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Although rate was 2.3% of babies under 3 months the rate increased gradually for circumcision at older ages, reaching 26.9% for children over 5 years [Samad et al., 2009].When circumcision is performed by traditional circumcisers in Africa as part of initiation into manhood high rates of complications and even deaths are seen.

Other studies in Africa noted high complication rates for both medical and traditional groups, albeit at half the rate for the medical [Bailey et al., 2008a; Kim & Goldstein, 2009].In another report, it was found that 7 days after circumcision by medical professionals following a one-day training workshop, there was insufficient skin removal in 5.5%, excessive skin removed in 1.3%, pain in 1.3%, infection in 1.3%, but no problems with excessive bleeding, swelling, hematoma, damage to the penis, problems urinating, dehydration or appearance [Peltzer & Kanta, 2009].All were managed successfully and they all resolved.An average of 3.8% adverse events has been seen for the first 1–100 circumcisions a clinician does [Krieger et al., 2007].In the Kenyan randomized controlled trial (RCT), 1.7% of the men had an adverse event.

Of these, the most common were postoperative bleeding (0.4%) or infection (0.4%), followed by wound disruptions (0.3%), delayed healing (0.2%), and swelling at the incision site (0.1%) [Bailey et al., 2007; Krieger et al., 2007].In the Ugandan RCT the rate of moderate adverse events was 3% and severe 0.2% [Gray et al., 2007a], i.e., 1 event per 500 surgeries.The severe events included 1 wound infection, 2 hematomas that required re-exploration and ligation of bleeding vessels, one wound disruption due to an external cause, and one postoperative herpetic ulceration [Gray et al., 2007a].The findings offered promise for scaling up of medical circumcision alongside traditional initiation into manhood.Deficiencies in training and resources in settings such as Africa need to be addressed and new methods such as use of simple, safe devices [Kim & Goldstein, 2009].Circumcision of Muslim boys by medical personnel during circumcision festivities in the Comoros Islands was associated with a low (2.3%) complication rate, mostly infections (1.5%) [Ahmed, 2007].