A Nationwide Community Survey of Prevalence of Circumcision among Egyptian Children and Risk of Hepatitis B Viral Infection


  • Iman I Salama Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Samia M Sami Department of Child Health, National Research Centre, Cairo, Egypt
  • Somaia I Salama Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Dalia M Elmosalami Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Rehan M Saleh Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Zeinab N Said Department of Microbiology and Immunology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
  • Fatma A Shaaban Department of Child Health, National Research Centre, Cairo, Egypt
  • Aida M Abdel Mohsen Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Thanaa Mahmoud Rabah Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Ghada A Abdel-Latif Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Walaa A Fouad Department of Community Medicine, National Research Centre, Cairo, Egypt
  • Amira Mohsen




Circumcision, HBV, National survey, Egypt, Children


AIM: To assess prevalence and risk factors of circumcision among Egyptian children and to assess the risk factors for HBV infection among them.

METHODS: A nationwide community survey was carried out on 3306 children aged from 9 months to 16 years, of both genders. Data were collected during face to face interviews with the parents and children. All studied children had received HBV vaccination during infancy. Total anti-HBc and HBsAg were assessed by ELISA followed by HBV DNA detection for positive cases by Real-time PCR.

RESULTS: Prevalence of circumcision was 92.3% among boys and 29.7% among girls. The percentage of circumcised girls was significantly higher in rural (38.1%) than urban (21.1%), P<0.01 and more in Upper (42.2%) and Lower Egypt (27.6%) compared to Cairo, the Capital (14.1%), P˂0.001. Boys showed significantly higher prevalence of circumcision in urban (94.1%) compared to rural areas (90.1%), P˂ 0.001.The prevalence of HBV breakthrough infection, detected by HBV-DNA, was 14/3306 (0.42%). No significant differences between circumcised and non-circumcised boys and girls regarding the different serological tests of HBV infection, P > 0.05. Using logistic regression analysis, mothers’ illiteracy or having primary and preparatory education carried six times and 2 times risk respectively of having their daughter circumcised compared to higher education, P < 0.01. Living in Upper or Lower Egypt carried three times and 1.5 times risk respectively of having circumcised girl compared to the Capital, P < 0.001. HBV infection among family was the independent risk factor for HBV infection among girls and boys, in addition to frequent medical injection among boys, P < 0.05.

CONCLUSION: Circumcision among girls is still a problem especially in Upper Egypt and in rural areas. Child circumcision in Egypt seems not to play a role in HBV infection and intra-familial HBV transmission and frequent medical injection are the most important risk factors.


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WHO-UNAIDS. Male Circumcision: Global Trends and Determinants of Prevalence, Safety and Acceptability; 2007. Available from: https://www.who.int/reproductivehealth/ publications/rtis/9789241596169/en. [Last accessed on 2020 Jan 25].

World Health Organization: Traditional Male Circumcision among Young People; 2009. Available from: https://www.who.int/maternal_child_adolescent/documents/9789241598910/en. [Last accessed on 2019 Dec 12].

Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, et al. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr. 2016;14:4. https://doi.org/10.1186/s12963-016-0080-6 PMid:26933388

Modrek S, Liu JX. Exploration of pathways related to the decline in female circumcision in Egypt. BMC Public Health. 2013;13:921. https://doi.org/10.1186/1471-2458-13-921 PMid:24090097

Odukogbe AT, Afolabi BB, Bello OO, Adeyanju AS. Female genital mutilation/cutting in Africa. Transl Androl Urol. 2017;6(2):138-48. https://doi.org/10.21037/tau.2016.12.01 PMid:28540220

UNICEF. Female Genital Mutilation in Egypt: Recent Trends and Projections. FGM-Brochure-Recent-Trends-Projections-Egypt- English-2020; 2020. Available from: https://www.data.unicef. org/resources/female-genital-mutilation-in-egypt-recent-trends-and-projections. [Last accessed on 2020 Oct 09]. https://doi.org/10.31899/rh11.1045

Peltzer K, Kanta X, Banyini M. Evaluation of a safer male circumcision training programme for Ndebele traditional surgeons and nurses in Gauteng, South Africa: Using direct observation of circumcision procedures. Afr J Tradit Complement Altern Med. 2009;7(2):153-9. https://doi.org/10.4314/ajtcam.v7i2.50876 PMid:21304627

Brewer DD. Scarification and male circumcision associated with HIV infection in Mozambican children and youth. Webmed Cent Epidemiol. 2011;2(9):WMC002206.

