Non reducible inguinal hernias in Malawi: an occupational hazard
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ORIGINAL ARTICLE
Non reducible inguinal hernias in Malawi: an occupational hazard B. M. Williams1 · L. N. Purcell1 · C. Varela2 · J. Gallaher1 · A. Charles1,2,3 Received: 14 March 2020 / Accepted: 4 November 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Inguinal hernias are one of the most common surgical conditions worldwide. Due to limited surgical access in low- and middle-income countries, many hernias present emergently; however, data on the resultant outcome disparities is limited. We, therefore, sought to describe the epidemiology, clinical features, and outcomes of incarcerated inguinal hernias at a tertiary center in Malawi. Methods This is a retrospective analysis of the acute care surgery registry at Kamuzu Central Hospital in Lilongwe, Malawi. All patients > 13 years admitted with a non-reducible inguinal hernia from 2013 to 2019 were included. The primary outcome was in-hospital mortality. A Poisson multivariable regression determined factors associated with increased risk of mortality. Results A total of 297 patients presented with non-reducible inguinal hernias, the majority of which were young (median age 38), male (93.6%), farmers (47.8%). Of the 81% who underwent surgery, 55% were delayed ≥ 24 h. 19.5% of hernias were strangulated. Overall mortality was 5.4%. Increased age (RR 1.06, 95% CI 1.01–1.12), shock index ≥ 1 (RR 4.82, 95% CI 1.45–16.09), and delay ≥ 24 h from presentation to operative intervention (RR 11.24, 95% CI 1.55–81.34) resulted in an increase in relative risk of mortality. Conclusion Non-reducible inguinal hernias largely affect young male farmers in Malawi. Delays to care can limit economic productivity for this rural population, as well as, yield considerable risk of mortality. While specific patient and institutional factors must be further elucidated, increased awareness, public health prioritization, and surgical capacity building is needed to reduce further hernia-related morbidity and mortality. Keywords Inguinal hernia · Low- and middle-income country · Hernia and occupation · Incarcerated hernia
Introduction Inguinal hernias are a common surgical condition with more than 20 million people worldwide undergoing an inguinal herniorrhaphy each year [1]. The estimated lifetime risk of developing an inguinal hernia is approximately 27–43% in men and 3–6% in women with the global prevalence of inguinal hernias estimated to be 2–9%; however, data on inguinal hernias are largely derived from population-based studies in high-income countries (HIC) [2, 3]. As disparities * A. Charles [email protected] 1
Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA
2
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
3
UNC School of Medicine, 4008 Burnett Womack Building, CB 7228, Chapel Hill, USA
in surgical access and capacity result in a large proportion of untreated inguinal hernias in low- and middle-income countries (LMIC), the prevalence of inguinal hernias in subSaharan Africa has be
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