? Human 1ights /rimer, Missouri,
@B?.
Wiswell 9. The &re&uce@ urinar! tract in%ection@ and the coneGuence . /ediatrics.
#$$$F '$7J8&$;8
9roparg
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APPENDIK 1
BINDURA UNI6ER#IT? O #CIENCE EDUCATION
ACU7T? O #CIENCE EDUCATION
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'$. What are the benefits of male circumcision
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
S
''. )o !ou know of an! complications that ma! arise from the procedure (/lease list
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
'#. Is male circumcision practiced in !our traditionDculture or 1eligion LesDAo
'%. If !es what is the basis of the practice. /lease e-plain.
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS.
'2 /lease e-plain how !ou view D perceive male circumcision
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
'7. Male circumcision is being practiced in some countries and in some regions of this
countr!. )o !ou think male circumcision should be practiced in these current da!s or
should have stopped long back
Bhould be provided Bhould have
'&. /lease e-plain !our answer to '7 above
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS.
'. 9his uestion is for people with male children. ?re !our male children circumcised
LesD AoD Aot applicable
'8. ?re !ou circumcised LesD AO
'0. If !ou answer to '8 above is !es, how was the procedure conducted
9raditionall! Medicall! )o not have
information
#$. ?t what age were !ou circumcised
&&
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+efore
adolescence
)uring
adolescence
?fter
adolescence
#'. Is male circumcision of an! benefit to !ou Les DAo
##. If !our answer to #' above is !es, what are the benefits
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
#%. If !ou are not circumcised, would !ou accept to be circumcised Les D Ao
#2. /lease give reasons for !ou choice to #% above.
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
#7. In the event of being blessed with bab! bo!(s, would accept to have himDthemcircumcised LesD Ao
#&. /lease e-plain wh! !ou would accept or den!
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BINDURA UNI6ER#IT? O #CIENCE EDUCATION
ACU7T? O #CIENCE EDUCATION
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Ordinar!
level
?dvanced
level
)iploma )egree
0. What do !ou understand b! male circumcision
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
'$. What are the benefits of male circumcision
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
''. )o !ou know of an! complications that ma! arise from the procedure (/lease list
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
'#. Is male circumcision practiced in !our traditionDculture or 1eligion LesDAo
'%. If !es what is the basis of the practice. /lease e-plain.
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SS
'2 /lease e-plain how !ou view D perceive male circumcision
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
'7. Male circumcision is being practiced in some countries and in some regions of this
countr!. )o !ou think male circumcision should be practiced in these current da!s or
should have stopped long back
Bhould be practiced Bhould have
stopped long back
'&. /lease e-plain !our answer to '7 above
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS.
$
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uestion ' and '8 are for people with male children.
'. ?re !our male children circumcised LesD Ao D Aot applicable
'8. If !ou answer to the above uestion is !es, how was the procedure done
9raditionall! Medicall!
'0. In the event of being blessed with bab! bo!(s, would accept to circumcise
him( themLesDAo
#$. /lease give reasons to !our choice in '0 above.
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS#'. @nder what conditions would !ou prefer male circumcision to be conducted
9raditionall! Medicall!
##. Is male circumcision of an! benefit to !ou LesD Ao
#%. If !es what are the benefits
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS..
#2. )o !ou there is need for males to be circumcised LesD Ao
#7. If !our answer to #2 above is !es, please e-plain the need for the procedure.
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS..
#&. Given the option to choose a male partner, what would be !ou preference in terms of
circumcision state
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SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS..
1ecent scientific studies have reviewed that medicall! performed male circumcision
reduces the rate of acuisition of HIV in males b! &$4. However it does not offer total
prevention against HIV acuisition. Would this information make !ou change !our
opinionD perception about male circumcision
#8. If so how does !our perception of male circumcision change
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
#0. )o !ou think there is need to embark on a nationwide programme to circumcised
males LesD Ao
%$. If !our answer to #0 above is !es, what age group would !ou suggest to be the ideal
to target group
Infants @nder fives +efore
adolescence
?t adolescence ?dults
%'. )o !ou have an! suggestion on how male circumcision can be promoted to be one of
the prevention methods of HIV transmission
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
9hank !ou ver! much for !our cooperation. Ma! !ou be blessed in ever!thing !ou do
APPENDIK "
#
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2
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7
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