NAVIGATING COMPLICATIONS FROM CULTURAL CIRCUMCISION: A QUALITATIVE CASE SERIES OF PATIENT EXPERIENCES AT A TERTIARY REFERRAL HOSPITAL IN KENYA

Abstract

Background: Male circumcision is widely practiced across Kenya through either voluntary medical circumcision, performed in healthcare facilities, or traditional cultural circumcision (CC), conducted within community settings. There has been an alarming increase in circumcision-related complications presenting to Kenyan hospitals, particularly associated with CC. These findings emphasize a need for evidence-based management protocols to reduce circumcision-related complications, but the culturally charged nature of CC demands respect and preservation of traditional practices. We aimed to explore patient and family experiences in managing post-circumcision complications to better understand key values and opportunities amenable to intervention for improving the safety of circumcision practices in our setting.
Methods: This study is a case-series report anchored in qualitative interviews with a cohort of patients who presented to our hospital with three categories of circumcision-related complications including wound infection/sepsis, bleeding, and penile amputation. The study team completed phone interviews with families of eligible patients, and rapid qualitative matrix techniques were used to analyse data.
Results: We enrolled six boys in our study with two representative patients in each main complication category. We identified four main thematic domains: “Lack of standardized practices increases risk for complications”, “families lack insight into qualifications of circumcision providers”, “families remain a major source of post-procedural care”, and “financial and psychological consequences of circumcision complications are significant”. We have also included a section for requests made by families regarding circumcision care.
Conclusion: Societal pressure to conform to tradition drives a preference for CC, despite high practice variability which leads to increased complication risks. Collaborating with communities and traditional providers is key to developing standardized procedural methods. Empowering patients and families in their care, improving provider accountability, and providing multifaceted support in the presence of complications are critical to ensuring positive results from this important traditional rite.