Adverse Events

Adverse events (AEs) related to male circumcision are defined as any injuries, harm, or undesired outcomes occurring during or following male circumcision that would not have occurred if the client had not undergone the procedure. AEs can be classified by severity, timing, and type. AE reporting provides data required for monitoring of service delivery and patient safety.

Rapid scale-up of VMMC has resulted in concerns regarding the management of AEs, especially during peak circumcision seasons. When short-staffed facilities face large influxes of VMMC clients, attention to detail regarding client safety might be compromised. Inconsistencies in identifying, recording, monitoring, handling, and reporting of AEs have been frequently been documented as areas needing improvement across sites.

Strategies for reducing AEs focus on increasing client follow-up rates; in-service training for VMMC staff on AE identification, classification, and management (including treatment and referral); and empowering clients with adequate information related to wound healing, wound care, importance of sexual abstinence for six weeks, signs of complications, and the importance of follow-up at 48 hours, seven days and six weeks after the procedure.

Regardless of provider experience, AEs can occur at any time during or after circumcision. It is important for facilities offering VMMC services to be able to identify, document, and report AEs to inform decision making. Proper management of AEs at the site level plays a crucial role in the successful implementation of VMMC programs.

Quality issues:

  • Poor surveillance and documentation of AEs
  • Poor pre-procedure physical examination and client history taking
  • Inadequate health worker training and/or clinical experience
  • Low capacity to manage VMMC follow-ups and identify AEs
  • Insufficient infection prevention measures
  • Inconsistent provision of information to clients regarding possible signs of AEs and post-operative wound care
  • Poor client knowledge on AEs, wound care, and VMMC follow-up

Resources

This guide was developed to help VMMC program managers address the most common adverse events (AEs) associated with both surgical and device-related male circumcision.

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The document provides recommendations from the USAID ASSIST Project in South Africa for addressing challenges that are commonly experienced in VMMC programs.

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These guidelines issued by the National Department of Health of the Republic of South Africa, provide comprehensive guidance for organizing and assuring the quality of VMMC service delivery.

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This case study describes how the CQI team at mobile van clinic in operating in Kayunga, Mukono, Buikwe, and Buvuma districts of Uganda improved its detection and management of adverse events.

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This excerpt from the Guide to Improving the Quality of Safe Male Circumcision in Uganda describes the successful changes tested by CQI teams to reduce rates of moderate and severe adverse events.

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