The (mis)reporting of male circumcision status by men and women in Zambia and Swaziland
N. Haberland1, B. Mensch1, L. Apicella2, P. Hewett3, J. Manda4, S. Abbott1
1Population Council, New York, United States, 2Population Council, Mbabane, Swaziland, 3Population Council, Lusaka, Zambia, 4Society for Family Health, Lusaka, Zambia
Background: As male circumcision (MC) programs are scaled-up for HIV prevention, measurement of MC prevalence in household-based surveys will be critical. Given that verification of circumcision status through physical examination is unlikely to be acceptable, there is a need to assess the reliability of self- and partner-reported MC status. This study sought to determine whether illustrations and/or interview methods improve accuracy of reporting.
Methods: The study was conducted in Lusaka, Zambia and Mbabane and Matsapha, Swaziland among men aged 18-50, their female partners, and adolescent boys aged 13-17. Over 400 males and females in each country were recruited in and around health clinics. Participants were randomized into one of three arms:
1) control arm that provided a detailed verbal description of MC in a face-to-face interview;
2) an arm that provided an illustration of a circumcised and uncircumcised penis during a face-to-face interview; and
3) an arm that provided the same illustration within the context of a computerized self-interview. Male respondents were requested to undergo a visual examination conducted by a trained clinician to verify their circumcision status.
Results: In Zambia and in Swaziland, preliminary findings show that between 5 and 9% of males reported they were circumcised when they were not. All but 3 circumcised men accurately reported their status. Female misreporting was higher (7 to 19%), with the error in reporting occurring in both directions. Although the illustration tended to lower misreporting, particularly for those who had low levels of literacy, the differences were not consistently statistically significant.
Conclusions: Misreporting of circumcision status by uncircumcised men occurs in both countries, but at levels lower than reported elsewhere. The illustration tended to lower misreporting, particularly for study participants who were not able to read. Misreporting by women is significantly higher than in men and is only marginally improved with an illustration.
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