Abstract：
South Africa\'s 2016 medical male circumcision (MMC) guidelines (\"the guidelines\") provide direction for the MMC programme\'s implementation in South Africa. The aim of our document analysis was to assess the guidelines, particularly in lieu of changing guidance from WHO and PEPFAR. We then assessed how the guidelines might be applied to infant and child male circumcision (ICMC). The analysis was performed by reviewing South Africa\'s guidelines, along with international documents used in developing those guidelines, to identify the historical development of the guidelines, as well as the implications for MMC and ICMC decision-making within the South African context. The following principles were analysed within the context of South Africa\'s guidelines: (1) quality and safety; (2) informed consent; (3) confidentiality; (4) human rights; and (5) accessibility of services. Tthe document analysis also identified ambiguities that exist in the guidelines, particularly regarding consent, recognising religious or cultural exemptions, and guaranteeing the best interests of the child. South Africa\'s MMC guidelines could benefit from incorporating common definitions to assist with interpretation and understanding, thus preventing confusion and controversy among programme planners, parents and boys. The guidelines were made available in 2016 and recommendations for circumcision have evolved as new research and information has become available. South Africa\'s National Department of Health should review and update these guidelines, with a focus on both MMC and ICMC issues, so that they reflect the most up-to-date, accurate information available, to avoid inconsistent practices, risks, and litigation in the management of the programme. This study was situated within a qualitative paradigm and applied a social choice theory perspective to make sense of the MMC guidelines. The study concludes that future policy revisions should develop a broader understanding of the complex medical male circumcision decision-making process, particularly faced by parents.
摘要：
南非2016年医疗男性包皮环切（MMC）指南（“指南”）为MMC计划在南非的实施提供了指导。我们文件分析的目的是评估指导方针，特别是代替世卫组织和PEPFAR不断变化的指导。然后，我们评估了该指南如何应用于婴儿和儿童男性包皮环切术（ICMC）。分析是通过回顾南非的指导方针进行的，以及制定这些准则时使用的国际文件，为了确定指导方针的历史发展，以及在南非背景下对MMC和ICMC决策的影响。在南非准则的背景下分析了以下原则：（1）质量和安全；（2）知情同意；（3）保密；（4）人权；（5）服务的可及性。文档分析还确定了指南中存在的歧义，特别是关于同意，承认宗教或文化豁免，保证儿童的最大利益。南非的MMC指南可以受益于纳入共同的定义，以帮助解释和理解，从而防止方案规划者之间的混乱和争议，父母和男孩。该指南于2016年发布，随着新的研究和信息的出现，包皮环切术的建议也在不断发展。南非国家卫生部应该审查和更新这些指南，同时关注MMC和ICMC问题，所以他们反映了最新的，准确的信息可用，为了避免不一致的做法，风险,以及该计划管理中的诉讼。这项研究位于定性范式内，并应用了社会选择理论的观点来理解MMC指南。该研究的结论是，未来的政策修订应该对复杂的医疗男性包皮环切决策过程有更广泛的理解，尤其是面对父母。
