Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic

Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic Olivia Mettler, Isabelle Smuts, Jesse von Mollendorff, Tarryn Gabler This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7198101/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Human immunodeficiency virus (HIV) remains hyperendemic in South Africa (SA). Circumcision reduces the risk of HIV transmission from female to male by 60% and is considered a mainstay in the public health attempt to prevent the spread of HIV. Neonatal Male Circumcision (NMC) is recommended by the World Health Organisation (WHO) alongside Voluntary Male Medical Circumcision (VMMC) in HIV hyperendemic areas due to benefits including ease of procedure, decreased complication rates and decreased cost. The WHO considers knowledge regarding circumcision a human right and recommends that education around circumcision begins with pregnant women at antenatal clinics. This study aims to assess the knowledge of pregnant women attending an antenatal clinic regarding circumcision. It explores knowledge surrounding religious, cultural and medical reasons for circumcision, costs, legislation, autonomy and the associated risks and benefits of NMC and VMMC. Methods A prospective cross-sectional study was conducted using a digital close-ended multiple- choice questionnaire. A pilot study was conducted to refine the questionnaire. The final calculated sample size was 408 participants. Data was analysed using Power Bi and Stata 17. Knowledge was assessed by comparing assigned knowledge scores to the median for each question, with a score above or equal to the median considered good knowledge. Results There was good knowledge regarding religious and medical reasons for circumcision, safety and complications, but poor knowledge regarding accessing VMMC. There are multiple common misconceptions regarding legislation in SA. There is a common misconception that circumcision cannot be performed in neonates, however, knowledge of the benefits of NMC was good. Conclusions Although knowledge surrounding circumcision is good, several common misconceptions exist, compounded by confusion brought about in SA legislation. There is ethical debate around the public health benefits of NMC in opposition to child autonomy and decision making. However, overwhelming benefits of NMC compared to VMMC necessitate further research regarding ethics, acceptability and accessibility of NMC as well as knowledge in the physician population treating these patients. Education surrounding circumcision in the antenatal population needs to be improved in line with the WHO recommendation that this is a human right. HIV circumcision neonatal circumcision antenatal clinic knowledge Background Circumcision is a surgical procedure to excise the prepuce of the male penis and is performed for various reasons at different ages. It is a religious practice in Judaism ( 1 , 2 ) and Islam ( 3 ), a cultural tradition to initiate boys into manhood, a medical procedure performed for health benefits and part of Voluntary Male Medical Circumcision (VMMC) campaigns ( 4 ). Circumcision is one of the mainstays in HIV prevention as it decreases the risk of HIV transmission from females to males by 60%. This is important in areas hyperendemic for HIV, such as SA where the prevalence of HIV between the ages of 15 and 49 years is approximately 13.5%, the highest in Africa ( 5 ). As such, the World Health Organisation (WHO) recommends upscaling the access and uptake of neonatal male circumcision (NMC) alongside VMMC especially in hyperendemic areas ( 4 ). NMC is advantageous over VMMC because of its simplicity, lower complication rates, and cost-effectiveness ( 4 ). The WHO deems knowledge about circumcision to be a human right and recommends education about circumcision to start with pregnant women attending antenatal clinics ( 6 ). There is, however, much controversy surrounding NMC in SA. Circumcision is regulated by various legislation, including the Children’s Act 38 of 2005 ( 7 ). According to section 129 of the act, a child may consent to surgery if over 12 years and can understand the risks, benefits and implications of the procedure, or is assisted by a parent/guardian ( 7 ). If the child does not meet these criteria, the parent/guardian may provide proxy consent. However, section 12( 8 ) stipulates that male circumcision under 16 years of age is illegal unless performed for religious or medical reasons ( 7 ). Circumcisions may only be legally performed over the age of 16 for social or cultural reasons. Specific medical indications are not stipulated in the act, and medical practitioners are legally able to perform circumcisions below the age of 16 to lower the risk of sexually transmitted infections and any broader interpretation of ‘medical reasons’ ( 8 ). Although this ethical debate about the child’s autonomy vs the benefit to the public health of the general population, and whether circumcision to reduce the risk of HIV transmission is a suitable medical reason for neonatal circumcision is an important discussion, it is not within the scope of this paper. This study aims only to assess the knowledge of circumcision in pregnant women attending an antenatal clinic (ANC) at Chris Hani Baragwanath Academic Hospital (CHBAH) as this knowledge is considered an integral part of the basic information that should be made available to all pregnant women ( 6 ). In Judaism, male circumcision is traditionally performed on the eighth day after birth by a religious figure called a mohel ( 2 ). In Islam, it is traditionally performed on the seventh day after birth but can be performed during puberty ( 3 ). Cultural circumcision is a practice performed among various cultures in SA, including Venda, Pedi, Xhosa, and other cultures that may not have been recognised in this source ( 5 ). Cultural circumcision is performed in adolescence, serving as an initiation into manhood ( 9 ). Traditional circumcision costs an average of R500 ( 10 ), while circumcision in the private sector costs an average of R1484 ( 11 ). These costs create a financial barrier to accessing safe circumcision ( 12 ) but are mitigated by the availability of free VMMC clinics. The health benefits of NMC are primarily preventative and may only be realised long after the procedure is performed ( 6 ). Documented benefits include a 60% decreased risk of female-to-male transmission of HIV and other sexually transmitted infections (STI), namely Herpes Simplex Virus (HSV) and Human Papilloma Virus (HPV); decreased risk of urinary tract infection (UTI) in the first six months of life; prevention of phimosis, paraphimosis, balanitis, and posthitis; decreased risk of cancer of the penis; and decreased risk of cervical cancer and bacterial vaginosis in female sexual partners ( 6 ). Specific benefits of NMC compared to older age groups are procedural simplicity (less vascular foreskin and less developed penis); suturing is usually unnecessary; faster healing time (within 5–7 days); lower complication rates; and fewer complications related to erections ( 6 ). In addition, NMC programs are more cost-effective ( 6 ). A systematic review concluded that adverse events in NMC were rare, with median occurrence rates of 1.5% for adverse events and 0% for serious adverse events ( 13 ). Possible complications include pain, bleeding, infection, injury to the penis and surrounding structures, poor cosmetic outcomes, meatitis, meatal stenosis, and reactions to local anaesthesia ( 13 ). While NMC can be performed for specific medical and religious reasons, this requires sufficient knowledge of the availability, medical benefits and the laws governing the procedure. Therefore, this study attempts to assess the knowledge of circumcision among mothers attending the ANC at CHBAH. Methods Aim This study aims to assess the knowledge of pregnant women attending an antenatal clinic regarding circumcision. It explores knowledge surrounding religious, cultural and medical reasons for circumcision, costs, legislation, autonomy and the associated risks and benefits of NMC and VMMC. Study design This was a prospective cross-sectional study. Setting This study was conducted in the ANC at CHBAH. This site was chosen because of the large number of patients seen in this clinic (3400 patients on average per month) allowing the sample size to be reached and for the access to paediatric surgery if parents required referral for circumcision. Study population and sampling strategy: Inclusion criteria for this study were all pregnant women over the age of 18 attending the ANC at CHBAH. Exclusion criteria for this study included pregnant women who declined participation and women under the age of 18 years. Furthermore, data was not collected on Thursdays as requested by the head of the Department of Obstetrics & Gynaecology because this is a high-risk clinic day and patients that have experienced complications from previous pregnancies and births may be triggered by some questions. Participants were selected via convenience sampling. A study conducted by Phili and Karim found the acceptability of NMC among 1778 pregnant women in KwaZulu-Natal to be 82.9% (14). This conservative proportion of 83% was used to estimate the representative sample size for the current study at 95% CI, with an alpha of 5% and an anticipated margin error of 5% due to other logistics and financial considerations. This resulted in an imputed sample size of 408 which was calculated using the Stata 17 Statistical program with the following formula: Power oneprop 0.3, diff (0.050) p(0.8) a(0.05). Data collection A digital questionnaire was created and used to collect the data using an anonymous Google form. This questionnaire contained close-ended, multiple-choice questions (please refer to Additional File 1). The questions were developed using information from three main sources (6,15,16). The answers were recorded and organised in an Excel spreadsheet. A pilot study of 60 patients attending the ANC at CHBAH was conducted to determine the useability of the questionnaire and identify any areas for improvement. This sample size was recommended by statisticians based on their calculation of the total sample size. The questionnaire did not require significant changes after the pilot study. Therefore, these 60 questionnaires from the pilot study were absorbed into the final study sample of 408 participants. The questionnaire was then administered to all pregnant women who provided informed written consent. Participants were given a handheld device, and the questionnaire was delivered electronically on a Google form. One of the researchers was available for the participant while they filled out the questionnaire to assist with understanding and translation if necessary. The following data points, regarding participant knowledge, were collected: Religious: Knowledge of circumcision performed for religious reasons. Which religions perform the procedure. The age at which religious circumcisions are performed. Culture: Knowledge of circumcision performed for cultural reasons. Which cultures perform the procedure. The age at which cultural circumcisions are performed. Who should perform the procedure. Cost of circumcision VMMC: Knowledge of the procedure Knowledge of free VMMC clinics Age at which boys are eligible for VMMC. Autonomy: Who should consent for the circumcision procedure. Age that a child can make their own decision regarding circumcision. Law: Knowledge of laws regarding circumcision Legal age and knowledge of religious, cultural, and medical exceptions permitting circumcision. Disclosure of the procedure to the child Medical Benefits of circumcision Risks and complications of circumcision Age at which risks and complications are lowest. NMC Safety of NMC Benefits of NMC compared to circumcision at an older age. After the mothers completed the questionnaire, they received a pamphlet containing information about circumcision. Data analysis Power Bi (Microsoft. 2024. Power BI Desktop. Redmond, WA: Microsoft Corporation) and Excel (Microsoft. 