Provider-Related and Demographic Determinants in Circumcision Mishaps: A Retrospective Study from Ho Teaching Hospital, Ghana (Preprint)

BACKGROUND Introduction: The success of circumcision depends primarily on the skill-level or level of supervision of the provider; but also on some key physical and socio-demographic features of the client being circumcised. In Ghana, both medical and traditional practitioners perform circumcisions, leading to variable outcomes. This study examines demographic and provider-related factors influencing circumcision outcomes in the Volta Region of Ghana. OBJECTIVE Objective: To analyse the impact of circumcision provider skill-level, and some socio-demographic features of clients on circumcision outcomes; as a way of identifying common demographic and provider-related determinants of circumcision mishaps. METHODS Methodology: A five-year retrospective study was conducted at Ho Teaching Hospital. Data on demographic and clinical factors, provider characteristics, and outcomes were extracted using a structured Ms Excel sheet. Bivariate and multivariate regression analyses were performed to assess the relationship between provider factors and circumcision outcomes, all at the 5% level of statistical significance. RESULTS Results: Of 186 circumcisions, 33 (17.74%; 12.4% anatomic and 4.34%, non-anatomic). The mishaps included incomplete circumcision (43.48%), post-circumcision bleeding (21.74%), urethrocutaneous fistula (13.04%), and infections. Midwives-as-circumcisers and traditional circumcisers (Wanzams) had higher complication rates (13.3% and 60.0% respectively). Doctors had the lowest complication rate (3.4%). Age range of the clients was 1 week to 28 years, with a mean age of 11 months, and a standard deviation of 10 months. Most clients were aged 1 month to 1 year (41.4%) and had parents primarily engaged in service and manual labour occupations (47.3%). Most of the parents had secondary education (52.15%), were Christians (68.8%), of Ewe ethnicity (82.8%), Ghanaian nationality (95.7%), and resided in Ho and its surroundings (69.9%) The demographic determinants of risk of circumcision mishaps in this study includes: Age of child: χ² = 48.9990, p = 0.000; highest Educational level of parent: χ² = 10.8811, p = 0.012; Occupation of parent: χ² = 44.7225, p = 0.013 and Residence: χ² = 33.7421, p = 0.000. Religion: χ² = 5.2154, p = 0.448 and Ethnicity: χ² = 8.3792, p = 0.253(were not statistically significant). The provider-related determinants include, provider skill-level; χ² =18.5119, p-value = 0.047 and the provider facility; χ²=26.04, p = 0.000. CONCLUSIONS Conclusion: The demographic and provider-related determinants of circumcision complications among the Ghanaian circumcising population include: provider skill-level, provider facility, the age of circumcised client, occupation, educational level and residence of parents. These identified determinants will be aggregated into risk-stratification and mitigation nomograms or digital risk calculators, as tools for public health prevention, in future research.