03199nas a2200253 4500000000100000008004100001260003700042653005700079653004900136653002100185100001800206700001700224700001400241700001300255700001400268700002100282700001200303245013200315856009800447300001300545490000700558520236600565022001402931 2021 d bPublic Library of Science (PLoS) 10 aGeneral Biochemistry, Genetics and Molecular Biology 10 aGeneral Agricultural and Biological Sciences 10 aGeneral Medicine 1 aLama Yonzon C 1 aPadmawati RS 1 aSubedi RK 1 aPaudel S 1 aGhimire A 1 aMurhandarwati EH 1 aZhang Y 00 aExploring determinants of hydrocele surgery coverage related to Lymphatic Filariasis in Nepal: An implementation research study uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0244664&type=printable ae0244664 0 v16 3 a
Background
Hydrocele is a chronic condition in males in which there is an excessive collection of straw-colored fluid, which leads to enlargement of the scrotum. It is a common manifestation of lymphatic filariasis (LF) affecting nearly 25 million men worldwide. Surgery is the recommended treatment for hydrocele and is available free of cost in all government hospitals in Nepal. This research explored patient, provider, and community factors related to accessing hydrocele surgery services by the patients.
Methods
This study employed a qualitative method. The research was conducted in two LF endemic districts, namely Kanchanpur and Dhading, which are reported to have the highest number of hydrocele cases during morbidity mapping conducted in 2016. In addition to five key informant interviews with the LF focal persons (one national and 4 district-level), nine in-depth interviews were conducted with hydrocele patients (5 of whom had undergone surgery and 4 who had not undergone surgery) and with 3 family members, and two focus group discussions with the female community health volunteers.
Results
Most of the respondents did not have knowledge of hydrocele as one of the clinical manifestations of LF nor that it is transmitted through a mosquito bite. Although perceived as treatable with surgery, most of the patients interviewed believed in as well as practiced home remedies. Meanwhile, fear of surgery, embarrassment, lack of money, along with no knowledge of the free hydrocele surgery acted as barriers for accessing the surgery. On the other hand, financial support, flexible guidelines enabling the hospital to conduct surgery, decentralization and scaling up of morbidity mapping along with free hydrocele surgery camps in any remaining endemic districts were identified as enablers for accessing surgery.
Conclusion
Hydrocele surgery coverage could be improved if the program further addresses community awareness. There is a need for more focus on information dissemination about hydrocele and hydrocele surgery.
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