2024. Microsoft Excel. Redmond, WA: Microsoft Corporation) were used to visualize and analyse the data. Categorical data was expressed using frequencies and percentages. Percentages were calculated based on the number of responses to each question as some questions were follow-up questions, obtaining fewer responses, while others had the option to select multiple answers. Knowledge was assessed by assigning knowledge scores (KS) to the correct responses and comparing these to the median knowledge score (MKS) for each question. A knowledge score above or equal to the median was defined as having adequate knowledge. This method was derived from a study titled “Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study” (17). Only the researchers and supervisor had access to the raw data. Results The results are depicted in table 1 and 2 below. These show all the questions with their associated answers. [Insert Table 1 here] Table 1: Frequency distribution table for the first 14 questions and responses obtained from the questionnaire assessing knowledge of circumcision in pregnant mothers at CHBAH ANC. Responses are represented in number and percentage. The total number of responses is different for some questions as they were follow on questions and would only have been asked to the people who replied appropriately to the preceding question. Variable Number, (Frequency (%)) Do you know any religions in South Africa that practice religious circumcision? (n =408) Yes 268 (65,7) No 140 (34,3) Which religion(s) are you aware of that routinely practice circumcision? (n = 268) Traditional African Religions 146 (54,5) Christian 127 (47,4) Islam 28 (10,4) Judaism 8 (3,0) Hinduism 5 (1,9) Nazareth 1 (0,4) I don’t know 0 (0,0) No religion 5 (1,9) When do religious circumcisions usually get done? (n = 268) I don’t know 29 (10,8) Before 1 month of age 30 (11,2) Between 1 month and 12 years old 62 (23,1) 12 - 16 years 91 (34,0) Older than 16 years 56 (20,9) Do you know any cultures in South Africa that practice cultural circumcision? (n = 408) Yes 334 (81,9) No 74 (18,1) Which of the following perform cultural circumcisions? (n = 334) Afrikaans 20 (6,0) Coloured 20 (6,0) English 44 (13,2) Ethiopian 1 (0,3) Hindu 15 (4,5) Muslim 32 (9,6) Ndebele 65 (19,5) Pedi 85 (25,4) Sotho 149 (44,6) Swazi 23 (6,9) Tsonga 71 (21,3) Tswana 37 (11,1) Venda 58 (17,4) Xhosa 164 (49,1) Zulu 67 (20,1) At what age do cultural circumcisions usually get done? (n = 334) Before 1 month of age 24 (7,2) Between 1 month and 12 years old 65 (19,5) 12 years and older 114 (34,1) 16 years and older 131 (39,2) Who should perform the circumcision? (n = 334) Family or community member 6 (1,8) Medical doctor/ Healthcare professional 239 (71,6) Religious person trained to do circumcisions 13 (3,9) Traditional circumcision practitioner 76 (22,8) What does a circumcision cost? (n = 408) I don’t know 99 (24,3) Free 240 (58,8) Less than R500 20 (4,9) R500-1500 36 (8,8) More than R1500 13 (3,2) Have you heard about voluntary medical male circumcision? (n = 408) Yes 228 (55,9) No 180 (44,1) Do you know of places that do free voluntary medical male circumcision? (n = 228) Yes 195 (85,5) No 33 (14,5) Who should decide if your son needs circumcision? (n = 408) A community leader 3 (0,7) A healthcare professional 58 (14,2) A parent/guardian 274 (67,2) A religious leader 10 (2,5) It should be a joint decision by my son and any of the people above 51 (12,5) Your son 90 (22,1) Should circumcision wait to be done until your son can decide for himself if he wants it done or not? (n = 408) I don’t know 38 (9,3) Yes 189 (46,3) No 181 (44,4) At what age (in years) is a child able to decide if they want a circumcision? (n = 408) Answers with the 4 highest frequencies are highlighted in bold. 0 11 (2,7) 1 9 (2,2) 2 2 (0,5) 3 2 (0,5) 4 2 (0,5) 5 7 (1,7) 6 8 (2,0) 7 5 (1,2) 8 6 (1,5) 9 10 (2,5) 10 66 (16,2) 11 4 (1,0) 12 114 (27,9) 13 12 (2,9) 14 2 (0,5) 15 10 (2,5) 16 71 (17,4) 17 4 (1,0) 18 58 (14,2) 20 1 (0,2) 21 3 (0,7) 40 1 (0,2) It is better to tell a child that they are going to have a circumcision. (n = 408) I don’t know 23 (5,6) False 140 (34,3) True 245 (60,0) Amongst the participants who were aware of religious circumcisions performed in Islam and Judaism, 22.2% (8/36) selected that they were performed before one month of age. This correlates to a knowledge score of 8 which is above the median knowledge score of 5. In those who were aware of Christian religious circumcisions, the responses regarding the age of circumcision were distributed as follows: 12-16 years (31.5% 40/127), between one month and 12 years old (26.8% 34/127), before one month of age (15.8% 20/127), older than 16 years (13.4% 17/127), and 12.6% (16/127) did not know. [Insert Table 2 here] Table 2: Frequency distribution table for the last 10 questions and responses obtained from the questionnaire assessing knowledge of circumcision in pregnant mothers at CHBAH ANC. Responses are represented in number (knowledge score) and percentage. How the knowledge score corresponds to the Median Knowledge Score (MKS) is depicted in the third column. Those questions where the knowledge score for the correct answer was equal to or above the MKS are in bold. Those questions where the knowledge score was above or equal to the MKS for the incorrect answer are in italics. Variable Number [knowledge score], (Frequency (%)) Knowledge score compared to MKS There are laws in South Africa that govern circumcision. (n = 408; MKS = 97) I don’t know 97 (23,8) Equal False 25 (6,1) Below True 286 (70,1) Above Circumcision is illegal (not allowed by law) in SA if a child is younger than 16 and has no religious or medical reason for circumcision. (n = 408; MKS = 100) I don’t know 71 (17,4) Below False 237 (58,1) Above True 100 (24,5) Equal It is illegal (not allowed by law) to circumcise children under 12 years old for cultural reasons. (n = 408; MKS = 146) I don’t know 88 (21,6) Below False 174 (42,6) Above True 146 (35,8) Equal Children 12 years and older must understand what a circumcision is. They must understand the good and bad reasons for circumcisions. They must agree (assent) to have the circumcision done. This must happen otherwise it is illegal. (n = 408; MKS = 47) I don’t know 45 (11,0) Below False 47 (11,5) Equal True 316 (77,5) Above From what age can voluntary medical male circumcision be performed on your son? (n = 408; MKS = 109) I don’t know 98 (24,0) Below Less than 12 years old 120 (29,4) Above 12 years and older 131 (32,1) Above 16 years and older 59 (14,5) Below Why is it good to have a circumcision? (n = 408; MKS = 181, Average KS = 174,1) I don’t know 26 (6,4) Below Lower the chance of cancer and infections in female partners 157 (38,5) Below Lower the chance of cancer of the penis 155 (38,0) Below Lower the chance of emergency swelling of the penis (paraphimosis) 168 (41,2) Below Lower the chance of HIV infection 295 (72,3) Above Lower the chance of infection of the penis 194 (47,5) Above Lower the chance of sexually transmitted diseases (STDs) 301 (73,8) Above Lower the chance of tight foreskin ring (phimosis) 208 (51,0) Above Lower the chance of urinary infection 229 (56,1) Above None of the above 8 (2,0) Below What can go wrong when you have a circumcision? (n = 408; MKS = 146,7) I don’t know 34 (8,3) Below Allergic reaction to medication/anaesthetic 143 (35,0) Below Bleeding 247 (60,5) Above Infection 243 (59,6) Above Injury of penis 192 (47,1) Above Pain 262 (64,2) Above Poor cosmetic outcome (bad physical appearance) 109 (26,7) Below Redness of the opening of the penis 117 (28,7) Below Scarring of the urine opening 114 (27,9) Below None of the above 6 (1,5) Below Is it safe to perform circumcision in a baby less than 1 month old? (n = 408; MKS = 126) I don’t know 106 (26,0) Below Yes 176 (43,1) Above No 126 (30,9) Equal When are there less bad outcomes when getting a circumcision? (n = 408; MKS = 92,5) Circumcision performed less than 1 month 143 (35,0) Above Circumcision performed between 1 month and 12 years 99 (24,3) Above Circumcision performed between 12 years and 16 years 86 (21,1) Below Circumcision performed older than 16 years 80 (19,6) Below It may be better to perform circumcision in children less than 1 month old compared to adolescent circumcision. What are the good reasons? (n = 408; MKS = 160) I don’t know 63 (15,4) Below Complication rates are lower 192 (47,1) Above Healing is quicker 309 (75,7) Above The procedure is not complicated by erections 167 (40,9) Above They do not need stitches 153 (37,5) Below None of the above 12 (2,9) Below Discussion Circumcision may be performed for religious and/or cultural reasons. Over sixty percent (65.7%) of participants in our cohort were aware of religious circumcisions. The most recognized religions practicing circumcision in this cohort were Christian and traditional African religions (which overlap considerably with traditional African cultures and will be discussed later) (Table 1 ). This is incongruent with the most reported groups in the literature (Islam and Judaism) ( 2 ).This discrepancy could be accounted for by the scarcity of these religious groups in our study group inferred from the general population statistics with only 2% of South Africans identifying as Muslim and 0.2% as Jewish ( 18 ). What is notable is the common misconception that Christian religion requires circumcision with 47.7% of the study group choosing Christian faith as a reason for circumcision. The Children’s Act 38 of 2005 does not specifically define religious reasons for circumcision but stipulates that circumcision performed under the age of 16 for religious reasons must be “in accordance with the practices of the religion concerned and in the manner prescribed” ( 7 ). There are defined religious doctrines regarding circumcision in Islam and Judaism stating that the procedure be performed in the neonatal period ( 2 ). In our cohort, the participants who indicated that they knew of Islamic and Jewish circumcisions, had good knowledge about the age of circumcision before one month old, as it is outlined in the religious doctrines. On the other hand, Christians have varying beliefs and inconsistent practices regarding circumcision as it is not required by most Christian denominations, but it is still practiced by some communities (eg. Oriental Orthodox Churches who still perform NMC as a rite of passage) ( 19 ). Participants who were aware of Christian circumcisions reinforced these inconsistencies, with similar percentages choosing different age ranges in which the circumcision should be performed (Table 1 ). The lack of consistent practices and absence of a defined Christian religious doctrine regarding circumcision makes it difficult to apply the regulations stipulated in The Children’s Act 38 of 2005. This is of concern as this implies ambiguity in the majority (84.2%) of the South African population who identify as Christian ( 18 ). Knowledge of cultural circumcisions was high among our cohort (81.9%), with the most well-known cultures including Xhosa (49.1%), Sotho (44.6%), Pedi (25.4%), Tsonga (21.3%), Zulu (20.1%), Ndebele (19.5%), Venda (17.4%) (Table 1 ). Most of these African cultures are well described in the literature as performing traditional circumcisions at varying ages ( 5 ), most commonly between 12 and 22 years old ( 9 ). While reports of much younger initiates are common, there is little evidence that these cultures routinely practice neonatal male circumcision ( 20 ). Traditional African religions are very closely related to African cultures, and they have been analysed and discussed together as a result. Of the participants who indicated that they knew of traditional African Religious circumcisions, nearly forty percent of participants thought it was performed between 12–16 years, with fewer participants selecting the legal age above 16 years old (Table 1 ). This is in keeping with the traditional practices amongst different African Cultures ( 20 ). Half of the participants who were aware of Xhosa cultural circumcisions, indicated the age of circumcision to be above 16 years old which is consistent with the literature ( 20 ). Amongst participants who were aware of cultural circumcisions, most participants (71.6%) thought that the procedure should be performed by a Medical Doctor or Healthcare professional rather than a traditional circumcision practitioner, religious leader trained in circumcision or family/community member (Table 1 ). Despite the strong awareness of cultural circumcision, The Children’s Act 38 of 2005 does not provide for cultural reasons for circumcision below the age of 16, and this omission implies that cultural circumcision may only be legally performed after the age of 16. This creates legal barriers to access for those adolescents below the age of 16 seeking circumcision for purely cultural reasons ( 21 ). Regarding the cost of circumcision, many participants in our cohort (58.8%) thought that they were free, which is in accordance with the demographic of the participants surveyed who access public health care. However, several participants (16.9%) thought that there was a cost associated with circumcision which may create a financial barrier to accessing circumcision. In the public sector, free VMMC is the best option for many patients. However, only about half (55.9%) of the