Estimates of the prevalence of male circumcision in sub-Saharan Africa from 2010–2023 —A systematic review and meta-analysis

Male circumcision (MC) is a key part of the package of interventions to prevent HIV, the biggest health challenge in sub-Saharan Africa.To estimate the male circumcision prevalence and to evaluate the progress towards meeting WHO targets in sub-Saharan Africa during the period 2010–2023.We carried out a systematic review and meta-analysis of studies published during the period 2010–2023. We searched PubMed, Scopus, Cochrane CENTRAL, Google Scholar, WHO and the Demographic and Health Survey for reports on MC prevalence in sub-Saharan Africa. MC prevalence was synthesized using inverse-variance heterogeneity models, heterogeneity using I2 statistics and publication bias using funnel plots.A total of 53 studies were included. The overall prevalence during the study period was 45.9% (95% CI 32.3–59.8), with a higher MC prevalence in Eastern (69.9%, 95%CI 49.9–86.8) compared to Southern African (33.3%, 95%CI 21.7–46.2). The overall prevalence was higher in urban (45.3%, 95%CI 27.7–63.4) compared to rural settings (42.6%, 95% 26.5–59.5). Male circumcision prevalence increased from 40.2% (95% CI 25.0–56.3) during 2010–2015 to 56.2% (95% CI 31.5–79.5) during 2016–2023. Three countries exceeded 80% MC coverage, namely, Ethiopia, Kenya and Tanzania.Overall, the current MC prevalence is below 50%, with higher prevalence in Eastern African countries and substantially lower prevalence in Southern Africa. Most of the priority countries need to do more to scale up medical male circumcision programs.

男性割礼（MC）是预防艾滋病（HIV）这一撒哈拉以南非洲地区最大健康挑战的关键干预措施之一。为估算男性割礼的流行率并评估在2010年至2023年期间达到世界卫生组织（WHO）目标在撒哈拉以南非洲的进展，我们对该时期发表的研究进行了系统综述和荟萃分析。我们检索了PubMed、Scopus、Cochrane CENTRAL、Google Scholar、WHO以及人口与健康调查报告，以获取有关撒哈拉以南非洲男性割礼流行率的数据。采用逆方差异质性模型对男性割礼的流行率进行了综合分析，使用I2统计量评估异质性，并利用漏斗图评估发表偏倚。共纳入53项研究。研究期间的总流行率为45.9%（95%置信区间32.3–59.8），东部非洲的男性割礼流行率（69.9%，95%置信区间49.9–86.8）高于南部非洲（33.3%，95%置信区间21.7–46.2）。总体而言，城市地区的男性割礼流行率（45.3%，95%置信区间27.7–63.4）高于农村地区（42.6%，95%置信区间26.5–59.5）。男性割礼的流行率从2010年至2015年的40.2%（95%置信区间25.0–56.3）上升到2016年至2023年的56.2%（95%置信区间31.5–79.5）。三个国家的男性割礼覆盖率超过了80%，分别是埃塞俄比亚、肯尼亚和坦桑尼亚。总体而言，目前的男性割礼流行率低于50%，东部非洲国家的流行率较高，而南部非洲的流行率则显著较低。大多数优先国家需要采取更多措施以扩大男性医疗割礼项目。