Members of Operation Hernia with a large piece of mosquito-net mesh. During the last several years, Operation Hernia has treated more than 1,000 hernias, trained both European and Ghanaian surgeons, and just opened its second hernia treatment center in Ghana. It plans to expand capacity to establish centers in the Ivory Coast and Nigeria.
An interesting additional use for mosquito-nets…
Despite the much higher prevalence and severity of inguinal hernias in many African countries compared to high-income countries, inguinal hernia repair has been overlooked as a public health priority due to the belief that insufficient infrastructure, human resources and funding are available for effective delivery of care. Interestingly, many recent studies indicate that these hernias can be repaired with low-cost techniques using locally produced mosquito-nets. Briefly, hernias can be repaired using either the Bassini or “tension” technique, where the edges of the defect are sewn together without use of any prosthesis or reinforcement, or the “tension-free” Lichtenstein method using prosthetic mesh. The tension-free method is generally recommended to minimize short- and long-term recurrence and complications, but most African surgeons favor the Bassini technique due to the low associated cost. However, inexpensive polyester or nylon mosquito-net mesh has been found to be a suitable alternative to the prohibitively expensive, commercial mesh.
In 2006, a randomized double-blind study in Burkina Faso found no increased incidences of complications or mesh rejections in hernia repair with sterilized 100% Nylon mosquito-net mesh available in most African village markets, when compared to hernia repair with commercial grafts (Ultrapro). The total cost to buy and autoclave a 10 cm x 15 cm locally produced mesh is less than $1.50 whereas an Ultrapro mesh of the same size, purchased in Europe and shipped to Burkina Faso, costs $108. Imported meshes are also sold in Burkina Faso for about 200% of the price paid in the U.S. The 250% reduction in cost would make tension-free hernia repair much more affordable for local patients. Tension-free repair is also easily learned by local surgeons who found little difficulties handling the mesh.
A more recent 2009 study in western Ghana, where 2.7% of the adult male population have inguinal hernias (compare to 0.4% prevalence of TB and 2.2% prevalence of HIV), assessed the cost-effectiveness of using mosquito-net meshes to be only $68.31 per DALY (Disability-Adjusted Life Year) averted. Combined with the proper training of local surgeons, use of low-cost mesh holds great potential for scaling up capacity to address the high prevalence of inguinal hernias. The use of locally produced mosquito-nets also encourages eventual self-sustainability, which should be the ultimate goal of any public health intervention.
