Lama Yonzon Choden, Padmawati Retna Siwi, Subedi Raj Kumar, Paudel Sagun, Ghimire Ashmita, Murhandarwati Elsa Herdiana
Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Bhaskar-Tejshree Memorial Foundation, Kathmandu, Nepal.
PLoS One. 2021 Feb 26;16(2):e0244664. doi: 10.1371/journal.pone.0244664. eCollection 2021.
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.
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.
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.
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.
鞘膜积液是男性的一种慢性疾病，表现为阴囊内积聚过多淡黄色液体，导致阴囊肿大。它是淋巴丝虫病（LF）的常见表现，全球近2500万男性受其影响。手术是鞘膜积液的推荐治疗方法，在尼泊尔所有政府医院均可免费进行。本研究探讨了与患者获得鞘膜积液手术服务相关的患者、医疗服务提供者和社区因素。
本研究采用定性方法。研究在两个淋巴丝虫病流行区进行，即坎昌普尔和达丁，据报道，在2016年进行的发病情况测绘中，这两个地区的鞘膜积液病例数最多。除了对淋巴丝虫病协调人进行五次关键 informant 访谈（一名国家级和四名地区级）外，还对鞘膜积液患者（其中5人已接受手术，4人未接受手术）和3名家庭成员进行了九次深入访谈，并与女性社区卫生志愿者进行了两次焦点小组讨论。
大多数受访者不知道鞘膜积液是淋巴丝虫病的临床表现之一，也不知道它是通过蚊虫叮咬传播的。尽管认为手术可治疗，但大多数接受访谈的患者既相信也采用家庭疗法。同时，对手术的恐惧、尴尬、缺钱以及不了解免费鞘膜积液手术成为获得手术的障碍。另一方面，财政支持、使医院能够进行手术的灵活指导方针、发病情况测绘的权力下放和扩大以及在任何剩余流行区设立免费鞘膜积液手术营地被确定为获得手术的促进因素。
如果该项目进一步提高社区意识，鞘膜积液手术覆盖率可能会提高。需要更多地关注鞘膜积液和鞘膜积液手术的信息传播。