Ayeni OA, Ayeni OO, Jackson R. Observations on the procedural aspects and health effects of scarification in sub- Saharan Africa. J Cutan Med Surg. 2007;11(6):217-21. https://doi.org/10.2310/7750.2007.00026 PMid:18042335

World Health Organization. Global Hepatitis Report, 2017. Geneva: World Health Organization; 2017. Available from: https://www.who.int/hepatitis/publications/globalhepatitis-report2017/en. [Last accessed on 2019 Jun 10].

World Health Organization. Hepatitis B Fact Sheet No. 204; 2020. Available from: https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-b. [Last accessed on 2019 Aug 23].

Spearman CW, Afihene M, Ally R, Apica B, Awuku Y, Cunha L, et al. Hepatitis B in sub-Saharan Africa: Strategies to achieve the 2030 elimination targets. Lancet Gastroenterol Hepatol. 2017;2(12):900-9. https://doi.org/10.1016/s2468-1253(17)30295-9 PMid:29132759

Mousa H. Transmission of blood borne infections by circumcision procedure. J Infect Dis Ther. 2015;3(3):e107.

Sami SM, Salama II, Abdel-Latif GA, El Etreby LA, Metwally AI, Abd El Haliem NF. Hepatitis B seroprotection and the response to a challenging dose among vaccinated children in red sea governorate. Open Access Maced J Med Sci. 2016;4(2):219-25. https://doi.org/10.3889/oamjms.2016.043 PMid:27335590

Fahmy SI, El-Sherbiny AF. Determining simple parameters for social classifications for health research. Bull High Inst Public Health. 1983;13(5):95-107.

Salama II, Sami SM, Said ZN, Salama SI, Rabah TM, Abdel- Latif GA, et al. Early and long term anamnestic response to HBV booster dose among fully vaccinated Egyptian children during infancy. Vaccine. 2018;36:2005-11. https://doi.org/10.1016/j.vaccine.2018.02.103 PMid:29530634

Lau FK, Jayakumar S, Sgaier SK. Understanding the socio-economic and sexual behavioural correlates of male circumcision across eleven voluntary medical male circumcision priority countries in Southeastern Africa. BMC Public Health. 2015;15:813. https://doi.org/10.1186/s12889-015-2135-1

Tram KH, Bertrand JT. Correlates of male circumcision in Eastern and Southern African countries: Establishing a baseline prior to VMMC scale-up. PLoS One. 2014;9(6):e100775. https://doi.org/10.1371/journal.pone.0100775 PMid:24955963

Weiss HA, Plummer ML, Changalucha J, Mshana G, Shigongo ZS, Todd J, et al. Circumcision among adolescent boys in rural Northwestern Tanzania. Trop Med Int Health. 2008;13(8):1054- 61. https://doi.org/10.1111/j.1365-3156.2008.02107.x PMid:18564352

Aziz S, Khanani R, Noorulain, W, Rajper J. Frequency of hepatitis Band C in rural and peri urban Sindh. J Pak Med Assoc. 2010;60(10):853-7. PMid:21381619

Tosun S, Balik I, Inan N, Saltoğlu N, Ormeci N, Sencan I, et al. The relationship between the methods of male circumcision procedures used in the past and the prevalence of viral hepatitis. Viral Hepat J. 2016;22(1):6-9. https://doi.org/10.4274/vhd.65487

Tag-Eldin MA, Gadallah MA, Al-Tayeb MN, Abdel-Aty M, Mansour E, Sallem M. Prevalence of female genital cutting among Egyptian girls. Bull World Health Organ. 2008;86:269-74. https://doi.org/10.2471/blt.07.042093

Egypt Health Issues Survey, Ministry of Health and Population, Cairo, Egypt. El-Zanaty and Associates, Cairo, Egypt. Rockville, Maryland, USA: The DHS Program, ICF International; 2015. Available from: https://www.dhsprogram.com/pubs/pdf/fr313/ fr313.pdf. [Last accessed on 2019 Sep 15].

