Male circumcision declines in Uganda
Uganda has registered a drastic decline in the number of voluntary medical male circumcisions (VMMCs) performed, from 900,000 procedures conducted annually in the past years to 556,000 in 2015, The Monitor reports. The manager of the Ministry of Health’s (MOH’s) AIDS control programme is quoted as saying that the reduction came after the government began giving VMMC clients two tetanus toxoid (TT)-containing vaccinations four weeks apart before circumcising them. The World Health Organization (WHO) recommended integrating TT vaccination into VMMC services after rare but fatal cases of tetanus infection were reported in Uganda and several other countries. WHO’s latest guidance, based on a technical review of tetanus cases after VMMC, recommends different approaches to TT vaccination depending on whether male circumcision is performed surgically or with an elastic-collar compression device. The Monitor reports that Uganda’s MOH is reviewing its policy and will likely move to giving one dose of TT-containing vaccine before surgical male circumcision but retain the two-dose schedule for nonsurgical VMMC procedures unless clients have documented evidence of adequate protection against tetanus (The Monitor, 8 February 2017).