abstract: 'Background: Herniorrhaphy is one of the most frequently performed

  general surgical operations worldwide. However, most low- and

  middle-income countries (LMICs) are unable to provide this essential

  surgery to the general public, resulting in considerable morbidity and

  mortality. This study aimed to estimate the prevalence, barriers to care

  and disability of untreated hernias in Nepal. Methods: Nepal is a

  low-income country in South Asia with rugged terrain, infrastructure

  deficiencies and a severely under-resourced healthcare system resulting

  in substantial unmet surgical need. A cluster randomized,

  cross-sectional household survey was performed using the validated

  Surgeons OverSeas Assessment of Surgical (SOSAS) tool. Fifteen

  randomized clusters consisting of 30 households with two randomly

  selected respondents each were sampled to estimate surgical need. The

  prevalence of and disability from groin hernias and barriers to

  herniorrhaphy were assessed. Results: The survey sampled 1350

  households, totaling 2695 individuals (97\% response rate). There were

  1434 males (53\%) with 1.5\% having a mass or swelling in the groin at

  time of survey (95\% CI 1.8-4.0). The age-standardized rate for inguinal

  hernias in men ranged from 1144 per 100,000 persons between age 5 and 49

  years and 2941 per 100,000 persons age >= 50 years. Extrapolating

  nationally, there are nearly 310,000 individuals with groin masses and

  66,000 males with soft/reducible groin masses in need of evaluation in

  Nepal. Twenty-nine respondents were not able to have surgery due to lack

  of surgical services (31\%), fear or mistrust of the surgical system

  (31\%) and inability to afford care (21\%). Twenty percent were unable

  to work as previous or perform self-care due to their hernia.

  Conclusions: Despite the lower than expected prevalence of inguinal

  hernias, hundreds of thousands of people in Nepal are currently in need

  of surgical evaluation. Given that essential surgery is a necessary

  component in health systems, the prevalence of inguinal hernias and the

  cost-effectiveness of herniorrhaphy, this disease is an important target

  for LMICs planning surgical capacity improvements. (C) 2014 Surgical

  Associates Ltd. Published by Elsevier Ltd. All rights reserved.'
affiliation: 'Stewart, BT (Corresponding Author), Univ Washington, Dept Surg, 1959
  NE Pacific St,Suite BB 487,POB 356410, Seattle, WA 98195 USA.

  Stewart, Barclay T., Univ Washington, Dept Surg, Seattle, WA 98195 USA.

  Pathak, John, Kathmandu Med Coll, Kathmandu, Nepal.

  Gupta, Shailvi; Nwomeh, Benedict C.; Kushner, Adam L., Surg OverSeas SOS, New York,
  NY USA.

  Gupta, Shailvi, Univ Calif San Francisco East Bay, Dept Surg, Oakland, CA USA.

  Shrestha, Sunil, Nepal Med Coll, Dept Surg, Kathmandu, Nepal.

  Groen, Reinou S., Johns Hopkins Univ Hosp, Dept Gynecol \& Obstet, Baltimore, MD
  21287 USA.

  Nwomeh, Benedict C., Nationwide Childrens Hosp, Dept Pediat Surg, Columbus, OH USA.

  Kushner, Adam L., Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore,
  MD USA.

  Kushner, Adam L., Columbia Univ, Dept Surg, New York, NY USA.

  McIntyre, Thomas, SUNY Downstate Med Sch, Kings Cty Hosp Ctr, Program Surg \& Publ
  Hlth, Brooklyn, NY USA.'
author: Stewart, Barclay T. and Pathak, John and Gupta, Shailvi and Shrestha, Sunil
  and Groen, Reinou S. and Nwomeh, Benedict C. and Kushner, Adam L. and McIntyre,
  Thomas
author-email: stewarb@uw.edu
author_list:
- family: Stewart
  given: Barclay T.
- family: Pathak
  given: John
- family: Gupta
  given: Shailvi
- family: Shrestha
  given: Sunil
- family: Groen
  given: Reinou S.
- family: Nwomeh
  given: Benedict C.
- family: Kushner
  given: Adam L.
- family: McIntyre
  given: Thomas
da: '2023-09-28'
doi: 10.1016/j.ijsu.2014.12.003
eissn: 1743-9159
files: []
issn: 1743-9191
journal: INTERNATIONAL JOURNAL OF SURGERY
keywords: Hernia; Surgical capacity; Nepal; Low-income; Community assessment
keywords-plus: 'CATARACT SURGICAL COVERAGE; MIDDLE-INCOME COUNTRIES; INGUINAL-HERNIA;

  SIERRA-LEONE; COST-EFFECTIVENESS; GROIN HERNIA; RISK-FACTORS; SURGERY;

  BARRIERS; EPIDEMIOLOGY'
language: English
month: JAN
number-of-cited-references: '34'
orcid-numbers: 'Stewart, Barclay/0000-0002-8099-9218

  Kushner, Adam/0000-0002-7797-4837'
pages: 111-114
papis_id: c6a219ef55cba23da084e9d398519569
ref: Stewart2015estimatehernia
times-cited: '11'
title: An estimate of hernia prevalence in Nepal from a countrywide community survey
type: article
unique-id: WOS:000348666000021
usage-count-last-180-days: '0'
usage-count-since-2013: '5'
volume: '13'
web-of-science-categories: Surgery
year: '2015'