participants were aware of this option and fewer (47.8%) knew where to access it, creating a physical barrier to free VMMC (Table 1 ). Most participants (70.1%) stated that they were aware of laws governing circumcision in South Africa. The Children’s Act 38 of 2005 prohibits circumcision in boys younger than 16 years old. However, the General Regulations of Children make provision for circumcisions under the age of 16 for religious or medical reasons (Table 2 ) ( 7 , 21 ). Religious circumcisions can be performed at any age if it forms part of the doctrines for that religion and both parents / guardians have documented consent on Form 3 ( 21 ). Medical circumcisions can be performed in boys younger than 12 years old with the consent of a parent or guardian, or, above the age of 12 with the consent of the boy himself with assistance of a parent or guardian ( 7 ). Because of the strong recommendations from the WHO to increase access and uptake of circumcision in areas with a high prevalence of HIV, accurate information about male circumcision is considered a human right and should be freely accessible ( 9 , 22 ). When asked whether circumcision was illegal in children under 16 yrs (without religious or medical reasons) and whether it was illegal to circumcise boys under 12 yrs for cultural reasons, the correct answers were equivocal to the MKS. While a knowledge score equal to the median was considered good knowledge, we must also account for the high number of incorrect answers (Table 2 ). When comparing answers to the MKS, an incorrect answer score above the median (as is the case in these 2 questions) can either mean that the question was ambiguous or that there is a common misconception toward the falsehood in the population sampled ( 23 ). Since we conducted a pilot study and ratified the questions before hand, we believe that there is a strong common misconception in our population that circumcision is legal in children under the age of 16 for reasons outside medical indication or religious belief. As access to correct knowledge surrounding circumcisions is a human right ( 22 ) these equivocal numbers of correct answers as well as the high numbers of incorrect answers could reveal possible need for improvement in this area as insufficient legal knowledge may create a barrier to accessing and practicing legal circumcisions. Further research into this area is necessary. There was good knowledge regarding the fact that children over the age of 12 can legally have VMMC for medical reasons and that these children need to assent to the procedure, however, over two thirds of participants (67.2%) thought that the decision for circumcision should be made by the parent or guardian alone with only 12.5% of the cohort believing that the decision should be made by the parents/guardian in conjunction with the child (Table 2 ). These findings are contradictory suggesting the child should assent to the procedure but that the parents/guardian should decide on the performance of a circumcision without consulting the child. Ninety participants (22.1%) felt the decision for circumcision should be made by the child himself and 27.9% of the population felt that the age at which that decision could be made was 12 years old (Table 2 ). This shows good knowledge with respect to the laws surrounding circumcision but does show inconsistency with the understanding of child autonomy in surgical decision making. This discrepancy in knowledge speaks to the ongoing ethical debate surrounding circumcision and advocacy for children’s autonomy ( 24 ) In terms of the medical benefits of circumcision, mothers revealed good knowledge that it lowers the risk of HIV, STIs, UTIs, phimosis and infections of the penis (Table 2 ). This is in line with recommendations from the WHO which advocate for upscaling of circumcision primarily for the benefit of reduced transmission in HIV hyperendemic areas. However, there was poor knowledge that circumcision also lowers the chance of paraphimosis, cancer of the penis and cancer and infections in female partners (Table 2 ). This infers the need for improved education. In terms of the complications of circumcision, there was good knowledge about pain, bleeding, infection, injury and allergic reactions, but poor knowledge about urethral erythema, scarring and poor cosmetic outcomes. Poor knowledge in the above areas should direct the focus of future efforts at education. NMC is a safer procedure compared with adolescent/adult circumcision with lower complication rates ( 6 ). There was good knowledge of these facts specifically that circumcision can be performed in children less than 1 month old, that there are less complications when circumcision is performed below the age of 1 month, that healing is quicker and not complicated by erections. Only the fact that there is usually no need for sutures in NMC had poor knowledge. However, it is important to note that knowledge score for the question of whether you can perform a circumcision below the age of 1 month was equivocal for the answer of False. There were also 25% of the cohort that responded that they did not know if NMC were possible (Table 2 ). So, although knowledge surrounding NMC was good, there remains a common misconception that it isn’t safe and this needs to be addressed with good quality antenatal education because of the medical benefits and cost efficacy of NMC in resource limited settings with poor knowledge regarding access to VMMC ( 9 ). There were several limitations to this study. The study was conducted at a single ANC limiting the study’s generalizability. Convenience sampling at this site may have introduced sampling bias. Translation or explanation of questions by healthcare professionals may have created social desirability bias, as participants could alter their responses to align with perceived expectations. The questionnaire was only available in English, introducing language bias. However, the largest limitation in this study was that, after educating parents about NMC and its benefits, NMC is not available at CHBAH, nor is it available routinely in any government facilities in Johannesburg. NMC undoubtedly has significant benefits which is why is it recommended as a parallel program (which includes VMMC) for the prevention of HIV in hyperendemic countries. Roll out of NMC is legally challenging in SA because of the ambiguity in the definition of ‘medical reasons’. If one considers future protection against HIV transmission a valid medical reason for circumcision in a newborn in an HIV hyperendemic region (due to the ample scientific evidence of its benefits) then the law allows circumcision in all children for this medical reason ( 8 , 25 ) Although NMC does pose questions regarding the protection of the child’s right to bodily autonomy, in HIV hyperendemic areas, the public roll-out of NMC with an acceptability uptake of 50–80% could result in a decrease in HIV prevalence by 25–67% and save an estimated $ 2.3 billion over a 20-year period ( 25 ). Conclusion This study shows good knowledge in this cohort regarding many aspects of circumcision including decreased risk of HIV and other STI transmission, legal aspects of medical circumcision and benefits of NMC. It also elicited many areas for improved education including where to access VMMC, other benefits and risks associated with circumcisions, legality regarding age for cultural circumcision and safety of circumcision in children under 1 month of age. With the obvious benefit of NMC in public health regarding HIV, there is wide scope for further studies evaluating knowledge about NMC in practitioners dealing with mothers and neonatal circumcisions (e.g. clinic staff, obstetricians and gynaecologists, urologists and paediatric surgeons), acceptability of NMC and the implementation of NMC programs in public hospitals around South Africa. Abbreviations ANC – Antenatal Clinic CHBAH – Chris Hani Baragwanath Academic Hospital HIV – Human Immunodeficiency Virus HPV – Human Papilloma Virus HSV – Herpes Simplex Virus KS – Knowledge Score MKS – Median Knowledge Score NMC – Neonatal Male Circumcision SA – South Africa STI – Sexually Transmitted Infection UTI – Urinary Tract Infection VMMC – Voluntary Male Medical Circumcision WHO – World Health Organisation Declarations Ethics approval and consent to participate Ethics approval was acquired from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (protocol reference number: M231030). Approval was also obtained from the Medical Advisory Committee of CHBAH, the Academic and Clinical Heads of the Department of Paediatric Surgery of CHBAH and the Department of Obstetrics and Gynaecology of CHBAH. Written consent was obtained from all participants prior to receiving the questionnaire. This study adheres to the Declaration of Helsinki principles. Consent for publication All authors consent to publication of ‘Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic’ in the BMC Public Health journal. Availability of data and materials The data from this study will be secured in a database that is password-protected for a period of six years and made available from the corresponding author on reasonable request. Competing interests The authors have declared that no competing interest exists Funding The authors received no financial support for the research, authorship, and/or publication of this article. Author contributions O.M. for drafting of article abstract, introduction, literature review, methodology, ethical considerations, discussion and conclusion. I.S. (corresponding author) for designing the questionnaire, drafting the results section and literature review, data processing and analysis using Power Bi and managing referencing. J.vM. for assistance in drafting the literature review, revising and editing the article as well as formatting for publication. T.G. for conception of the article content and assistance with drafting, critically revising the article, data analysis and interpretation and approval of the version to be published. Acknowledgements Faatimah Dollie for data collection, assistance with research proposal and presentations Leigh Mogable for data collection and assistance with research proposal Preshanthi Naidoo for data collection and assistance with research proposal Hunadi Malatji for data collection and assistance with research proposal Setsweke Phala for data collection Dr Clarence Yah from the Department of Statistics at the University of The Witwatersrand for calculation of the study sample size. Disclaimer The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article's results, findings, and content. References Kacker S, Tobian AAR. Male Circumcision: Integrating Tradition and Medical Evidence. Isr Med Assoc J. 2013 Jan;15(1):37–8. Mark EW. The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. UPNE; 2003. 292 p. Alahmad G, Dekkers W. Bodily Integrity and Male Circumcision: An Islamic Perspective. J IMA. 2012 Mar 20;44(1):44-1–7903. World Health Organisation. Male circumcision: global trends and determinants of prevalence, safety and acceptability [Internet]. Geneva: World Health Organization; 2008 [cited 2023 May 5]. Available from: https://apps.who.int/iris/handle/10665/43749 Palmer E, Rau A, Engelbrecht M. Changing Cultural Practices: A Case Study of Male Circumcision in South Africa. American Journal of Men’s Health. 2020;14(4):1557988320927285. World Health Organisation, JHPIEGO. Manual for early infant male circumcision under local anaesthesia [Internet]. Geneva: World Health Organization; 2010 [cited 2023 Jul 6]. Available from: https://apps.who.int/iris/handle/10665/44478 Department of Justice. Children’s Act no. 38 of 2005. Government Gazette. 2006 Jun 19;492(28944). Honermann B. Neo-natal circumcision not in conflict with Children’s Act of 2005 [Internet]. SECTION27. 2010 [cited 2023 May 5]. Available from: https://section27.org.za/2010/08/neo-natal-circumcision-not-in-conflict-with-childrens-act-of-2005/ World Health Organisation. Traditional male circumcision among young people : a public health perspective in the context of HIV prevention. 2009;48. Douglas M, Hongoro C. The consideration of socioeconomic determinants in prevention of traditional male circumcision deaths and complications. American Journal of Men’s Health. 2018;12(3):597–607. Tchuenche M, Njeuhmeli E, Schütte C, Ngubeni L, Choge I, Martin E, et al. Voluntary medical male circumcision service delivery in South Africa: The economic costs and potential opportunity for private sector involvement. PLOS ONE. 2018 Dec 17;13(12):e0208698. Kaufman MR, Smelyanskaya M, Lith LMV, Mallalieu EC, Waxman A, Hatzhold K, et al. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review. PLOS ONE. 2016 Mar 3;11(3):e0149892. Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urology. 2010 Feb 16;10(1):2. Phili R, Karim QA. Acceptability of neonatal circumcision by pregnant women in KwaZulu-Natal, South Africa: original research. Curationis. 2015 Jan;38(1):1–5. Joint United Nations Programme on HIV/AIDS. Safe, voluntary, informed male circumcision and comprehensive HIV prevention programming: guidance for decision-makers on human rights, ethical and legal considerations. [Internet]. UNAIDS; 2008 [cited 2023 Jul 7]. Available from: https://www.cabdirect.org/cabdirect/abstract/20083157136 Joint United Nations Programme on HIV/AIDS WHO. Joint strategic action framework to accelerate the scale-up of voluntary medical male circumcision for HIV prevention in eastern and southern Africa, 2012–2016. 2011. Shezi MH, Tlou B, Naidoo S. Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study. BMC Public Health. 2023 Feb 16;23(1):349. Statistics South Africa. General Household Survey 2015 [Internet]. Pretoria; 2015 [cited 2024 May 7]. Available from: https://www.statssa.gov.za/publications/P0318/P03182015.pdf Stearns PN. The Oxford encyclopedia of the modern world [Internet]. Oxford University Press; 2008 [cited 2024 Jul 1]. 602 p. Available from: https://cir.nii.ac.jp/crid/1130282271728779392 Gwata F. Traditional male circumcision: What is its socio-cultural significance among young Xhosa men? 2009 [cited 2024 Jul 1]; Available from: https://open.uct.ac.za/handle/11427/19824 Strode AE, Toohey JD, Slack CM. Addressing legal and policy barriers to male circumcision for adolescent boys in South Africa : in practice - medicine and the law. South African Medical Journal. 2016 Dec;106(12):1173–6. UN Economic and Social Council. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant) [Internet]. UN Committee on Economic, Social and Cultural Rights (CESCR); 2000 [cited 2023 Jul 17]. Available from: https://www.refworld.org/docid/4538838d0.html Glynn SM, Britton BK, Yeany RH, editors. The Psychology of Learning Science. New York: Routledge; 2012. 280 p. McMath A. Infant male circumcision and the autonomy of the child: two ethical questions. Journal of Medical Ethics. 2015 Aug 1;41(8):687–90. Vawda YA, Maqutu LN. Neonatal circumcision – violation of children’s rights or public health necessity? South African Journal of Bioethics and Law. 2011;4(1):36–42. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 02 Nov, 2025 Reviewers agreed at journal 21 Oct, 2025 Reviewers agreed at journal 16 Oct, 2025 Reviewers invited by journal 16 Oct, 2025 Editor invited by journal 16 Sep, 2025 Editor assigned by journal 11 Aug, 2025 Submission checks completed at journal 08 Aug, 2025 First submitted to journal 08 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Clinic","fulltext":[{"header":"Background","content":"\u003cp\u003eCircumcision is a surgical procedure to excise the prepuce of the male penis and is performed for various reasons at different ages. It is a religious practice in Judaism (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and Islam (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), a cultural tradition to initiate boys into manhood, a medical procedure performed for health benefits and part of Voluntary Male Medical Circumcision (VMMC) campaigns (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Circumcision is one of the mainstays in HIV prevention as it decreases the risk of HIV transmission from females to males by 60%. This is important in areas hyperendemic for HIV, such as SA where the prevalence of HIV between the ages of 15 and 49 years is approximately 13.5%, the highest in Africa (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). As such, the World Health Organisation (WHO) recommends upscaling the access and uptake of neonatal male circumcision (NMC) alongside VMMC especially in hyperendemic areas (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). NMC is advantageous over VMMC because of its simplicity, lower complication rates, and cost-effectiveness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The WHO deems knowledge about circumcision to be a human right and recommends education about circumcision to start with pregnant women attending antenatal clinics (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere is, however, much controversy surrounding NMC in SA. Circumcision is regulated by various legislation, including the Children\u0026rsquo;s Act 38 of 2005 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to section 129 of the act, a child may consent to surgery if over 12 years and can understand the risks, benefits and implications of the procedure, or is assisted by a parent/guardian (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). If the child does not meet these criteria, the parent/guardian may provide proxy consent. However, section 12(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) stipulates that male circumcision under 16 years of age is illegal unless performed for religious or medical reasons (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Circumcisions may only be legally performed over the age of 16 for social or cultural reasons. Specific medical indications are not stipulated in the act, and medical practitioners are legally able to perform circumcisions below the age of 16 to lower the risk of sexually transmitted infections and any broader interpretation of \u0026lsquo;medical reasons\u0026rsquo; (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough this ethical debate about the child\u0026rsquo;s autonomy vs the benefit to the public health of the general population, and whether circumcision to reduce the risk of HIV transmission is a suitable medical reason for neonatal circumcision is an important discussion, it is not within the scope of this paper. This study aims only to assess the knowledge of circumcision in pregnant women attending an antenatal clinic (ANC) at Chris Hani Baragwanath Academic Hospital (CHBAH) as this knowledge is considered an integral part of the basic information that should be made available to all pregnant women (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Judaism, male circumcision is traditionally performed on the eighth day after birth by a religious figure called a mohel (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Islam, it is traditionally performed on the seventh day after birth but can be performed during puberty (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Cultural circumcision is a practice performed among various cultures in SA, including Venda, Pedi, Xhosa, and other cultures that may not have been recognised in this source (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Cultural circumcision is performed in adolescence, serving as an initiation into manhood (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Traditional circumcision costs an average of R500 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), while circumcision in the private sector costs an average of R1484 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These costs create a financial barrier to accessing safe circumcision (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) but are mitigated by the availability of free VMMC clinics.\u003c/p\u003e\u003cp\u003eThe health benefits of NMC are primarily preventative and may only be realised long after the procedure is performed (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Documented benefits include a 60% decreased risk of female-to-male transmission of HIV and other sexually transmitted infections (STI), namely Herpes Simplex Virus (HSV) and Human Papilloma Virus (HPV); decreased risk of urinary tract infection (UTI) in the first six months of life; prevention of phimosis, paraphimosis, balanitis, and posthitis; decreased risk of cancer of the penis; and decreased risk of cervical cancer and bacterial vaginosis in female sexual partners (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Specific benefits of NMC compared to older age groups are procedural simplicity (less vascular foreskin and less developed penis); suturing is usually unnecessary; faster healing time (within 5\u0026ndash;7 days); lower complication rates; and fewer complications related to erections (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In addition, NMC programs are more cost-effective (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A systematic review concluded that adverse events in NMC were rare, with median occurrence rates of 1.5% for adverse events and 0% for serious adverse events (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Possible complications include pain, bleeding, infection, injury to the penis and surrounding structures, poor cosmetic outcomes, meatitis, meatal stenosis, and reactions to local anaesthesia (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile NMC can be performed for specific medical and religious reasons, this requires sufficient knowledge of the availability, medical benefits and the laws governing the procedure. Therefore, this study attempts to assess the knowledge of circumcision among mothers attending the ANC at CHBAH.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAim\u003c/p\u003e\n\u003cp\u003eThis study aims to assess the knowledge of pregnant women attending an antenatal clinic regarding circumcision. It explores knowledge surrounding religious, cultural and medical reasons for circumcision, costs, legislation, autonomy and the associated risks and benefits of NMC and VMMC.\u003c/p\u003e\n \n\u003cp\u003eStudy design\u003c/p\u003e\n\u003cp\u003eThis was a prospective cross-sectional study.\u003c/p\u003e\n \n\u003cp\u003eSetting\u003c/p\u003e\n\u003cp\u003eThis study was conducted in the ANC at CHBAH. This site was chosen because of the large number of patients seen in this clinic (3400 patients on average per month) allowing the sample size to be reached and for the access to paediatric surgery if parents required referral for circumcision.\u003c/p\u003e\n \n\u003cp\u003eStudy population and sampling strategy:\u003c/p\u003e\n\u003cp\u003eInclusion criteria for this study were all pregnant women over the age of 18 attending the ANC at CHBAH. Exclusion criteria for this study included pregnant women who declined participation and women under the age of 18 years. Furthermore, data was not collected on Thursdays as requested by the head of the Department of Obstetrics \u0026amp; Gynaecology because this is a high-risk clinic day and patients that have experienced complications from previous pregnancies and births may be triggered by some questions. Participants were selected via convenience sampling. A study conducted by Phili and Karim found the acceptability of NMC among 1778 pregnant women in KwaZulu-Natal to be 82.9% (14). This conservative proportion of 83% was used to estimate the representative sample size for the current study at 95% CI, with an alpha of 5% and an anticipated margin error of 5% due to other logistics and financial considerations. This resulted in an imputed sample size of 408 which was calculated using the Stata 17 Statistical program with the following formula: Power oneprop 0.3, diff (0.050) p(0.8) a(0.05).\u003c/p\u003e\n \n\u003cp\u003eData collection\u003c/p\u003e\n\u003cp\u003eA digital questionnaire was created and used to collect the data using an anonymous Google form. This questionnaire contained close-ended, multiple-choice questions (please refer to Additional File 1). The questions were developed using information from three main sources (6,15,16). The answers were recorded and organised in an Excel spreadsheet. A pilot study of 60 patients attending the ANC at CHBAH was conducted to determine the useability of the questionnaire and identify any areas for improvement. This sample size was recommended by statisticians based on their calculation of the total sample size. The questionnaire did not require significant changes after the pilot study. Therefore, these 60 questionnaires from the pilot study were absorbed into the final study sample of 408 participants.\u0026nbsp;\u003c/p\u003e\n \n\u003cp\u003eThe questionnaire was then administered to all pregnant women who provided informed written consent. Participants were given a handheld device, and the questionnaire was delivered electronically on a Google form. One of the researchers was available for the participant while they filled out the questionnaire to assist with understanding and translation if necessary.\u0026nbsp;\u003c/p\u003e\n \n\u003cp\u003eThe following data points, regarding participant knowledge, were collected:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eReligious:\u003cul\u003e\n \u003cli\u003eKnowledge of circumcision performed for religious reasons.