title: Exploring hydrocoele surgery accessibility and impact in a lymphatic filariasis endemic area of southern Malawi.
abstract: BACKGROUND
  Hydrocoele surgery is the recommended treatment for the common clinical manifestation of lymphatic filariasis in men. This study determined the geographical differences in surgery accessibility, and improvements in the quality of life of patients in Chikwawa district, Malawi.
  
  
  METHODS
  Surgery records from Chikwawa District Hospital (CDH), between 2008 and 2013, were used to map surgery rates by village, spatial dependence by census enumeration area and relationship of distance (kilometres) to CDH. A subset of patients were selected to quantify and compare their physical and socio-economic well-being and level of disability pre- and post-surgery using a standardised questionnaire.
  
  
  RESULTS
  A total of 476 hydrocoele surgical cases were identified with 260 cases geo-referenced and mapped. A significant negative relationship between village-level surgery rates and distance to CDH (r=-0.137; 95% CI: -0.47 to -0.26) was found, and clusters of enumeration areas with high surgery rates identified around the CDH. Significant improvements in patients' ability to walk and work were found and the overall level of disability was reduced post-surgery.
  
  
  CONCLUSIONS
  Hydrocoele surgery positively impacted on patients, improving their physical and socio-economic output. Surgical services need to scale-up and expand to reach cases that have less access to the best treatment currently available.
authors: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK michelle.stanton@lstmed.ac.uk.
authors: Michelle C
authors: MC
authors: Stanton
authors: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
authors: Emma L
authors: EL
authors: Smith
authors: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
authors: Sarah
authors: S
authors: Martindale
authors: Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi.
authors: Square Z
authors: SZ
authors: Mkwanda
authors: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
authors: Louise A
authors: LA
authors: Kelly-Hope
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004605:Elephantiasis, Filarial / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D058069:Neglected Diseases; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006848:Testicular Hydrocele / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*
keywords: Hydrocoele; Hydrocoelectomy; Lymphatic filariasis; Malawi; Morbidity; Socio-economic