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Characterizing the Global Burden of Surgical Disease: A Method to Estimate Inguinal Hernia Epidemiology in Ghana

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Abstract

Background

Surgical conditions represent an immense yet underrecognized source of disease burden globally. Characterizing the burden of surgical disease has been defined as a priority research agenda in global surgery. Little is known about the epidemiology of inguinal hernia, a common easily treatable surgical condition, in resource-poor settings.

Methods

Using data from the National Health and Nutrition Examination Survey prospective cohort study of inguinal hernia, we created a method to estimate hernia epidemiology in Ghana. We calculated inguinal hernia incidence and prevalence using Ghanaian demographic data and projected hernia prevalence under three surgical rate and hernia incidence scenarios. Disability adjusted life-years (DALYs) associated with inguinal hernia along with costs for surgical repair were estimated.

Results

According to this approach, the prevalence of inguinal hernia in the Ghanaian general population is 3.15 % (range 2.79–3.50 %). Symptomatic hernias number 530,082 (range 469,501–588,980). The annual incidence of symptomatic hernias is 210 (range 186–233) per 100,000 population. At the estimated Ghanaian hernia repair rate of 30 per 100,000, a backlog of 1 million hernias in need of repair develop over 10 years. The cost of repairing all symptomatic hernias in Ghana is estimated at US$53 million, and US$106 million would be required to eliminate hernias over a 10-year period. Nearly 5 million DALYs would be averted with the repair of prevalent cases of symptomatic hernia in Ghana.

Conclusions

Data generated by our method indicate the extent to which Ghana lacks the surgical capacity to address its significant inguinal hernia disease burden. This approach provides a simple framework for calculating inguinal hernia epidemiology in resource-poor settings that may be used for advocacy and program planning in multiple country contexts.

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References

  1. Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT, Brennan JG, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York, pp 1245–1260

    Google Scholar 

  2. Luboga S, Macfarlane SB, von Schreeb J et al (2009) Increasing access to surgical services in sub-Saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 6(12):e1000200

    Article  PubMed  Google Scholar 

  3. Taira BR, McQueen KA, Burkle FM (2009) Burden of surgical disease: does the literature reflect the scope of the international crisis? World J Surg 33:893–898. doi:10.1007/s00268-009-9981-x

    Article  PubMed  Google Scholar 

  4. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571

    Article  PubMed  Google Scholar 

  5. Mock C, Cherian M, Juillard C et al (2010) Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg 34:381–385. doi:10.1007/s00268-009-0263-4

    Article  PubMed  Google Scholar 

  6. Shillcutt SD, Clarke MG, Kingsnorth AN (2010) Cost-effectiveness of groin hernia surgery in the western region of Ghana. Arch Surg 145:954–961

    Article  PubMed  Google Scholar 

  7. Everhart JE (1994) Abdominal wall hernia. In: Everhart JE (ed) Digestive diseases in the United States: epidemiology and impact. National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, pp 471–507

    Google Scholar 

  8. Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25:835–839

    Article  PubMed  CAS  Google Scholar 

  9. Reuben B, Neumayer L (2006) Surgical management of inguinal hernia. Adv Surg 40:299–317

    Article  PubMed  Google Scholar 

  10. Fitzgibbons RJ, Giobbie-Hurder A, Gibbs J (2006) Watchful waiting vs. repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 295:285–292

    Article  PubMed  CAS  Google Scholar 

  11. Belcher DW, Nyame PK, Murapa FK (1978) The prevalence of inguinal hernia in Ghanaian males. Trop Georgr Med 30:39–43

    CAS  Google Scholar 

  12. Yardov YS, Stoyanov SK (1969) The incidence of hernia on the island of Pemba. East Afr Med J 46:687–691

    Google Scholar 

  13. Kingsnorth AN, Clarke MG, Shillcutt SD (2009) Public health and policy issues of hernia surgery in Africa. World J Surg 33:1188–1193. doi:10.1007/s00268-009-9964-y