\u003c/li\u003e\n \u003cli\u003eWhich religions perform the procedure.\u003c/li\u003e\n \u003cli\u003eThe age at which religious circumcisions are performed.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eCulture:\u003cul\u003e\n \u003cli\u003eKnowledge of circumcision performed for cultural reasons.\u003c/li\u003e\n \u003cli\u003eWhich cultures perform the procedure.\u003c/li\u003e\n \u003cli\u003eThe age at which cultural circumcisions are performed.\u003c/li\u003e\n \u003cli\u003eWho should perform the procedure.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eCost of circumcision\u003c/li\u003e\n \u003cli\u003eVMMC:\u003cul\u003e\n \u003cli\u003eKnowledge of the procedure\u003c/li\u003e\n \u003cli\u003eKnowledge of free VMMC clinics\u003c/li\u003e\n \u003cli\u003eAge at which boys are eligible for VMMC.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eAutonomy:\u003cul\u003e\n \u003cli\u003eWho should consent for the circumcision procedure.\u003c/li\u003e\n \u003cli\u003eAge that a child can make their own decision regarding circumcision.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eLaw:\u003cul\u003e\n \u003cli\u003eKnowledge of laws regarding circumcision\u003c/li\u003e\n \u003cli\u003eLegal age and knowledge of religious, cultural, and medical exceptions permitting circumcision.\u003c/li\u003e\n \u003cli\u003eDisclosure of the procedure to the child\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eMedical Benefits of circumcision\u003c/li\u003e\n \u003cli\u003eRisks and complications of circumcision\u003cul\u003e\n \u003cli\u003eAge at which risks and complications are lowest.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eNMC\u003cul\u003e\n \u003cli\u003eSafety of NMC\u003c/li\u003e\n \u003cli\u003eBenefits of NMC compared to circumcision at an older age.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n \n\u003cp\u003eAfter the mothers completed the questionnaire, they received a pamphlet containing information about circumcision.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData analysis\u003c/p\u003e\n\u003cp\u003ePower Bi (Microsoft. 2024. Power BI Desktop. Redmond, WA: Microsoft Corporation) and Excel (Microsoft. 2024. Microsoft Excel. Redmond, WA: Microsoft Corporation) were used to visualize and analyse the data. Categorical data was expressed using frequencies and percentages. Percentages were calculated based on the number of responses to each question as some questions were follow-up questions, obtaining fewer responses, while others had the option to select multiple answers. Knowledge was assessed by assigning knowledge scores (KS) to the correct responses and comparing these to the median knowledge score (MKS) for each question. A knowledge score above or equal to the median was defined as having adequate knowledge. This method was derived from a study titled \u0026ldquo;Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study\u0026rdquo; (17). Only the researchers and supervisor had access to the raw data. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results are depicted in table 1 and 2 below. These show all the questions with their associated answers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 1 here]\u003c/p\u003e\n\u003cp\u003eTable 1: Frequency distribution table for the first 14 questions and responses obtained from the questionnaire assessing knowledge of circumcision in pregnant mothers at CHBAH ANC. Responses are represented in number and percentage. The total number of responses is different for some questions as they were follow on questions and would only have been asked to the people who replied appropriately to the preceding question.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNumber, (Frequency (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know any religions in South Africa that practice religious circumcision? (n =408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e268 (65,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e140 (34,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich religion(s) are you aware of that routinely practice circumcision? (n = 268)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTraditional African Religions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e146 (54,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e127 (47,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e28 (10,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eJudaism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e8 (3,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eHinduism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5 (1,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNazareth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e0 (0,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo religion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5 (1,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhen do religious circumcisions usually get done? (n = 268)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e29 (10,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eBefore 1 month of age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e30 (11,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eBetween 1 month and 12 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e62 (23,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e12 - 16 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e91 (34,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eOlder than 16 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e56 (20,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know any cultures in South Africa that practice cultural circumcision? (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e334 (81,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e74 (18,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhich of the following perform cultural circumcisions? (n = 334)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eAfrikaans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e20 (6,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eColoured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e20 (6,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e44 (13,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eEthiopian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eHindu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e15 (4,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e32 (9,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNdebele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e65 (19,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePedi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e85 (25,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSotho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e149 (44,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSwazi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e23 (6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTsonga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e71 (21,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTswana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e37 (11,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eVenda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e58 (17,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eXhosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e164 (49,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eZulu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e67 (20,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt what age do cultural circumcisions usually get done? (n = 334)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eBefore 1 month of age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e24 (7,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eBetween 1 month and 12 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e65 (19,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e12 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e114 (34,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e16 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e131 (39,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWho should perform the circumcision? (n = 334)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eFamily or community member\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6 (1,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMedical doctor/ Healthcare professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e239 (71,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eReligious person trained to do circumcisions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e13 (3,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTraditional circumcision practitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e76 (22,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat does a circumcision cost? (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e99 (24,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eFree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e240 (58,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eLess than R500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e20 (4,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eR500-1500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e36 (8,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMore than R1500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e13 (3,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you heard about voluntary medical male circumcision? (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e228 (55,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e180 (44,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know of places that do free voluntary medical male circumcision? (n = 228)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e195 (85,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e33 (14,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWho should decide if your son needs circumcision? (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eA community leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (0,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eA healthcare professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e58 (14,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eA parent/guardian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e274 (67,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eA religious leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e10 (2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eIt should be a joint decision by my son and any of the people above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e51 (12,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYour son\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e90 (22,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eShould circumcision wait to be done until your son can decide for himself if he wants it done or not? (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e38 (9,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e189 (46,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e181 (44,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAt what age (in years) is a child able to decide if they want a circumcision? (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAnswers with the 4 highest frequencies are highlighted in bold.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e11 (2,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e9 (2,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (0,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (0,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (0,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e7 (1,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e8 (2,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5 (1,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6 (1,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e10 (2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e66 (16,2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e4 (1,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e114 (27,9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e12 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (0,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e10 (2,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e71 (17,4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e4 (1,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e58 (14,2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (0,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIt is better to tell a child that they are going to have a circumcision. (n = 408)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e23 (5,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eFalse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e140 (34,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTrue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e245 (60,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmongst the participants who were aware of religious circumcisions performed in Islam and Judaism, 22.2% (8/36) selected that they were performed before one month of age. This correlates to a knowledge score of 8 which is above the median knowledge score of 5. In those who were aware of Christian religious circumcisions, the responses regarding the age of circumcision were distributed as follows: 12-16 years (31.5% 40/127), between one month and 12 years old (26.8% 34/127), before one month of age (15.8% 20/127), older than 16 years (13.4% 17/127), and 12.6% (16/127) did not know.