Barriers to inguinal hernia repair in Ghana: prospective, multi-centre cohort study


  • Abass Alhassan
  • Francis Atidana Abantanga
  • Omar Omar
  • Dmitri Nepogodiev
  • Aneel Bhangu
  • Saeed F. Majeed
  • Kwame Opare-Asamoah
  • Michael Ohene- Yeboah
  • Stephen Tabiri


Inguinal hernia (IH) is the most common general surgical pathology in Ghana with hernia repair rate verylow. The objective was to assess patient-perceived barriers to IH repair in Ghana and identify predictors ofexperiencing delays until surgery. A multicenter prospective study was conducted during the Ghana HerniaSociety outreach. Data regarding diagnosis using Kingsnorth’s classification of IH, age of patients, durationof hernia, reason for delay in repair, insurance status, American Society of Anesthesiologists (ASA) class,travel distance, region, hospital, and waiting times were obtained from patients and folders. Multivariablelinear regression models were constructed to analyze delay until surgery and Kingsnorth’s classificationwhile controlling for the covariates of age, insurance status, ASA class among others. The most commonreasons were queues for surgery (23%), poverty (10%), and seeking traditional medicine (9%). Onmultivariate linear regression, increasing age and ASA class III were predictors of longer delays. Patientsexperienced significant increase of 1.1 years delay to surgery for every 10 year increase in of age. ASA ClassIII patients were significantly more likely to be delayed by 11.5 years compared to ASA Class I patients.Efforts should be made to address and overcome the barriers to IH repair identified