UNICEF, FEMALE Genital Mutilation/Cutting: A Global Concern; 2016. p. 1-2. Available from: https://www.unicef.org/media/files/ fgmc_2016_brochure_final_unicef_spread.pdf. [Last accessed on 2019 Jun 19].

El-Zanaty F, Way A. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International; 2009. Available from: https://www.dhsprogram.com/pubs/pdf/fr220/fr220.pdf. [Last accessed on 2019 Nov 22].

Otkun M, Erdogan MS, Tatman-Otkun M, Akata F. Exposure time to hepatitis B virus and associated risk factors among children in Edirne, Turkey. Epidemiol Infect. 2005;133(3):509- 16. https://doi.org/10.1017/s0950268805003675 PMid:15962558

Muro FJ, Fiorillo SP, Sakasaka P, Odhiambo C, Reddy EA, Cunningham CK, et al. Seroprevalence of hepatitis B and C viruses among children in Kilimanjaro region, Tanzania. J Pediatric Infect Dis Soc. 2013;2(4):320-6. https://doi.org/10.1093/jpids/pit018 PMid:24363930

Ashraf H, Alam NH, Rothermundt C, Brooks A, Bardhan P, Hossain L, et al. Prevalence and risk factors of hepatitis B and C virus infections in an impoverished urban community in Dhaka, Bangladesh. BMC Infect Dis. 2010;10:208. https://doi.org/10.1186/1471-2334-10-208 PMid:20630111

Afifi SS, Mahran MH, Said ZN, Salama II, El Khayat H. Serum level of anti-hepatitis B surface antigen among newborns and fully vaccinated infants and children aged 6 to 11 years. Aust J Basic Appl Sci. 2009;3(4):3239-45.

Agbede OO, Iseniyi JO, Kolawole MO, Ojuawo A. Risk factors and seroprevalence of hepatitis B surface antigenemia in mothers and their preschool age children in Ilorin, Nigeria. Therapy. 2007;4(1):67-72. https://doi.org/10.2217/14750708.4.1.67

Olayinka AT, Oyemakinde A, Balogun MS, Ajudua A, Nguku P, Aderinola M, et al. Seroprevalence of hepatitis B infection in Nigeria: A national survey. Am J Trop Med Hyg. 2016;95(4):902- 7. https://doi.org/10.4269/ajtmh.15-0874 PMid:27527630

Eke CB, Ogbodo SO, Ukoha OM, Ibekwe RC, Asinobi IN, Ikefuna AN, et al. Seroprevalence and risk factors of hepatitis B virus infection among adolescents in Enugu, Nigeria. J Trop Pediatr. 2015;61(6):407-13. https://doi.org/10.1093/tropej/fmv035 PMid:26411561

Seerat I, Mushtaq H, Rafiq M, Nadir A. Frequency and associated risk factors of hepatitis B virus and hepatitis C virus infections in children at a hepatitis prevention and treatment clinic in Lahore, Pakistan. Cureus. 2020;12(5):e7926. https://doi.org/10.7759/cureus.7926 PMid:32494536

Salama II, Sami SM, Salama SI, Rabah TM, El Etreby LA, Hamid AT, et al. Immune response to second vaccination series of hepatitis B virus among booster dose non-responders. Vaccine. 2016;34(16):1904-8. https://doi.org/10.1016/j.vaccine.2016.02.050 PMid:26930367




How to Cite

Salama II, Sami SM, Salama SI, Elmosalami DM, Saleh RM, Said ZN, Shaaban FA, Abdel Mohsen AM, Rabah TM, Abdel-Latif GA, Fouad WA, Mohsen A. A Nationwide Community Survey of Prevalence of Circumcision among Egyptian Children and Risk of Hepatitis B Viral Infection. Open Access Maced J Med Sci [Internet]. 2021 Mar. 7 [cited 2022 May 21];9(E):209-15. Available from: https://oamjms.eu/index.php/mjms/article/view/5827



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