The perceptions and attitudes of doctors and midwives towards neonatal male circumcision: a study in four maternity units in Swaziland 2012

Abstract

Background: Male circumcision (MC) is increasingly being considered as a tool to reduce the transmission of Human Immunodeficiency Virus (HIV). The relentless spread of the HIV epidemic (a prevalence of 26% for the reproductive age group 15 - 49 years, in the year 200617) in Swaziland, led to the adoption of a MC policy following the recommendation of the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Despite considerable national efforts, the country has been unable to reach national targets for the number of neonates who are circumcised within five days ofbirth. Purpose: The low level of NMCs performed in Swaziland required a study to explore possible fundamental reasons for the low uptake of this service, if this service was to serve its intended purpose of the reduction of new HIV infections. The purpose of the study was to investigate the knowledge, perceptions and attitudes of doctors and midwives in the maternity wards of four hospitals in Swaziland towards neonatal male circumcision (NMC). This was an attempt to detennine if the failure to reach the national NMC targets could be due to the negative perceptions and attitudes of health care workers, in doctors and midwives. Moreover, there is relatively little published documentation on the perceptions and attitudes of doctors and midwives towards NMC. Methods: A cross-sectional descriptive study usmg a structured self-administered questionnaire was conducted to collect data from seven doctors and sixty midwives at four hospitals in Swaziland, including the national referral hospital, in 2012. The questionnaire collected data on the socio-demographic profile of the respondents and their perceptions about and attitude towards NMC. Results: The respondents were predominantly female (88.1 %) and midwives (89.6%). Swazi citizens formed 77.6% of the study population and 41.8% had spent their childhood in a rural area. The majority, 80.6% (n=50) of the respondents reported to have been working in maternity unit, for a period between one to five years and most of them (85 .1%) had not been trained to perform NMC. Overall, doctors and midwives had positive perceptions about and attitudes towards NMC. There was no statistically significant relationship between perceptions and attitudes towards NMC and most of the socio-demographic characteristics. However, there was a statistically significant association between number of years qualified as a doctor or midwife and perception ofNMC (p=0.053), meaning, the more the years qualified, the more positive was the perception towards NMC. There was also a statistically significant association between the number of years working in the maternity unit and attitude towards NMC (p=0.031 ), meaning the longer time spent working in the maternity unit; the more positive was the attitude towards NMC.