Abstract
Hydrocele is a chronic condition in males in which there is an excessive collection of straw-colored fluid, which leads to enlargement of the scrotum. It is a common manifestation of lymphatic filariasis (LF) affecting nearly 25 million men worldwide. Surgery is the recommended treatment for hydrocele and is available free of cost in all government hospitals in Nepal. This research explored patient, provider, and community factors related to accessing hydrocele surgery services by the patients. This study employed a qualitative method. The research was conducted in two LF endemic districts, namely Kanchanpur and Dhading, which are reported to have the highest number of hydrocele cases during morbidity mapping conducted in 2016. In addition to five key informant interviews with the LF focal persons (one national and 4 district-level), nine in-depth interviews were conducted with hydrocele patients (5 of whom had undergone surgery and 4 who had not undergone surgery) and with 3 family members, and two focus group discussions with the female community health volunteers. Most of the respondents did not have knowledge of hydrocele as one of the clinical manifestations of LF nor that it is transmitted through a mosquito bite. Although perceived as treatable with surgery, most of the patients interviewed believed in as well as practiced home remedies. Meanwhile, fear of surgery, embarrassment, lack of money, along with no knowledge of the free hydrocele surgery acted as barriers for accessing the surgery. On the other hand, financial support, flexible guidelines enabling the hospital to conduct surgery, decentralization and scaling up of morbidity mapping along with free hydrocele surgery camps in any remaining endemic districts were identified as enablers for accessing surgery. Hydrocele surgery coverage could be improved if the program further addresses community awareness. There is a need for more focus on information dissemination about hydrocele and hydrocele surgery.
Highlights
Lymphatic filariasis (LF) is a mosquito-borne, highly disfiguring parasitic disease and is considered as one of the major public health problems in 73 countries worldwide, including Nepal [1]
In line with the Global Program to Eliminate Lymphatic Filariasis (GPELF) launched by the World Health Organization (WHO) in 2000, Mass Drug Administration (MDA) and Morbidity Management and Disability Prevention (MMDP) are the two main strategies adopted by the government of Nepal to eliminate LF as a public health problem by 2020 [5]
MDA involves an annual provision of a combined dose of medications (DEC and Albendazole) to all eligible persons living in endemic areas for at least five years and MMDP involves a basic package of recommended health services which includes treating acute dermatolymphangioadenitis (ADLA), surgery for hydrocele to prevent progression of lymphoedema to ADLA
Summary
Lymphatic filariasis (LF) is a mosquito-borne, highly disfiguring parasitic disease and is considered as one of the major public health problems in 73 countries worldwide, including Nepal [1]. MDA involves an annual provision of a combined dose of medications (DEC and Albendazole) to all eligible persons living in endemic areas for at least five years and MMDP involves a basic package of recommended health services which includes treating ADLA, surgery for hydrocele to prevent progression of lymphoedema to ADLA. Hydrocele is a chronic condition in males in which there is an excessive collection of strawcolored fluid, which leads to enlargement of the scrotum It is a common manifestation of lymphatic filariasis (LF) affecting nearly 25 million men worldwide. This research explored patient, provider, and community factors related to accessing hydrocele surgery services by the patients
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