Determinants of Poor Uptake of Voluntary Medical Male Circumcision by Males Aged 18-49 in Rural Zimbabwe. The Case of Mashonaland West Province

Uptake of VMMC services has remained low in Mashonaland West province with a total of 10,593 males having been circumcised since 2013 (MoHCC, 2013), with a percentage uptake of 7.2%, a figure way off the 80% target of circumcising 145, 646 by 2017 in the province. This low performance was transcending down to all districts which are implementing the VMMC programme. This study sought come up with determinates of poor uptake of the VMMC programme in Mashonaland West. An analytical cross sectional study design was used, where clients were drawn into the study and their circumcision status assessed at the same with measurement of the determinants variables to VMMC uptake. The study was carried out in Mashonaland West Province. Clients were interviewed from four of the seven districts of the province. 8 Key Informant interviews were conducted and an observation checklist was administered in 3 sites. Both circumcised and uncircumcised men aged 18-49 years found in the enumeration area during the course of the research, who consented to be enrolled in the study were included in the survey. Males below the age of 18 years and those above 49 years were excluded. Men residing outside the enumerated area were excluded. The sample size achieved by this survey was 718 with a response rate of 98.1%. Multistage sampling was employed with purposive sampling being utilized in the selection of 4 districts with the lowest Male Circumcision coverage which were Hurungwe and Mhondoro/Ngezi and the highest coverage in Sanyati and Kariba and then random selection of urban and rural wards in each respective district. Each district provided 25% of the sample size (175 men per district). The researchers randomly select one ward from the urban and one from the rural within each of the respective districts making up 4 rural and 4 urban wards to be randomly selected into the study. Then from each ward selected randomly systematic selection of households was done. A register of the number of households kept by the Town Council/Village Heads was used as a sampling frame and the sampling interval was calculated based on the number of households. The prevalence of male circumcision in Mashonaland West Province was found to be 12.3% in this study. Men in rural areas were less likely to be circumcised, indeed residing in rural areas was protective as men in rural areas were 0.83 less likely to be circumcised however this was not statistically significant [POR=0.83 (0.53-1.31) P-Value=0.49]. Educational level was found to be an effect modifier with those with none/primary education 3 times more likely to be circumcised [POR=3.00 95% CI (0.65-13.89)] compared to those that had attained secondary/tertiary level were 7.5 more times more likely to be circumcised after undergoing HIV testing and counselling [POR=7.5 95% CI (3.64-15.46)]. Church’s as sources of information were 15.5 times more likely to influence men to be circumcised [AOR=15.5 95%CI(3.8-63.2) P-value=0.00]. Those that failed initially to access MC services were 3.93 more times likely to be circumcised [AOR=3.93 95% CI (1.2-12.83) P-value=0.02]. Those referred for MC by counsellors were 7.17 time more likely to be circumcised [AOR=7.17 95%CI (3.34-15.41) P-value=0.00]. Men that indicated it reduces chances of penile cancer as a benefit were 3.35 times more likely to be circumcised compare to those that did not. [AOR=3.35 95% CI (1.67-6.7) P-value=0.00]. The messaging of male circumcision should take in cognisance the less educated population. There is need to decentralise the procedure to facilities in the periphery areas for easy access, and training of more nurses to ensure the procedure is not only limited to major hospitals alone. Thus need to accelerate task shifting allowing nurses to conduct the procedure be it surgical or Prepex device. They is need to design messages that target traditional/religious circumcising communities and specific messages for non-circumcising communities. Need to strengthen integration VMMC with HIV testing and counselling referral system. Need to give more emphasis of MC benefits such as reducing penile cancer, improved hygiene and cervical cancer for the 18-49 age groups to uptake MC.u0000