title: An estimate of hernia prevalence in Nepal from a countrywide community survey.
abstract: BACKGROUND
  Herniorrhaphy is one of the most frequently performed general surgical operations worldwide; however, most low-income and middle-income countries (LMICs) are unable to provide this essential surgery resulting in substantial morbidity and mortality. This study aimed to estimate the prevalence of, barriers to care for, and disability from untreated hernias in Nepal.
  
  
  METHODS
  A cluster randomised, cross-sectional household survey was performed in Nepal using the validated Surgeons OverSeas Assessment of Surgical (SOSAS) tool. Sample size was based on a pilot study that reported a 5% prevalence of unmet surgical need. 15 clusters consisting of 30 households each were sampled proportional to population. In each, two randomly selected family members underwent a verbal head-to-toe physical examination and answered questions about barriers to care and disability.
  
  
  RESULTS
  The survey sampled 1350 households, totalling 2695 individuals (97% response rate). 1434 (53%) of responders were men and 1·5% (95% CI 1·8-4·0) had a mass or swelling in the groin at time of survey. The age-standardised 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 aged 50 years and older. 29 respondents were not able to have surgery due to lack of surgical services (nine; 31%), fear or mistrust of the surgical system (nine; 31%), and inability to afford care (six; 21%). 10 respondents (20%) were unable to work as previous or perform self-care due to their hernia.
  
  
  CONCLUSIONS
  Despite the lower than expected prevalence of inguinal hernias, more than 300 000 people in Nepal are currently in need of herniorrhaphy. In view 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.
  
  
  BACKGROUND
  Surgeons OverSeas, Association for Academic Surgery, and the Fogarty International Center.
authors: Department of Surgery, University of Washington, Seattle, Washington DC, USA. Electronic address: stewarb@uw.edu.
authors: Barclay T
authors: BT
authors: Stewart
authors: Kathmandu Medical College, Kathmandu, Nepal.
authors: John
authors: J
authors: Prathak
authors: Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Shailvi
authors: S
authors: Gupta
authors: Department of Surgery, Nepal Medical College, Kathmandu, Nepal.
authors: Sunil
authors: S
authors: Shrestha
authors: Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Reinou S
authors: RS
authors: Groen
authors: Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors: Benedict C
authors: BC
authors: Nwomeh
authors: Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Adam L
authors: AL
authors: Kushner
authors: Program for Surgery and Public Health, Kings County Hospital Center, SUNY Downstate Medical School, Brooklyn, NY, USA.
authors: Thomas
authors: T
authors: McIntyre