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PLoS One. 2012;7(5):e36251. doi: 10.1371/journal.pone.0036251. Epub 2012 May 22.

The (mis)reporting of male circumcision status among men and women in Zambia and Swaziland: a randomized evaluation of interview methods.

Author information

1
HIV-AIDS Program, Population Council, Lusaka, Zambia. phewett@popcouncil.org

Abstract

BACKGROUND:

To date, male circumcision prevalence has been estimated using surveys of men self-reporting their circumcision status. HIV prevention trials and observational studies involving female participants also collect data on partners' circumcision status as a risk factor for HIV/STIs. A number of studies indicate that reports of circumcision status may be inaccurate. This study assessed different methods for improving self- and partner reporting of circumcision status.

METHODS/FINDINGS:

The study was conducted in urban and rural Zambia and urban Swaziland. Men (N = 1264) aged 18-50 and their female partners (N = 1264), and boys (N = 840) aged 13-17 were enrolled. Participants were recruited from HIV counseling and testing sites, health centers, and surrounding communities. The study experimentally assessed methods for improving the reporting of circumcision status, including: a) a simple description of circumcision, b) a detailed description of circumcision, c) an illustration of a circumcised and uncircumcised penis, and d) computerized self-interviewing. Self-reports were compared to visual examination. For men, the error in reporting was largely unidirectional: uncircumcised men more often reported they were circumcised (2-7%), depending on setting. Fewer circumcised men misrepresented their status (0.05-5%). Misreporting by women was significantly higher (11-15%), with the error in both directions. A sizable number of women reported that they did not know their partner's circumcision status (3-8%). Computerized interviewing did not improve accuracy. Providing an illustration, particularly for illiterate participants, significantly improved reporting of circumcision status, decreasing misreporting among illiterate participants from 13% to 10%, although misreporting was not eliminated.

CONCLUSIONS:

Study results suggest that the prevalence of circumcision may be overestimated in Zambia and Swaziland; the error in reporting is higher among women than among men. Improved reporting when a description or illustration is provided suggests that the source of the error is a lack of understanding of male circumcision.

PMID:
22629312
PMCID:
PMC3358314
DOI:
10.1371/journal.pone.0036251
[Indexed for MEDLINE]
Free PMC Article
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