02151nas a2200205   4500000000100000008004100001653001200042653002000054653003900074653001100113653002500124100001600149700001400165700001700179700001600196700001900212245011700231520158300348022001401931       2015                            d10aSurgery10aQuality of Life10aNeglected tropical diseases (NTDs)10aMalawi10aLymphatic filariasis1 aStanton M C1 aSmith E L1 aMartindale S1 aMkwanda S Z1 aKelly-Hope L A00aExploring hydrocoele surgery accessibility and impact in a lymphatic filariasis endemic area of southern Malawi.3 a<div>
<p><strong>Background</strong> 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.</p>
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<p><strong>Methods</strong> 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.</p>
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<p><strong>Results</strong> 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.</p>
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<p><strong>Conclusions</strong> 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.</p>
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