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Insert Table 2 here]\u003c/p\u003e\n\u003cp\u003eTable 2: Frequency distribution table for the last 10 questions and responses obtained from the questionnaire assessing knowledge of circumcision in pregnant mothers at CHBAH ANC. \u0026nbsp;Responses are represented in number (knowledge score) and percentage. How the knowledge score corresponds to the Median Knowledge Score (MKS) is depicted in the third column. Those questions where the knowledge score for the correct answer was equal to or above the MKS are in bold. Those questions where the knowledge score was above or equal to \u0026nbsp;the MKS for the incorrect answer are in italics.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eNumber [knowledge score], (Frequency (%))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eKnowledge score compared to MKS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThere are laws in South Africa that govern circumcision. (n = 408; MKS = 97)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003e97\u003c/em\u003e (23,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eEqual\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFalse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e25 (6,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eTrue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e286\u003c/strong\u003e (70,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCircumcision is illegal (not allowed by law) in SA if a child is younger than 16 and has no religious or medical reason for circumcision. (n = 408; MKS = 100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e71 (17,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFalse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003e237\u003c/em\u003e (58,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eAbove\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eTrue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e100 (24,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEqual\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIt is illegal (not allowed by law) to circumcise children under 12 years old for cultural reasons. (n = 408; MKS = 146)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e88 (21,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFalse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003e174\u003c/em\u003e (42,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eAbove\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eTrue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e146\u0026nbsp;\u003c/strong\u003e(35,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEqual\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildren 12 years and older must understand what a circumcision is. They must understand the good and bad reasons for circumcisions. They must agree (assent) to have the circumcision done. This must happen otherwise it is illegal. (n = 408; MKS = 47)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e45 (11,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eFalse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003e47\u003c/em\u003e (11,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eEqual\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eTrue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e316\u003c/strong\u003e (77,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrom what age can voluntary medical male circumcision be performed on your son? (n = 408; MKS = 109)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e98 (24,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLess than 12 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003e120\u003c/em\u003e (29,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eAbove\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e12 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e131\u003c/strong\u003e (32,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e16 years and older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e59 (14,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhy is it good to have a circumcision? (n = 408; MKS = 181, Average KS = 174,1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e26 (6,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of cancer and infections in female partners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e157 (38,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of cancer of the penis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e155 (38,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of emergency swelling of the penis (paraphimosis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e168 (41,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of HIV infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e295\u003c/strong\u003e (72,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of infection of the penis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e194\u003c/strong\u003e (47,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of sexually transmitted diseases (STDs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e301\u003c/strong\u003e (73,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of tight foreskin ring (phimosis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e208\u0026nbsp;\u003c/strong\u003e(51,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eLower the chance of urinary infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e229\u003c/strong\u003e (56,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNone of the above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e8 (2,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat can go wrong when you have a circumcision? (n = 408; MKS = 146,7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e34 (8,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eAllergic reaction to medication/anaesthetic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e143 (35,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e247\u003c/strong\u003e (60,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e243\u003c/strong\u003e (59,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eInjury of penis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e192\u003c/strong\u003e (47,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e262\u003c/strong\u003e (64,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003ePoor cosmetic outcome (bad physical appearance)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e109 (26,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eRedness of the opening of the penis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e117 (28,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eScarring of the urine opening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e114 (27,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNone of the above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e6 (1,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs it safe to perform circumcision in a baby less than 1 month old? (n = 408; MKS = 126)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e106 (26,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e176\u0026nbsp;\u003c/strong\u003e(43,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003e126\u003c/em\u003e (30,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cem\u003eEqual\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhen are there less bad outcomes when getting a circumcision? (n = 408; MKS = 92,5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eCircumcision performed less than 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e143\u003c/strong\u003e (35,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eCircumcision performed between 1 month and 12 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99\u003c/strong\u003e (24,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eCircumcision performed between 12 years and 16 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e86 (21,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eCircumcision performed older than 16 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e80 (19,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIt may be better to perform circumcision in children less than 1 month old compared to adolescent circumcision. What are the good reasons? (n = 408; MKS = 160)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e63 (15,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eComplication rates are lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e192\u003c/strong\u003e (47,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eHealing is quicker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e309\u003c/strong\u003e (75,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eThe procedure is not complicated by erections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e167\u003c/strong\u003e (40,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbove\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eThey do not need stitches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e153 (37,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003eNone of the above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003e12 (2,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 200px;\"\u003e\n \u003cp\u003eBelow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCircumcision may be performed for religious and/or cultural reasons. Over sixty percent (65.7%) of participants in our cohort were aware of religious circumcisions. The most recognized religions practicing circumcision in this cohort were Christian and traditional African religions (which overlap considerably with traditional African cultures and will be discussed later) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This is incongruent with the most reported groups in the literature (Islam and Judaism) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).This discrepancy could be accounted for by the scarcity of these religious groups in our study group inferred from the general population statistics with only 2% of South Africans identifying as Muslim and 0.2% as Jewish (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). What is notable is the common misconception that Christian religion requires circumcision with 47.7% of the study group choosing Christian faith as a reason for circumcision. The Children\u0026rsquo;s Act 38 of 2005 does not specifically define religious reasons for circumcision but stipulates that circumcision performed under the age of 16 for religious reasons must be \u0026ldquo;in accordance with the practices of the religion concerned and in the manner prescribed\u0026rdquo; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). There are defined religious doctrines regarding circumcision in Islam and Judaism stating that the procedure be performed in the neonatal period (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In our cohort, the participants who indicated that they knew of Islamic and Jewish circumcisions, had good knowledge about the age of circumcision before one month old, as it is outlined in the religious doctrines. On the other hand, Christians have varying beliefs and inconsistent practices regarding circumcision as it is not required by most Christian denominations, but it is still practiced by some communities (eg. Oriental Orthodox Churches who still perform NMC as a rite of passage) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Participants who were aware of Christian circumcisions reinforced these inconsistencies, with similar percentages choosing different age ranges in