Pre-circumcision screening for genital anomalies: 6-year experience from Pakistan

Area of Science:

• Pediatric Surgery
• Public Health
• Global Health

Background:

• Pre-circumcision genital screening is crucial for detecting anomalies requiring specialist care.
• In Pakistan, untrained providers often perform circumcisions, lacking routine screening.
• This study assessed health worker training for identifying genital anomalies in a Safe Circumcision Program (SCP).

Purpose of the Study:

• To evaluate the effectiveness of training health workers (HWs) to identify infant genital anomalies.
• To assess the feasibility and safety of task-shifting in low-resource settings for pre-circumcision screening.
• To improve early detection and referral of congenital anomalies in male infants.

Main Methods:

• Retrospective data review of 9,898 male infants screened between June 2016 and June 2022.
• Trained HWs performed pre-circumcision screening, referring infants with suspected anomalies.
• Analysis of concordance between HW and specialist diagnoses using Cohen's Kappa.

Main Results:

• 3.9% (382/9,898) of infants had suspected genital anomalies.
• Common anomalies included webbed penis (27.8%), hydrocele (21.0%), and hypospadias (11.6%).
• Overall concordance between HWs and specialists was 73.1%, with most discordance due to false positives.

Conclusions:

• Structured training enables HWs to competently identify genital anomalies, proving task-shifting is feasible and safe.
• Pre-circumcision screening by trained HWs prevents unsafe procedures in resource-limited settings.
• This approach facilitates timely specialist referral where routine newborn screening is absent.