    Article  PubMed  Google Scholar 

  14. Ohene-Yeboah M, Abantanga F, Oppong J et al (2009) Some aspects of the epidemiology of external hernia in Kumasi, Ghana. Hernia 13:529–532

    Article  PubMed  CAS  Google Scholar 

  15. Harouna Y, Yaya H, Abdou I et al (2000) Prognosis of strangulated hernia in adult with necrosis of small bowel: a 34 cases report. Bull Soc Pathol Exot 93:317–320

    PubMed  CAS  Google Scholar 

  16. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83:1045–1051

    Article  PubMed  Google Scholar 

  17. Hair A, Paterson C, Wright D et al (2001) What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg 193:125–129

    Article  PubMed  CAS  Google Scholar 

  18. Nordberg E (1984) Incidence and estimated need of cesarean section, inguinal hernia repair, and operation for strangulated hernia in rural Africa. Br Med J (Clin Res Ed) 289:92–93

    Article  CAS  Google Scholar 

  19. Grimes CE, Law RS, Borgstein ES et al (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36:8–23. doi:10.1007/s00268-011-1330-1

    Article  PubMed  Google Scholar 

  20. Ruhl CE, Everhart JE (2007) Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 165:1154–1161

    Article  PubMed  Google Scholar 

  21. Adesunkanmi ARK, Badmus TA, Ogundoyin O (2004) Determinants of outcome of inguinal herniorrhaphy in Nigerian patients. Ann Coll Surg Hong Kong 8:14–21

    Article  Google Scholar 

  22. Anonymous (2012) CIA the world factbook: Ghana. https://www.cia.gov/library/publications/the-world-factbook/geos/gh.html. Accessed 16 May 2012

  23. Anonymous (2009) World Health Organization disease and injury country estimates. http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html. Accessed 5 June 2012

  24. Herman W, Sinnock P, Brenner E et al (1984) Epidemiologic model for diabetes mellitus: incidence, prevalence, and mortality. Diabetes Care 7:367–371

    Article  PubMed  CAS  Google Scholar 

  25. Atun R, Pothapregada S, Kwansah J et al (2011) Critical interactions between the Global Fund-supported HIV programs and the health system in Ghana. J Acquir Immune Defic Syndr 57(Suppl 2):S72–S76

    Article  PubMed  Google Scholar 

  26. Anonymous (2010) USAID Ghana HIV/AIDS Health Profile. http://www.usaid.gov/our_work/global_health/aids/Countries/africa/ghana_profile.pdf. Accessed 24 May 2012

  27. Clarke MG, Oppong C, Simmermacher R et al (2009) The use of sterilised polyester mosquito net mesh for inguinal hernia repair in Ghana. Hernia 13:155–159

    Article  PubMed  CAS  Google Scholar 

  28. Kruk ME, Pereira C, Vaz F et al (2007) Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. Br J Obstet Gynaecol 114:1253–1260

    Article  CAS  Google Scholar 

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Acknowledgments

We thank Dr. Constance Ruhl and Dr. Wendy Max for their valuable help. We received grant support from the UCSF Department of Surgery, University of California San Francisco (UCSF).

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Authors and Affiliations

  1. Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S321, San Francisco, CA, 94143, USA

    Jessica H. Beard, Lawrence B. Oresanya, Rochelle A. Dicker & Hobart W. Harris

  2. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana

    Michael Ohene-Yeboah

Authors
  1. Jessica H. Beard
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  2. Lawrence B. Oresanya
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  3. Michael Ohene-Yeboah
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  4. Rochelle A. Dicker
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  5. Hobart W. Harris
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Corresponding author

Correspondence to Jessica H. Beard.

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Beard, J.H., Oresanya, L.B., Ohene-Yeboah, M. et al. Characterizing the Global Burden of Surgical Disease: A Method to Estimate Inguinal Hernia Epidemiology in Ghana. World J Surg 37, 498–503 (2013). https://doi.org/10.1007/s00268-012-1864-x

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  • DOI: https://doi.org/10.1007/s00268-012-1864-x

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