Physicians' and nurses' thoughts and concerns about introducing neonatal male circumcision in Thailand: a qualitative study.

BACKGROUND: Neonatal male circumcision (NMC) is an alternative approach to adult male circumcision for HIV prevention. Recent studies found that NMC was rarely performed in Thailand and that most Thai health professionals did not recognize that NMC could reduce the risk of HIV infection and would not want NMC services in their hospitals. This study explored the thoughts and concerns of Thai government health staff regarding the introduction of NMC in government health facilities as a public health measure. METHODS: In-depth interviews with physicians, nurses and physician administrators from four different levels of government hospitals in four provinces representing 4 regions of Thailand were conducted after provision of education regarding the benefits and risks of NMC. Interviews were audio recorded and analyzed using Atlas.ti software to develop themes. RESULTS: Six themes emerged from the data of 42 respondents: understanding of the benefits of NMC; risks of NMC; need for a pilot project; need for staff training and hospital readiness; need for parental/family education; and need for public awareness educational campaign. Major concerns included possible medical complications of NMC, infringement of child rights, and lack of understanding from staff and parents. The respondents emphasized the need for a clear policy, proper training of staff, financial and equipment support, and piloting NMC rollout before this measure could be fully implemented. CONCLUSIONS: Thai health professionals who took part in this study expressed several concerns if NMC had to be performed in their health care facilities. There is significant preparation that needs to be done before NMC can be introduced in the country.

Thai health care provider knowledge of neonatal male circumcision in reducing transmission of HIV and other STIs.

BACKGROUND: Male circumcision (MC) reduces the risk of female-to-male transmission of HIV and other sexually transmitted infections (STIs). MC has not been practiced as a disease prevention measure in Thailand probably because of low recognition of its benefits among stakeholders. Neonatal male circumcision (NMC) is simpler, safer and cheaper than adult MC. This study aimed to assess Thai health care provider knowledge of benefits implementing NMC in Thailand. METHODS: Multi-stage sampling identified 16 government hospitals to represent various hospital sizes and regions of the country. Researchers administered a fixed choice questionnaire, developed by the research team based on a previous study, to physician administrators, practicing physicians, and nurses whose jobs involved NMC clinical procedures or oversight. The participants reviewed printed educational materials on the benefits of NMC during questionnaire completion. Data were analyzed using descriptive statistics, chi square tests, odds ratios, and logistic regression. RESULTS: One hundred thirty-three individuals participated in this quantitative study. Only 38% of the participants agreed that NMC reduced the risk of sexual transmission of HIV while 65% indicated that they knew that NMC prevented STIs. Most participants recognized the benefits of NMC on hygiene (96%) as well as cancer prevention (74%). Major concerns raised were potential trauma to the child, child rights and safety of NMC. After reviewing written information about the benefits of NMC, 59% of the participants agreed that NMC should be offered in their hospital. Physicians and nurses who had previous experience with circumcising patients of all ages were more reluctant to have NMC performed in their hospital. CONCLUSIONS: A clear policy advocating NMC, thorough preparation of health facilities, and staff training are needed before NMC could be used in Thailand as prevention strategy for HIV and other STIs.

Capability of Thailand to implement newborn male circumcision: a nation-wide survey.

This study was designed to gain baseline information on the capability of the hospitals of Thailand to provide newborn male circumcision (NC) and on the opinions of health-care personnel towards NC. Two questionnaires were sent to every hospital in Thailand that might have obstetrical services. One questionnaire requested information about the degree to which NC was provided by the hospital. The second questionnaire targeted health-care providers' opinions about NC. The response rate was 55.1% (747/1355). Of the 562 hospitals that had deliveries in 2010, 8.2% (46) provided at least one NC. Thirty-eight percent (35/92) of private hospitals and 2.3% (11/470) of government hospitals provided the service. The primary reason for performing NC was parental request (82.6%). Some providers (31.3%) said that NC was easy to perform and 39.1% thought NC was safe. Most respondents (91.8%) stated that physicians should perform the procedure instead of nurses, and choices about undergoing NC should be left to parents (55.0%). NC was rarely performed in government hospitals, and its staffs seemed to not recognize the health benefits of NC. A massive education program for health-care providers would be necessary before implementing a national program for NC. More information on the opinions of health authorities, health-care personnel and parents as well as cost-effectiveness studies are needed before a proper policy can be implemented.