Thirty-one teenage boys have died from complications after botched traditional circumcision rites in South Africa's rural Eastern Cape region, officials said on Friday.
"Since the beginning of June, two deaths are being recorded almost every day," regional health spokesman Sizwe Kupelo told AFP.
"This is a grim situation that we deal with every year, the health department has rescued hundreds of boys from schools run by unscrupulous surgeons," he said.
Health authorities say the main causes of death which have been concentrated in the rural Transkei area are dehydration, hypothermia and excessive bleeding and that most boys only seek medical attention when it is too late.
Traditional circumcision is a rite of passage practised by the region's Xhosa clan, where boys from the age of 18 are banished to the bush for about a month and taught social values.
The bi-annual event culminates in a circumcision ritual which is performed without any anaesthetic, using traditional surgical tools.
Kupelo said the number of deaths had been slowly declining over the past five years since the health authorities started clamping down on illegal schools.
"Boys are still dying, some seasons we experience a surge, sometimes the numbers are lower," Kupelo said.
The 2008 winter season saw 24 deaths with some 535 initiates being admitted to hospitals with injuries and suffering from hypothermia.
"This tradition is meant to be like a graduation ceremony from boyhood to manhood, but illegal schools are admitting boys as young as 13 years," said Kupelo.
Deaths continue to plague this age-old tradition despite the passing of a Circumcision Act in 2001 which is aimed at regulating the practice.
Last month, a boy was admitted to hospital with a nearly severed rotting penis, after being cut by an untrained traditional surgeon.