Groin Hernia Surgery in Uganda: Caseloads and Practices at Hospitals Operating Within the Publicly Funded Healthcare Sec
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ORIGINAL SCIENTIFIC REPORT
Groin Hernia Surgery in Uganda: Caseloads and Practices at Hospitals Operating Within the Publicly Funded Healthcare Sector Alphonsus Matovu1,2 • Pa¨r Nordin3 • Andreas Wladis4 • Mary Margaret Ajiko5 Jenny Lo¨fgren5
•
Ó The Author(s)
Abstract Background Groin hernia is a major public health problem with over 200 million people affected. The unmet need for surgery is greatest in Sub-Saharan Africa where specialist surgeons are few. This study was carried out in Uganda to investigate caseloads and practices of groin hernia surgery at publicly funded hospitals. Methods The study employed mixed methods covering 29 hospitals: the National Referral Hospital (NRH), 14 Regional Referral Hospitals (RRH) and 14 General Hospitals (GH). In part one of the study, surgeons and medical doctors performing hernia repair were interviewed about their practices and experiences of groin hernia surgery. In part two, operating theater records from 2013 to 2014 from the participating hospitals were reviewed and information about groin hernia operations collected. Results All respondents reported that sutured repair was the first-choice method. A total of 5518 groin hernia repairs were performed at the participating hospitals, i.e., an annual hernia repair rate of 7/100 000 population. Of the patients operated, almost 16% were women and 24% were children. Local anesthesia (LA) was used in 40% of the cases, and non-surgeon physicians performed 70.3% of the groin hernia repairs. Conclusion Groin hernia repair outputs need to increase along with the training of surgical providers in modern hernia repair methods. Methods and outcomes for hernia repair in women and children should be investigated to improve the quality of care.
Introduction & Alphonsus Matovu [email protected] 1
Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
2
Department of Surgery, Mubende Regional Referral Hospital, Plot M.4 Kakumiro Road, P.O Box 4, Mubende, Uganda
3
Department of Surgery and Perioperative Sciences, Umea˚ University, Umea˚, Sweden
4
Department of Clinical and Experimental Medicine, Linko¨ping University, Linko¨ping, Sweden
5
Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Sweden
Groin hernia repair is the most commonly performed general surgical procedure worldwide [1]. Over 200 million people are affected with groin hernias globally [2], and untreated groin hernias have significant morbidity and mortality [3]. In Sub-Saharan Africa (SSA), the volume of groin hernia surgery relative to the prevalence is insufficient [4–6]. Many people live with untreated groin hernias representing an enormous unmet need for surgery [7, 8]. In Ghana, the annual incidence of symptomatic hernias was 210/100,000 people with an estimated hernia repair rate of 30/100,000 [9]. In Uganda, the total groin hernia prevalence rate was 9.4%, 6.6% untreated or with recurrence and 3.3% with scars and an annual inguinal hernia repair rate of
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