title: A prospective cohort study comparing the African and European hernia.
abstract: BACKGROUND
  The prevalence of inguinal hernia in Ghana, western Africa, is as high as 7.7% of the population. The elective operation rate is significantly lower because many of the hernias are repaired as emergencies. This discrepancy results in a pool of longstanding large hernias.
  
  
  METHODS
  This prospective cohort study compared consecutive patients having day case local anaesthetic inguinal hernia repairs under the Plymouth Hernia Service, UK, and in Ghana, Africa. Assessment was made of hernia size and subscapular skin-fold thickness. In the Ghanaian group, data were collected on patient age, type of inguinal hernia, duration of the hernia, and disability caused.
  
  
  RESULTS
  A total of 241 patients were included in the study (UK: n = 106, Ghana: n = 135). The mean age of the UK group was 62 years (range 28-91 years) and of the Ghanaian group 34 years (range 2 months-80 years). One hundred and twelve (82.9%) of the Ghanaian hernias were indirect. Ninety (67%) of the Ghanaian hernias extended into the scrotum compared with 7 (6.0%) in the UK group. The Ghanaian hernias were significantly larger (P = 0.01) and the patients significantly thinner (P = 0.02). In the Ghanaian group, 22 (16%) of the patients were unable to work due to their hernia, and in a further 87 (64%) patients, the hernia limited daily activity. One hundred and fifteen (85%) of the Ghanaian hernias were present for more than 1 year, and of those, 50 (37%) had been present for more than 5 years.
  
  
  CONCLUSIONS
  In Ghana (a developing country), the hernia is larger than the UK hernia. The majority of Ghanaian hernias are indirect and occur in a young population. This places an economic burden on the country. Appropriate management is needed to reduce the pool of these hernias.
authors.affiliation: Department of Surgery, Derriford Hospital, Plymouth, PL6 8DH, UK. dsanders@doctors.org.uk
authors.forename: D L
authors.initials: DL
authors.lastname: Sanders
authors.forename: C S
authors.initials: CS
authors.lastname: Porter
authors.forename: K C D
authors.initials: KC
authors.lastname: Mitchell
authors.forename: A N
authors.initials: AN
authors.lastname: Kingsnorth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005869:Ghana; D006552:Hernia, Inguinal / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D011446:Prospective Studies; D006113:United Kingdom; D055815:Young Adult