Abstract
Childhood male circumcision is a key intervention for reducing the transmission of HIV infection. Despite its proven efficacy, the uptake of childhood male circumcision across Uganda remains suboptimal. This study assessed the caregiver acceptability, and uptake of voluntary medical circumcision among male children under five years old in Gulu city, Uganda. A cross-sectional quantitative approach was employed, involving multistage sampling strategy to randomly select 16 parishes from Gulu City’s two divisions. Systematic household sampling, and random caregiver selection using even-numbered random assignments was conducted. Data was collected through structured surveys administered to 427 caregivers of male children under five years old, using a questionnaire informed by Sekhon’s theory of acceptability of medical interventions. Sekhon’s theory constructs (affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, self-efficacy), with Likert scale and categorical questions to quantitatively evaluate caregivers’ perceptions of childhood male circumcision acceptability. Data was analysed using STATA version 18 to determine uptake, acceptability, and associated factors. Pearson’s chi-square and modified Poisson regression was used to determine factors associated with caregiver acceptability of childhood male circumcision, while controlling for caregiver gender, marital status, education level, occupation, residence, attendance at information sessions, community information availability, and father’s circumcision status. P < 0.05 was considered statistically significant. The acceptability of childhood male circumcision was 40.1% (95% CI: 35.4–44.8). Uptake of childhood male circumcision among study respondents was at 37.0% (158/427). Among the 269 (63.0%) who had not circumcised their children, 105 (39.0%) were unsure of considering it for their children. Having a circumcised father (aPR 2.6; 95% CI: 1.59–4.17, p < 0.001), information availability concerning childhood circumcision in the community (aPR: 1.2, 95% CI: 1.01–1.46, p = 0.034), and attending information sessions or talks about childhood male circumcision (aPR: 3.2; 95% CI: 2.09–4.82, p < 0.001) were significantly associated with the uptake of childhood male circumcision among respondents. Concerning factors significantly associated with the acceptability of childhood male circumcision, secondary level of education (aPR 1.6; 95% CI: 1.08–2.41, p = 0.019) and tertiary level of education (aPR 1.5; 95% CI: 1.01–2.34, p = 0.043), having attended information sessions (aPR 2.8; 95% CI: 2.00–4.04, p < 0.001), being in informal employment (aPR 1.2; 95% CI:1.01–1.52, p = 0.041) and having a circumcised father (aPR 2.9; 95% CI: 1.83–4.67, p < 0.001) were independently associated with acceptability of childhood male circumcision. Much as the uptake of childhood circumcision is still low in Gulu City, the caregiver acceptability is moderate but suboptimal. Specific interventions geared towards increasing information sessions, will improve on its acceptability, hence significantly enhancing uptake for HIV prevention.