which the circumcision should be performed (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The lack of consistent practices and absence of a defined Christian religious doctrine regarding circumcision makes it difficult to apply the regulations stipulated in The Children\u0026rsquo;s Act 38 of 2005. This is of concern as this implies ambiguity in the majority (84.2%) of the South African population who identify as Christian (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eKnowledge of cultural circumcisions was high among our cohort (81.9%), with the most well-known cultures including Xhosa (49.1%), Sotho (44.6%), Pedi (25.4%), Tsonga (21.3%), Zulu (20.1%), Ndebele (19.5%), Venda (17.4%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most of these African cultures are well described in the literature as performing traditional circumcisions at varying ages (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), most commonly between 12 and 22 years old (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). While reports of much younger initiates are common, there is little evidence that these cultures routinely practice neonatal male circumcision (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Traditional African religions are very closely related to African cultures, and they have been analysed and discussed together as a result. Of the participants who indicated that they knew of traditional African Religious circumcisions, nearly forty percent of participants thought it was performed between 12\u0026ndash;16 years, with fewer participants selecting the legal age above 16 years old (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This is in keeping with the traditional practices amongst different African Cultures (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Half of the participants who were aware of Xhosa cultural circumcisions, indicated the age of circumcision to be above 16 years old which is consistent with the literature (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Amongst participants who were aware of cultural circumcisions, most participants (71.6%) thought that the procedure should be performed by a Medical Doctor or Healthcare professional rather than a traditional circumcision practitioner, religious leader trained in circumcision or family/community member (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Despite the strong awareness of cultural circumcision, The Children\u0026rsquo;s Act 38 of 2005 does not provide for cultural reasons for circumcision below the age of 16, and this omission implies that cultural circumcision may only be legally performed after the age of 16. This creates legal barriers to access for those adolescents below the age of 16 seeking circumcision for purely cultural reasons (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding the cost of circumcision, many participants in our cohort (58.8%) thought that they were free, which is in accordance with the demographic of the participants surveyed who access public health care. However, several participants (16.9%) thought that there was a cost associated with circumcision which may create a financial barrier to accessing circumcision. In the public sector, free VMMC is the best option for many patients. However, only about half (55.9%) of the participants were aware of this option and fewer (47.8%) knew where to access it, creating a physical barrier to free VMMC (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMost participants (70.1%) stated that they were aware of laws governing circumcision in South Africa. The Children\u0026rsquo;s Act 38 of 2005 prohibits circumcision in boys younger than 16 years old. However, the General Regulations of Children make provision for circumcisions under the age of 16 for religious or medical reasons (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Religious circumcisions can be performed at any age if it forms part of the doctrines for that religion and both parents / guardians have documented consent on Form 3 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Medical circumcisions can be performed in boys younger than 12 years old with the consent of a parent or guardian, or, above the age of 12 with the consent of the boy himself with assistance of a parent or guardian (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Because of the strong recommendations from the WHO to increase access and uptake of circumcision in areas with a high prevalence of HIV, accurate information about male circumcision is considered a human right and should be freely accessible (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhen asked whether circumcision was illegal in children under 16 yrs (without religious or medical reasons) and whether it was illegal to circumcise boys under 12 yrs for cultural reasons, the correct answers were equivocal to the MKS. While a knowledge score equal to the median was considered good knowledge, we must also account for the high number of incorrect answers (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When comparing answers to the MKS, an incorrect answer score above the median (as is the case in these 2 questions) can either mean that the question was ambiguous or that there is a common misconception toward the falsehood in the population sampled (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Since we conducted a pilot study and ratified the questions before hand, we believe that there is a strong common misconception in our population that circumcision is legal in children under the age of 16 for reasons outside medical indication or religious belief. As access to correct knowledge surrounding circumcisions is a human right (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) these equivocal numbers of correct answers as well as the high numbers of incorrect answers could reveal possible need for improvement in this area as insufficient legal knowledge may create a barrier to accessing and practicing legal circumcisions. Further research into this area is necessary.\u003c/p\u003e\u003cp\u003eThere was good knowledge regarding the fact that children over the age of 12 can legally have VMMC for medical reasons and that these children need to assent to the procedure, however, over two thirds of participants (67.2%) thought that the decision for circumcision should be made by the parent or guardian alone with only 12.5% of the cohort believing that the decision should be made by the parents/guardian in conjunction with the child (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings are contradictory suggesting the child should assent to the procedure but that the parents/guardian should decide on the performance of a circumcision without consulting the child. Ninety participants (22.1%) felt the decision for circumcision should be made by the child himself and 27.9% of the population felt that the age at which that decision could be made was 12 years old (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This shows good knowledge with respect to the laws surrounding circumcision but does show inconsistency with the understanding of child autonomy in surgical decision making. This discrepancy in knowledge speaks to the ongoing ethical debate surrounding circumcision and advocacy for children\u0026rsquo;s autonomy (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn terms of the medical benefits of circumcision, mothers revealed good knowledge that it lowers the risk of HIV, STIs, UTIs, phimosis and infections of the penis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This is in line with recommendations from the WHO which advocate for upscaling of circumcision primarily for the benefit of reduced transmission in HIV hyperendemic areas. However, there was poor knowledge that circumcision also lowers the chance of paraphimosis, cancer of the penis and cancer and infections in female partners (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This infers the need for improved education. In terms of the complications of circumcision, there was good knowledge about pain, bleeding, infection, injury and allergic reactions, but poor knowledge about urethral erythema, scarring and poor cosmetic outcomes. Poor knowledge in the above areas should direct the focus of future efforts at education.\u003c/p\u003e\u003cp\u003eNMC is a safer procedure compared with adolescent/adult circumcision with lower complication rates (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). There was good knowledge of these facts specifically that circumcision can be performed in children less than 1 month old, that there are less complications when circumcision is performed below the age of 1 month, that healing is quicker and not complicated by erections. Only the fact that there is usually no need for sutures in NMC had poor knowledge. However, it is important to note that knowledge score for the question of whether you can perform a circumcision below the age of 1 month was equivocal for the answer of False. There were also 25% of the cohort that responded that they did not know if NMC were possible (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). So, although knowledge surrounding NMC was good, there remains a common misconception that it isn\u0026rsquo;t safe and this needs to be addressed with good quality antenatal education because of the medical benefits and cost efficacy of NMC in resource limited settings with poor knowledge regarding access to VMMC (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere were several limitations to this study. The study was conducted at a single ANC limiting the study\u0026rsquo;s generalizability. Convenience sampling at this site may have introduced sampling bias. Translation or explanation of questions by healthcare professionals may have created social desirability bias, as participants could alter their responses to align with perceived expectations. The questionnaire was only available in English, introducing language bias. However, the largest limitation in this study was that, after educating parents about NMC and its benefits, NMC is not available at CHBAH, nor is it available routinely in any government facilities in Johannesburg. NMC undoubtedly has significant benefits which is why is it recommended as a parallel program (which includes VMMC) for the prevention of HIV in hyperendemic countries. Roll out of NMC is legally challenging in SA because of the ambiguity in the definition of \u0026lsquo;medical reasons\u0026rsquo;. If one considers future protection against HIV transmission a valid medical reason for circumcision in a newborn in an HIV hyperendemic region (due to the ample scientific evidence of its benefits) then the law allows circumcision in all children for this medical reason (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) Although NMC does pose questions regarding the protection of the child\u0026rsquo;s right to bodily autonomy, in HIV hyperendemic areas, the public roll-out of NMC with an acceptability uptake of 50\u0026ndash;80% could result in a decrease in HIV prevalence by 25\u0026ndash;67% and save an estimated \u003cspan\u003e$\u003c/span\u003e2.3\u0026nbsp;billion over a 20-year period (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study shows good knowledge in this cohort regarding many aspects of circumcision including decreased risk of HIV and other STI transmission, legal aspects of medical circumcision and benefits of NMC. It also elicited many areas for improved education including where to access VMMC, other benefits and risks associated with circumcisions, legality regarding age for cultural circumcision and safety of circumcision in children under 1 month of age. With the obvious benefit of NMC in public health regarding HIV, there is wide scope for further studies evaluating knowledge about NMC in practitioners dealing with mothers and neonatal circumcisions (e.g. clinic staff, obstetricians and gynaecologists, urologists and paediatric surgeons), acceptability of NMC and the implementation of NMC programs in public hospitals around South Africa.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC \u0026ndash; Antenatal Clinic\u003c/p\u003e\n\u003cp\u003eCHBAH \u0026ndash; Chris Hani Baragwanath Academic Hospital\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHIV \u0026ndash; Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eHPV \u0026ndash; Human Papilloma Virus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHSV \u0026ndash; Herpes Simplex Virus\u003c/p\u003e\n\u003cp\u003eKS \u0026ndash; Knowledge Score\u003c/p\u003e\n\u003cp\u003eMKS \u0026ndash; Median Knowledge Score\u003c/p\u003e\n\u003cp\u003eNMC \u0026ndash; Neonatal Male Circumcision\u003c/p\u003e\n\u003cp\u003eSA \u0026ndash; South Africa\u003c/p\u003e\n\u003cp\u003eSTI \u0026ndash; Sexually Transmitted Infection\u003c/p\u003e\n\u003cp\u003eUTI \u0026ndash; Urinary Tract Infection\u003c/p\u003e\n\u003cp\u003eVMMC \u0026ndash; Voluntary Male Medical Circumcision\u003c/p\u003e\n\u003cp\u003eWHO \u0026ndash; World Health Organisation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was acquired from the Human Research Ethics Committee (Medical) of the University of the Witwatersrand (protocol reference number: M231030).