innovating to save lives

Caution in Interpreting Demographic and Health Survey Male Circumcision Results

by: Ephrem Daniel Sheferaw1, Tigistu Adamu Ashengo2,3, Tadele B. Yitaferu1, Bedada S. Abebe1, Kelly Curran2,3 and Hannah L. Gibson1 affiliate: 1Jhpiego, an affiliate of Johns Hopkins University/Ethiopia, 2Jhpiego, an affiliate of Johns Hopkins University/USA, 3 Johns Hopkins Bloomberg School of Public Health

Background n Ethiopia has a high self-reported male

n Gambela region has the lowest MC

circumcision prevalence93% according to the 2005 Ethiopia Demographic and Health Survey (EDHS). prevalence (46%) as reported in the 2005 EDHS. prevalence in Ethiopia (6.7% compared to the national average of 0.9%). with technical support from Jhpiego and financial support from PEPFAR/ CDC started voluntary medical male circumcision (VMMC) program implementation in August 2009.

Regional Resident Population and EDHS Sampled Adult Male Ethnic Composition, 2011 n EDHS adult male sample size was 940:
n 381 from indigenous ethnic groups n 559 from non-indigenous ethnic groups

n MC prevalence by ethnic group:

n n n n

n Gambela has the highest adult male HIV n The Gambela Regional Health Bureau

MC Prevalence according to the 2005 and 2011 EDHS

EDHS 2005 EDHS 2011
Tigray Tigray
ul-

12.3% (N=81) among Anyiuwak 6.8% (N=240) among Nuwer 1.7% (N=60) for Mejenger 97.7% (N=559) among non-indigenous ethnic groups

n The 2011 DHS reported MC prevalence

g an ish z n Be umu G

Amhara

Afar

0% - 50% 51% - 80% 81% - 100%

Dire Dawa Addis Ababa Harari

g an ish z n Be umu G

ul-

Amhara

Afar

Adult MC Prevalence by Ethnic Group in Gambela, 2011 EDHS

% Circumcised
Somali

Dire Dawa Addis Ababa Harari

of 92% for Ethiopia and 76% for Gambela region.

46%

Gambela 46% Southern Nations, Nationalities, and People's Region 79%

Oromia

Somali

76%

Gambela 76% Southern Nations, 51% - 80% Nationalities, and People's Region 79%

Oromia

97.7% 76%

79%

79%

Background of Gambela Region n Population: 306,916 n More than 65 ethnic groups with 3 major
indigenous groups

Regional Ethnic Composition, Census 2007

4%

How Did MC Prevalence in Gambela Increase Dramatically from 2005 to 2011? n The Ethiopia 2011 DHS data collection
n Before June 2011, fewer than 2,000
clients (< 5% of the adult male population) received VMMC services.

Indigenous Ethnic Groups of Gambela

1.7% Mejenger 6.8% Nuwer 12.3% Anuwak Other Ethnic Groups in Gambela Gambela Average

period was December 2010 to June 2011.

Conclusion

28%

21%

Indigenous - Mejenger Indigenous - Anyiwak Indigenous - Nuwer Non-Indigenous

n To assess the cause of the increased MC

prevalence, secondary data analysis was conducted.

47%

The Change in MC Prevalence between the 2005 and 2011 EDHS

90%

n The regional adult MC prevalence in the 2011 EDHS was calculated based on a sample that was predominantly (60%) non-indigenous. n Interpretation of the results of selfreported MC prevalence from DHS surveys should take into consideration the representativeness of the sampled population.

Percentage of Adult Males Circumcised

VMMC Program in Ethiopia n The Federal HIV/AIDS Prevention and

n To reach 80% MC prevalence, an

80% 70% 60% 50% 40% 30% 20% 10% 0% EDHS 2005 MC Program Performance 2005-2011 (until June 2011) The gap between program and survey

79%

80%

References

1. Central Statistical Agency [Ethiopia] and

Control Office included VMMC as part of the HIV prevention strategy in 2009. estimated 40,000 men aged 1549 need to be circumcised in Gambela by 2015, according to modeling estimates. adult males received VMMC services in health facilities in Gambela region.

46%

51%

EDHS 2011 (June 2011)

Program Target for 2015

n As of October 2013, more than 32,588

Time Period

Regional Resident Population and EDHS Sampled Adult Male Ethnic Composition, 2011
Non-indigenous (Amhara, Oromo, Tigre and other Ethiopian ethnic groups) Indigenous (Nuwer, Anyiwak, Mejenger) 28%

60%

72%

40%
Regional Samples of EDHS 2011

ORC Macro. 2006. Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro. 2. Central Statistical Agency [Ethiopia] and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International. 3. Federal Democratic Republic of Ethiopia Population and Housing Census Commission [Ethiopia]. 2009. Summary and Statistical Report of the 2007 Population and Housing Census. Addis Ababa, Ethiopia: Central Statistical Agency.

Population Size of Ethnic Groups Residing in Gambela