Table 1 Circumcision complications of initiates assessed at four time points in percent

Pain

3 or 4 on pain scale

Mild

13.2

26.4

21.2

22 (11.5)

5 or 6 on pain scale

Moderate

5.0

7 on pain scale

Severe

Excessive bleeding

Dressing/bandage soaked through with blood at a routine follow-up visit

Mild

4.6

1.9

3.1

2 (1.0)

Bleeding that requires a special visit by the attendant for medical attention.

Moderate

Bleeding that requires a visit to hospital or clinic and surgical re-exploration to control

Severe

Infection

Erythema (redness of skin) more than one cm beyond incision

Mild

16.4

13.8

20.3

31 (16.2)

Purulent discharge (pus) from wound

Moderate

1.6

Cellulitis (infection spreading under the skin) or wound necrosis (gangrene or black, dead tissue) requiring hospitalization

Severe

Excessive skin removed

Client concerned, but there is no discernable abnormality

Mild

2.0

1.9

1.6

1 (0.5)

Skin is tight, but additional operative work not necessary

Moderate

Requires re-operation or transfer to a medical facility to correct the problem

Severe

Insufficient kin removed

Foreskin partially covers the head only when extended

Mild

13.2

14.4

17.1

20 (10.4)

Foreskin still partially covers the head and re-operation is required to correct

Moderate

Not applicable

Severe

Swelling or haema-toma (collection of blood)

More swelling than usual, but no significant discomfort

Mild

9.9

4.4

2.6

4 (2.1)

Significant tenderness and discomfort; no surgical procedure needed or only minor surgical re-exploration required

Moderate

Surgical re-exploration or visit to hospital or clinic required to correct

Severe

Damage to the penis

Mild bruising or injury, not requiring treatment

Mild

Bruise or injury to the head or shaft of the penis requiring pressure dressing or additional surgery to control or repair

Moderate

0.6

0.6

0.5

1 (0.5)

Portion or all of the head or shaft of the penis severed

Severe

Delayed wound healing

Healing takes longer than usual, but no extra treatment necessary

Mild

2.0

11.9

16.6

40 (20.8)

Additional non-operative treatment required

Moderate

Requires re-operation to correct or visit to clinic or hospital required

Severe

Problems with passing urine

Temporary complaints that resolves without treatment

Mild

1.3

1.9

2.1

2 (1.0)

Requires special return to the clinic, but no additional treatment required

Moderate

Requires referral to another facility for management

Severe

Dehydration

Severe thirst, but passed urine in past 24 hours and no dizziness

Mild

5.3

5.7

7.8

7 (3.6)

Severe thirst, and becoming light-headed, with no urine in past 24 hours

Moderate

No urine in past 24 hours and lost consciousness or required visit to hospital or clinic to provide fluids or to treat related medical problems, such as kidney failure

Severe

Appearance

Client concerned, but no discernable abnormality

Mild

2.6

3.8

0.5

1 (0.5)

Significant wound disruption or scarring, but does not require re-operation

Moderate

Requires re-operation

Severe