\u0026nbsp;Approval was also obtained from the Medical Advisory Committee of CHBAH, the Academic and Clinical Heads of the Department of Paediatric Surgery of CHBAH and the Department of Obstetrics and Gynaecology of CHBAH. Written consent was obtained from all participants prior to receiving the questionnaire. This study adheres to the Declaration of Helsinki principles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors consent to publication of \u0026lsquo;Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic\u0026rsquo; in the BMC Public Health journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data from this study will be secured in a database that is password-protected for a period of six years and made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have declared that no competing interest exists\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eO.M. for drafting of article abstract, introduction, literature review, methodology, ethical considerations, discussion and conclusion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eI.S. (corresponding author) for designing the questionnaire, drafting the results section and literature review, data processing and analysis using Power Bi and managing referencing.\u003c/p\u003e\n\u003cp\u003eJ.vM. for assistance in drafting the literature review, revising and editing the article as well as formatting for publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eT.G. for conception of the article content and assistance with drafting, critically revising the article, data analysis and interpretation and approval of the version to be published. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFaatimah Dollie for data collection, assistance with research proposal and presentations\u003c/p\u003e\n\u003cp\u003eLeigh Mogable for data collection and assistance with research proposal \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePreshanthi Naidoo for data collection and assistance with research proposal\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHunadi Malatji for data collection and assistance with research proposal\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSetsweke Phala for data collection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Clarence Yah from the Department of Statistics at the University of The Witwatersrand for calculation of the study sample size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The authors are responsible for this article\u0026apos;s results, findings, and content.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKacker S, Tobian AAR. Male Circumcision: Integrating Tradition and Medical Evidence. Isr Med Assoc J. 2013 Jan;15(1):37\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMark EW. The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. UPNE; 2003. 292 p. \u003c/li\u003e\n\u003cli\u003eAlahmad G, Dekkers W. Bodily Integrity and Male Circumcision: An Islamic Perspective. J IMA. 2012 Mar 20;44(1):44-1\u0026ndash;7903. \u003c/li\u003e\n\u003cli\u003eWorld Health Organisation. Male circumcision: global trends and determinants of prevalence, safety and acceptability [Internet]. Geneva: World Health Organization; 2008 [cited 2023 May 5]. Available from: https://apps.who.int/iris/handle/10665/43749\u003c/li\u003e\n\u003cli\u003ePalmer E, Rau A, Engelbrecht M. Changing Cultural Practices: A Case Study of Male Circumcision in South Africa. American Journal of Men\u0026rsquo;s Health. 2020;14(4):1557988320927285. \u003c/li\u003e\n\u003cli\u003eWorld Health Organisation, JHPIEGO. Manual for early infant male circumcision under local anaesthesia [Internet]. Geneva: World Health Organization; 2010 [cited 2023 Jul 6]. Available from: https://apps.who.int/iris/handle/10665/44478\u003c/li\u003e\n\u003cli\u003eDepartment of Justice. Children\u0026rsquo;s Act no. 38 of 2005. Government Gazette. 2006 Jun 19;492(28944). \u003c/li\u003e\n\u003cli\u003eHonermann B. Neo-natal circumcision not in conflict with Children\u0026rsquo;s Act of 2005 [Internet]. SECTION27. 2010 [cited 2023 May 5]. Available from: https://section27.org.za/2010/08/neo-natal-circumcision-not-in-conflict-with-childrens-act-of-2005/\u003c/li\u003e\n\u003cli\u003eWorld Health Organisation. Traditional male circumcision among young people : a public health perspective in the context of HIV prevention. 2009;48. \u003c/li\u003e\n\u003cli\u003eDouglas M, Hongoro C. The consideration of socioeconomic determinants in prevention of traditional male circumcision deaths and complications. American Journal of Men\u0026rsquo;s Health. 2018;12(3):597\u0026ndash;607. \u003c/li\u003e\n\u003cli\u003eTchuenche M, Njeuhmeli E, Sch\u0026uuml;tte C, Ngubeni L, Choge I, Martin E, et al. Voluntary medical male circumcision service delivery in South Africa: The economic costs and potential opportunity for private sector involvement. PLOS ONE. 2018 Dec 17;13(12):e0208698. \u003c/li\u003e\n\u003cli\u003eKaufman MR, Smelyanskaya M, Lith LMV, Mallalieu EC, Waxman A, Hatzhold K, et al. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review. PLOS ONE. 2016 Mar 3;11(3):e0149892. \u003c/li\u003e\n\u003cli\u003eWeiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urology. 2010 Feb 16;10(1):2. \u003c/li\u003e\n\u003cli\u003ePhili R, Karim QA. Acceptability of neonatal circumcision by pregnant women in KwaZulu-Natal, South Africa: original research. Curationis. 2015 Jan;38(1):1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eJoint United Nations Programme on HIV/AIDS. Safe, voluntary, informed male circumcision and comprehensive HIV prevention programming: guidance for decision-makers on human rights, ethical and legal considerations. [Internet]. UNAIDS; 2008 [cited 2023 Jul 7]. Available from: https://www.cabdirect.org/cabdirect/abstract/20083157136\u003c/li\u003e\n\u003cli\u003eJoint United Nations Programme on HIV/AIDS WHO. Joint strategic action framework to accelerate the scale-up of voluntary medical male circumcision for HIV prevention in eastern and southern Africa, 2012\u0026ndash;2016. 2011. \u003c/li\u003e\n\u003cli\u003eShezi MH, Tlou B, Naidoo S. Knowledge, attitudes and acceptance of voluntary medical male circumcision among males attending high school in Shiselweni region, Eswatini: a cross sectional study. BMC Public Health. 2023 Feb 16;23(1):349. \u003c/li\u003e\n\u003cli\u003eStatistics South Africa. General Household Survey 2015 [Internet]. Pretoria; 2015 [cited 2024 May 7]. Available from: https://www.statssa.gov.za/publications/P0318/P03182015.pdf\u003c/li\u003e\n\u003cli\u003eStearns PN. The Oxford encyclopedia of the modern world [Internet]. Oxford University Press; 2008 [cited 2024 Jul 1]. 602 p. Available from: https://cir.nii.ac.jp/crid/1130282271728779392\u003c/li\u003e\n\u003cli\u003eGwata F. Traditional male circumcision: What is its socio-cultural significance among young Xhosa men? 2009 [cited 2024 Jul 1]; Available from: https://open.uct.ac.za/handle/11427/19824\u003c/li\u003e\n\u003cli\u003eStrode AE, Toohey JD, Slack CM. Addressing legal and policy barriers to male circumcision for adolescent boys in South Africa : in practice - medicine and the law. South African Medical Journal. 2016 Dec;106(12):1173\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eUN Economic and Social Council. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant) [Internet]. UN Committee on Economic, Social and Cultural Rights (CESCR); 2000 [cited 2023 Jul 17]. Available from: https://www.refworld.org/docid/4538838d0.html\u003c/li\u003e\n\u003cli\u003eGlynn SM, Britton BK, Yeany RH, editors. The Psychology of Learning Science. New York: Routledge; 2012. 280 p. \u003c/li\u003e\n\u003cli\u003eMcMath A. Infant male circumcision and the autonomy of the child: two ethical questions. Journal of Medical Ethics. 2015 Aug 1;41(8):687\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eVawda YA, Maqutu LN. Neonatal circumcision \u0026ndash; violation of children\u0026rsquo;s rights or public health necessity? South African Journal of Bioethics and Law. 2011;4(1):36\u0026ndash;42. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, circumcision, neonatal circumcision, antenatal clinic, knowledge","lastPublishedDoi":"10.21203/rs.3.rs-7198101/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7198101/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHuman immunodeficiency virus (HIV) remains hyperendemic in South Africa (SA). Circumcision reduces the risk of HIV transmission from female to male by 60% and is considered a mainstay in the public health attempt to prevent the spread of HIV. Neonatal Male Circumcision (NMC) is recommended by the World Health Organisation (WHO) alongside Voluntary Male Medical Circumcision (VMMC) in HIV hyperendemic areas due to benefits including ease of procedure, decreased complication rates and decreased cost. The WHO considers knowledge regarding circumcision a human right and recommends that education around circumcision begins with pregnant women at antenatal clinics. This study aims to assess the knowledge of pregnant women attending an antenatal clinic regarding circumcision. It explores knowledge surrounding religious, cultural and medical reasons for circumcision, costs, legislation, autonomy and the associated risks and benefits of NMC and VMMC.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective cross-sectional study was conducted using a digital close-ended multiple- choice questionnaire. A pilot study was conducted to refine the questionnaire. The final calculated sample size was 408 participants. Data was analysed using Power Bi and Stata 17. Knowledge was assessed by comparing assigned knowledge scores to the median for each question, with a score above or equal to the median considered good knowledge.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThere was good knowledge regarding religious and medical reasons for circumcision, safety and complications, but poor knowledge regarding accessing VMMC. There are multiple common misconceptions regarding legislation in SA. There is a common misconception that circumcision cannot be performed in neonates, however, knowledge of the benefits of NMC was good.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAlthough knowledge surrounding circumcision is good, several common misconceptions exist, compounded by confusion brought about in SA legislation. There is ethical debate around the public health benefits of NMC in opposition to child autonomy and decision making. However, overwhelming benefits of NMC compared to VMMC necessitate further research regarding ethics, acceptability and accessibility of NMC as well as knowledge in the physician population treating these patients. Education surrounding circumcision in the antenatal population needs to be improved in line with the WHO recommendation that this is a human right.\u003c/p\u003e","manuscriptTitle":"Assessing the knowledge of male circumcision among pregnant women attending the Chris Hani Baragwanath Academic Hospital Antenatal Clinic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 15:16:27","doi":"10.21203/rs.3.rs-7198101/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-02T21:11:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245026665831731410472618867116563638743","date":"2025-10-21T12:22:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220815606093154766121134293345993938633","date":"2025-10-16T11:57:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T11:19:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-16T12:36:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-11T09:50:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T14:28:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-08-08T14:25:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c82ff8b1-b86b-4cf7-b9be-da5a5d1b4809","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-30T15:16:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 15:16:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7198101","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7198101","identity":"rs-7198101","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}