The deaths were as a result of dehydration, septicaemia or assault.

Provincial health spokesman Sizwe Kupelo said 130 initiates have been admitted to hospitals in the OR Tambo region and one has been admitted at the Cecilia Makiwane Hospital, in East London.

Traditional leaders and men's groups yesterday expressed shock at the death toll. Last year, winter circumcisions resulted in 26 deaths - but this year's season is only half complete.

"It is alarming that 20 initiates died within two weeks. Our fears are that the four week-long season still has two more weeks to go," said the Eastern Cape House of Traditional Leaders CEO Mzi Nkantsu yesterday.

Yesterday morning, the House of Traditional Leaders claimed that only 14 initiates had died . That figure increased to 20 in the afternoon.

Clinical services director at StElizabeth Hospital, Lusikisiki, Dr Vusumzi Kalala, described the situation as "disastrous".

"A total of 38 initiates was admitted at St Elizabeth Hospital and Holy Cross Hospital, in Flagstaff. Four initiates have had their penises amputated. Eight are complicated cases in critical wards at St Elizabeth Hospital. We just pray to God for miracles, for no more deaths and amputations," said Kalala.

Eastern Cape is not the only province in which circumcision deaths have been recorded. In the Free State, four men appeared in the Botshabelo Magistrate's Court in connection with the deaths of four boys at an initiation school.

Local government and traditional affairs MEC Mlibo Qoboshiyane said it was disturbing that, despite working with traditional leaders and local forums, the circumcision death tolls kept on increasing.

He said many boys were circumcised without the consent of their parents.

Eastern Cape chairman of Men's Sector Lulama Ntshingwa said the tradition had become a business.

"Fly-by-night traditional surgeons are a threat to the tradition and many might opt for medical circumcision of our boys."