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An estimate of hernia prevalence in Sierra Leone from a nationwide community survey

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Abstract

Purpose

A large number of unrepaired inguinal hernias is expected in sub-Saharan Africa where late presentation often results in incarceration, strangulation, or giant scrotal hernias. However, no representative population-based data are available to quantify the prevalence of hernias. We present data on groin masses in Sierra Leone to estimate prevalence, barriers to care, and associated disability.

Methods

A cluster randomized, cross-sectional household survey of 75 clusters of 25 households with 2 respondents each was designed to calculate the prevalence of and disability caused by groin hernias in Sierra Leone using a verbal head-to-toe examination. Barriers to hernia repairs were assessed by asking participants the main reason for delay in surgical care.

Results

Information was obtained from 3,645 respondents in 1,843 households, of which 1,669 (46 %) were male and included in the study. In total, 117 males or 7.01 % (95 % CI 5.64–8.38) reported a soft or reducible swelling likely representing a hernia with four men having two masses. Of the 93.2 % who indicated the need for health care, only 22.2 % underwent a procedure, citing limited funds (59.0 %) as the major barrier to care. On disability assessment, 20.2 % were not able to work secondary to the groin swelling.

Conclusions

The results indicate groin masses represent a major burden for the male population in Sierra Leone. Improving access to surgical care for adult patients with hernias and early intervention for children will be vital to address the burden of disease and prevent complications or limitations of daily activity.

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Abbreviations

CI:

Confidence interval

DHS:

Demographic Health Surveys

SOSAS:

Surgeons OverSeas Assessment of Surgical need

SSA:

sub-Saharan Africa

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Acknowledgements

Surgeons OverSeas (SOS) with funding from private contributions provided logistical support. We would like to thank the Sierra Leone Ministry of Health and Sanitation, College of Medicine and Allied Health Sciences, and Connaught Hospital for assistance with local transportation and administrative support. We also thank the personnel from Statistics Sierra Leone and the enumerators and field supervisors for their enthusiastic work. HDP was supported by the Predoctoral Clinical Research Training Program and the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by Grant Number UL1 TR 000424-06 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. It’s contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH.

Conflict of interest

HP declares no conflict of interest. RG declares no conflict of interest. TK declares no conflict of interest. MS declares no conflict of interest. MF declares no conflict of interest. LC declares no conflict of interest. AK declares no conflict of interest. SW declares no conflict of interest.

Author information

Authors and Affiliations

  1. James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    H. D. Patel

  2. Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    H. D. Patel

  3. Surgeons OverSeas (SOS), New York, NY, USA

    R. S. Groen & A. L. Kushner

  4. Department of International Health, Royal Tropical Institute, Amsterdam, The Netherlands

    R. S. Groen

  5. Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA

    R. S. Groen

  6. College of Medicine and Allied Health Science, Freetown, Sierra Leone

    T. B. Kamara & M. Samai

  7. Department of Surgery, Connaught Hospital, Freetown, Sierra Leone

    T. B. Kamara

  8. University of Sierra Leone, Freetown, Sierra Leone

    T. B. Kamara

  9. Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    M. M. Farahzad & L. D. Cassidy

  10. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    A. L. Kushner

  11. Department of Surgery, Columbia University, New York, NY, USA

    A. L. Kushner

  12. Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA

    S. M. Wren

  13. Palo Alto Veterans Health Care System, 3801 Miranda Ave G112, Palo Alto, CA, 94304, USA

    S. M. Wren

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  1. H. D. Patel
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  2. R. S. Groen
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  3. T. B. Kamara
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  4. M. Samai
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  5. M. M. Farahzad
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  7. A. L. Kushner
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  8. S. M. Wren
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Corresponding author

Correspondence to S. M. Wren.

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Patel, H.D., Groen, R.S., Kamara, T.B. et al. An estimate of hernia prevalence in Sierra Leone from a nationwide community survey. Hernia 18, 297–303 (2014). https://doi.org/10.1007/s10029-013-1179-3

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  • DOI: https://doi.org/10.1007/s10029-013-1179-3

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