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      Knowledge on voluntary medical male circumcision in a low uptake setting in northern Uganda

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          Abstract

          Background

          Free VMMC services have been available in Uganda since 2010. However, uptake in Northern Uganda remains disproportionately low. We aimed to determine if this is due to men’s insufficient knowledge on VMMC, and if women’s knowledge on VMMC has any association with VMMC status of their male sexual partners.

          Methods

          In this cross sectional study, participants were asked their circumcision status (or that of their male sexual partner for female respondents) and presented with 14 questions on VMMC benefits, procedure, risk, and misconceptions. Chi square tests or fisher exact tests were used to compare circumcision prevalence among those who gave correct responses versus those who failed to and if p < 0.05, the comparison groups were balanced with propensity score weights in modified poisson models to estimate prevalence ratios, PR.

          Results

          A total of 396 men and 50 women were included in the analyses. Circumcision was 42% less prevalent among males who failed to reject the misconception that VMMC reduces sexual performance (PR = 0.58, 95% CI 0.38–0.89, p = 0.012), and less prevalent among male sexual partners of females who failed to reject the same misconception (PR = 0.22, 95% CI = 0.07–0.76, p = 0.016). Circumcision was also 35% less prevalent among male respondents who failed to reject the misconception that VMMC increases a man’s desire for more sexual partners i.e. promiscuity (PR = 0.65, 95% CI = 0.46–0.92, p = 0.014).

          Conclusion

          Misconceptions regarding change in sexual drive or performance were associated with circumcision status in this population, while knowledge of VMMC benefits, risks and procedure was not.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-018-6158-2) contains supplementary material, which is available to authorized users.

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          Most cited references12

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          Different methods to calculate effect estimates in cross-sectional studies. A comparison between prevalence odds ratio and prevalence ratio.

          According to results from the epidemiological literature, it can be expected that the prevalence odds ratio (POR) and the prevalence ratio (PR) differ with increasing disease prevalence. We illustrate different concepts to calculate these effect measures in cross-sectional studies and discuss their advantages and weaknesses, using actual data from the ISAAC Phase III cross-sectional survey in Münster, Germany. We analyzed data on the association between self-reported traffic density and wheeze and asthma by means of the POR, obtained from a logistic regression, and the PR, which was estimated from a log-linear binomial model and from different variants of a Poisson regression. The analysis based on the less frequent disease, i.e. asthma with an overall prevalence of 7.8%, yielded similar results for all estimates. When wheezing with a prevalence of 17.5% was analyzed, the POR produced the highest estimates with the widest confidence intervals. While the point estimates were similar in the log-binomial model and Poisson regression, the latter showed wider confidence intervals. When we calculated the Poisson regression with robust variances, confidence intervals narrowed. Since cross-sectional studies often deal with frequent diseases, we encourage analyzing cross-sectional data based on log-linear binomial models, which is the 'natural method' for estimating prevalence ratios. If algorithms fail to converge, a useful alternative is to define appropriate starting values or, if models still do not converge, to calculate a Poisson regression with robust estimates to control for overestimation of errors in the binomial data.
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            Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review.

            Circumcision of males is commonly carried out worldwide for reasons of health, medical need, esthetics, tradition, or religion. Whether circumcision impairs or improves male sexual function or pleasure is controversial.
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              Effects of circumcision on male sexual functions: a systematic review and meta-analysis.

              This meta-analysis was performed to assess sexual functions following adult male circumcision. We searched the Cochrane Central Register of Controlled Trials, PUBMED, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2013 to identify all eligible studies that reported on men's sexual function after circumcision. The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity. We identified 10 studies, which described a total of 9317 circumcised and 9423 uncircumcised men who were evaluated for the association of circumcision with male sexual function. There were no significant differences in sexual desire (odds ratio (OR): 0.99; 95% confidence interval (CI): 0.92-1.06), dyspareunia (OR: 1.12; 95% CI: 0.52-2.44), premature ejaculation (OR: 1.13; 95% CI: 0.83-1.54), ejaculation latency time (OR: 1.33; 95% CI: 0.69-1.97), erectile dysfunctions (OR: 0.90; 95% CI: 0.65-1.25) and orgasm difficulties (OR: 0.97; 95% CI: 0.83-1.13). These findings suggest that circumcision is unlikely to adversely affect male sexual functions. However, these results should be evaluated in light of the low quality of the existing evidence and the significant heterogeneity across the various studies. Well-designed and prospective studies are required for a further understanding of this topic.
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                Author and article information

                Contributors
                dr_nanteza@yahoo.co.uk
                dserwada@infocom.co.ug
                ekankaka@rhsp.org
                gmongo@rshp.org
                rgray4@jhu.edu
                fmakumbi@musph.ac.ug
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                20 November 2018
                20 November 2018
                2018
                : 18
                : 1278
                Affiliations
                [1 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, Department of epidemiology and biostatistics, , Makerere University School of Public Health, ; Kampala, Uganda
                [2 ]GRID grid.415705.2, Uganda Ministry of Health, AIDS Control Program- National Male Circumcision office, ; Kampala, Uganda
                [3 ]GRID grid.452655.5, Rakai Health Sciences Program, Department of Grants, Training & Science, ; Rakai, Uganda
                [4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Johns Hopkins Bloomberg School of Public health, Department of Epidemiology, ; Baltimore, MD USA
                Article
                6158
                10.1186/s12889-018-6158-2
                6245765
                30453966
                9e6552d0-b62d-4af3-88ce-5243dbb6e75e
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 August 2018
                : 26 October 2018
                Funding
                Funded by: Rakai Health Science Program/ Forgarty Grant
                Award ID: N/P
                Funded by: FundRef http://dx.doi.org/10.13039/501100009497, African Population and Health Research Center;
                Award ID: N/P
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Public health
                knowledge,misconception,circumcision,vmmc,sexual function,uganda,sub-saharan africa
                Public health
                knowledge, misconception, circumcision, vmmc, sexual function, uganda, sub-saharan africa

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