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Table 4 Health professionals’ reported knowledge about FGMC

From: Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice

Reference

Country

Knowledge of FGM/C ; FGM/C types ; high risk groups

Knowledge about complications

Knowledge about legislation / clinical guidelines

Publications from African Countries

 Ashimi et al. 2014 [21]

Nigeria

91 % - had heard of FGM/C

77 % - haemorrhage

NRa

40 % - did not know any of the 4 types

73 % - transmission of infectious disease (HIV, hepatitis and tetanus)

49 % identified “Angurya and Gishiri”b as forms of FGM/C

63 % - sexual dysfunction

54 % - difficult birth

48 % - epidermal cysts

 Kaplan et al. 2013 [22]

Gambia

NR

53 % - haemorrhage

NR

59 % - transmission of infectious disease

46 % - difficult birth

25 % - sexual dysfunction

21 % - affects health and welfare of women and girls

 Ali et al. 2012 [23]

Sudan

7 % - identified all 4 types correctly

46 % - transmission of infectious disease (HIV)

25.5 % - FGM/C is illegal

545 % - identified type 1 correctly

64 % - sexual dysfunction

74.5 % - FGM/C is legal

29 % - infertility

 Dike et al. 2012 [24]

Nigeria

NR

86 % - haemorrhage

100 % - FGM/C is banned in some states

84 % - transmission of infectious disease (HIV)

96 % - FGM/C is a crime against humanity

27 % - difficult birth

7 % - sexual dysfunction

 Rasheed et al. 2011 [25]

Egypt

NR

66 % - knew about complications of FGM/C

NR

 Refaat 2009 [26]

Egypt

76 % - know the type usually performed in Egypt (type II)

75 % - haemorrhage

NR

70 % - sexual dysfunction

64 % - shock

63 % - genital disfigurement

14 % - NO complications (if done by a physician or gynaecologist)

 Mostafa et al. 2006 [27]

Egypt

52 % - correctly identified type I

62 % - aware that FGMC can cause complications including:

17 % - knew Egyptian law which states that FGM/C cannot be performed by a non-physician

30 % - identified type II

48 % - short-term physical

28 % - reported that FGM/C violates the medical ethical principles of “do no harm” and “no not kill”

5 % - identified type III

39 % - long term physical

62 % - psychosocial complications

59 % - sexual dysfunction

 Onuh et al. 2006 [28]

Nigeria

100 % - identified at least one type of FGMC

98 % - haemorrhage

NR

38 % - identified Type I and Type II ONLY as FGM/C

81 % - transmission of infectious disease

7 % - identified all 4 types correctly

54 % - transmission of HIV

80 % - difficult birth

55 % - scars and keloid formation

21 % - infertility

59 % - sexual dysfunction

Publications from “Western Countries”

 Caroppo et al. 2014 [29]

Italy

9 % - knew that there are different types of FGM/C depending on the woman’s country of origin

5 % - knew how to manage a woman with FGMC

44 % - knew that Italy has a law prohibiting FGMC practice

 Purchase et al. 2013 [30]

UK

NR

92 % - identified each of the long term complications

94 % - FGM/C always illegal in the UK

75 % - HIV/hepatitis risk

79 % - were aware of the FGM/C Act

74 % - pelvic infection

84 % - knew to contact a child protection officer if they thought a child was at risk

10 % - associated psychiatric syndromes

To prevent complications during labour:

74 % - knew that defibulation should take place pre-conception

31 % - knew that defibulation is recommended at ~ 20 weeks pregnancy

52 % - unaware of referral pathways

 Relph et al. 2013 [31]

UK

100 % - aware of the practice of FGM/C

76 % - haemorrahge

72 % - aware of UK legislation on FGM/C

58 % - knew there are 4 types of FGM/C

32 % - knew that defibulation should be performed before pregnancy to avoid complications

89 % - family/religious figure performing FGM/C in UK is illegal

93 % of senior doctors

 

77 % - UK doctor performing FGM/C in UK is illegal

50 % of junior doctors

67 % - reinfibulation after delivery is illegal

40 % - confident in diagnosing FGM/C

78 % - sending a child abroad for FGM/C is illegal

 Hess et al. 2010 [32]

USA

18 % - knew that both Muslim and Christian women may have FGM/C

71 % - of nurse midwives who did not have direct experience with FGMC knew about FGMC complications , compared with 89 % of those who had direct experience

56 % - knew that it is illegal to perform FGM/C in girls and young women aged <18 years

39 % - knew FGM/C is NOT required by either religion

Over a half of respondents did not know that circumcised women avoid health care due to stigma and legal implications

Nurse midwives with direct practice experience of FGM/C scored better on a knowledge test

 Kaplan-Marcusan et al. 2009 [33]

Spain

97 % knew what FGM/C is

NR

20 % - aware of protocols or guidelines

Able to identify the 4 types:

 

42 % - of paediatricians aware of protocols or guidelines

41 % - of all professionals

68 % - of O&G

55 % - of paediatricians

38 % - general medicine

79 % - said they knew high risk countries

22 % - actually able to identify the high risk countries

 Leye 2008 [34]

Belgium

NR

NR

46 % - knew that FGM/C was illegal in Belgium

24 % - knew which types of FGM/C were included under the law

1 % (4 respondents) - knew of guidelines and information about FGM/C in their hospital

 Zaidi et al. 2007 [35]

UK

98 % - knew what FGMC was

84 % - knew of complications associated with FGMC

40 % - knew the details of the UK FGM/C Act

42 % - knew that there were different types of FGMC

70 % - knew that the best time for defibulation was before pregnancy (if FGMC diagnosed before pregnancy)

4 % - correctly classified the 4 types

80 % - knew that defibulation should be done during pregnancy if diagnosed during pregnancy

84 % - knew the high risk groups

54 % - knew that an anterior episiotomy should be performed if the woman is in the 2nd stage of labour

58 % - were NOT aware that women at risk should be identified during antenatal visits

 Tamaddon et al. 2006 [36]

Sweden

28 % - said they had adequate knowledge about FGM/C

NR

NR

20 % - of paediatricians said they had adequate knowledge about FGM/C

 Jager et al. 2002 [37]

Switzerland

NR

NR

Representatives from the Departments of Health in each Canton, did not know of any guidelines on FGM/C in their Canton

  1. aNR = Not reported b Angurya: is a form of FGMC type 4 that involves the scraping of tissue around the vaginal opening. Gishiri: is a form of FGMC type 4 where a long knife is inserted into the vagina and backward cuts from the vagina's anterior wall into the perineum are made