Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment
Abstract Background Adverse events (AE) resulting from voluntary medical male circumcision (VMMC) are commonly used to measure program quality. Mozambique’s VMMC program data reports a combined moderate and severe AE rate of 0.2% through passive surveillance. With active surveillance, similar progra...
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doaj-46f8509fa2864181bbc65a97dd64ebdf2020-11-25T04:11:30ZengBMCBMC Health Services Research1472-69632019-11-011911710.1186/s12913-019-4604-1Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessmentAtanásio Brito0Abigail Korn1Leonel Monteiro2Florindo Mudender3Adelina Maiela4Jotamo Come5Scott Barnhart6Caryl Feldacker7International Training and Education Center for Health (I-TECH), University of WashingtonInternational Training and Education Center for Health (I-TECH), University of WashingtonEduardo Mondlane University, School of MedicineInternational Training and Education Center for Health (I-TECH), University of WashingtonInternational Training and Education Center for Health (I-TECH), University of WashingtonNational Male Circumcision Programme – Ministry of HealthInternational Training and Education Center for Health (I-TECH), University of WashingtonInternational Training and Education Center for Health (I-TECH), University of WashingtonAbstract Background Adverse events (AE) resulting from voluntary medical male circumcision (VMMC) are commonly used to measure program quality. Mozambique’s VMMC program data reports a combined moderate and severe AE rate of 0.2% through passive surveillance. With active surveillance, similar programs report AE rates ranging from 1.0 to 17.0%. The objective of this activity was to assess potential underreporting of AEs via the passive surveillance system in Mozambique. Methods This mixed-methods assessment randomly selected one third (16) of all 46 VMMC clinics through stratified sampling, based on volume. A retrospective record review was conducted including patient clinical files, stock records of Amoxicillin/Clavulanic Acid (the choice antibiotic for VMMC-related infections), and clinic-level AE rates from the national database. Records from the month of April 21 to May 20, 2017 were analyzed to identify both reported and potentially unreported AEs. In addition, external, expert clinicians observed post-operative visits (n = 167). Descriptive statistics were calculated, including difference between reported and identified AEs, an adjusted retrospective AE rate, and an observed prospective AE rate in each clinic. Results A total of 5352 circumcisions were performed in the 16 clinics: 8 (0.15%) AEs were reported. Retrospective clinical record reviews identified 36 AEs (0.67%); AE severity or type was unknown. Using Amoxicillin/Clavulanic Acid dispensation as a proxy for VMMC-related infections, 39 additional AEs infections were identified, resulting in an adjusted AE rate of 1.4%, an 8.3 fold increase from the reported AE rate. Prospective, post-operative visit observations of 167 clients found 10 AEs (5.9%); infection was common and boys 10–14 years old represented 80% of AE clients. Conclusions Evidence suggests underreporting of AEs in the Mozambican VMMC program. Quality improvement efforts should be implemented in all VMMC sites to improve AE identification, documentation and prevention efforts.http://link.springer.com/article/10.1186/s12913-019-4604-1Voluntary medical male circumcisionData qualityAdverse eventsMozambique |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Atanásio Brito Abigail Korn Leonel Monteiro Florindo Mudender Adelina Maiela Jotamo Come Scott Barnhart Caryl Feldacker |
spellingShingle |
Atanásio Brito Abigail Korn Leonel Monteiro Florindo Mudender Adelina Maiela Jotamo Come Scott Barnhart Caryl Feldacker Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment BMC Health Services Research Voluntary medical male circumcision Data quality Adverse events Mozambique |
author_facet |
Atanásio Brito Abigail Korn Leonel Monteiro Florindo Mudender Adelina Maiela Jotamo Come Scott Barnhart Caryl Feldacker |
author_sort |
Atanásio Brito |
title |
Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment |
title_short |
Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment |
title_full |
Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment |
title_fullStr |
Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment |
title_full_unstemmed |
Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment |
title_sort |
need for improved detection of voluntary medical male circumcision adverse events in mozambique: a mixed-methods assessment |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2019-11-01 |
description |
Abstract Background Adverse events (AE) resulting from voluntary medical male circumcision (VMMC) are commonly used to measure program quality. Mozambique’s VMMC program data reports a combined moderate and severe AE rate of 0.2% through passive surveillance. With active surveillance, similar programs report AE rates ranging from 1.0 to 17.0%. The objective of this activity was to assess potential underreporting of AEs via the passive surveillance system in Mozambique. Methods This mixed-methods assessment randomly selected one third (16) of all 46 VMMC clinics through stratified sampling, based on volume. A retrospective record review was conducted including patient clinical files, stock records of Amoxicillin/Clavulanic Acid (the choice antibiotic for VMMC-related infections), and clinic-level AE rates from the national database. Records from the month of April 21 to May 20, 2017 were analyzed to identify both reported and potentially unreported AEs. In addition, external, expert clinicians observed post-operative visits (n = 167). Descriptive statistics were calculated, including difference between reported and identified AEs, an adjusted retrospective AE rate, and an observed prospective AE rate in each clinic. Results A total of 5352 circumcisions were performed in the 16 clinics: 8 (0.15%) AEs were reported. Retrospective clinical record reviews identified 36 AEs (0.67%); AE severity or type was unknown. Using Amoxicillin/Clavulanic Acid dispensation as a proxy for VMMC-related infections, 39 additional AEs infections were identified, resulting in an adjusted AE rate of 1.4%, an 8.3 fold increase from the reported AE rate. Prospective, post-operative visit observations of 167 clients found 10 AEs (5.9%); infection was common and boys 10–14 years old represented 80% of AE clients. Conclusions Evidence suggests underreporting of AEs in the Mozambican VMMC program. Quality improvement efforts should be implemented in all VMMC sites to improve AE identification, documentation and prevention efforts. |
topic |
Voluntary medical male circumcision Data quality Adverse events Mozambique |
url |
http://link.springer.com/article/10.1186/s12913-019-4604-1 |
work_keys_str_mv |
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