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CHAPTER ONE

1.0 INTRODUCTION

This chapter will present the following main ideas like, background, Statement of the
problem, purpose of the study, objectives of the study, major objective, specific objective,
research questions, scope of the study, content scope, geographical scope, time scope,
significance of the study, conceptual frame work and definition of terms.

1.1 BACKGROUND OF THE STUDY


An inguinal hernia is the most common type of hernia. The other types include Femoral
hernias, Umbilical hernias, and Hiatus hernias. An inguinal hernia is a protrusion of
abdominal-cavity contents through the inguinal canal. It is very common in men with
lifetime risk of 27% and 3% for women. Inguinal hernias can either be congenital or acquired
(Ruhl and Everhart, 2007).

Inguinal hernias have first been described by the ancient Egyptians in the Papyrus of Ebers.
The papyrus was written in about 1500 BC, but it is believed to have been copied from earlier
texts, perhaps dating as far back as 3400 BC. The first anatomical studies of the inguinal
region date back to Galen (131–210 A.D.). Antonio Benivieni (1440-1502), founder of
pathologic anatomy, wrote on inguinal hernias in 1507 (Abditis Morborum Causis).
Ambroise Pare described the hernia repair in his book The Apologie and Treatise (Apologie
et Traité) by reduction of abdominal organs into the abdominal cavity and sewing up the
peritoneum. Knowledge culminated during the early nineteenth century in complete anatomic
understanding of the inguinal canal by publications of Pott (Ruhl and Everhart, 2007).

During the first half of the nineteenth century little progress was made despite increasing
knowledge of anatomy and introduction of anesthesia in 1846, because of infectious
complications and recurrence after opening the inguinal canal. After introduction of antiseptic
spray (Lister 1870) and gloves (Halsted 1896) techniques of modern hernia surgery were
developed. Marcy, a pupil of Lister, published on his repair in 1871: high ligation of the sac
and narrowing of the internal ring. The Marcy repair still is the simplest non prosthetic repair
performed today, for treatment of indirect inguinal hernias in children and young adults.
Second half of the nineteenth century mortality rate was 2-7% and recurrence rate about
100% (Billroth, 1890 and Bull, 1891).
A study of 632 inguinal hernia repairs in Ife, Nigeria demonstrated that indirect hernia was
more common that the direct type with a ratio of three to one (3:1) . It is true that Erdman
found 313 cases of direct hernia in a series of 978 inguinal hernias but Coley makes the
following observations on this finding, "Erdman's proportion of direct to indirect hernias,
nearly 33%, is very much higher, we believe, than shown In any other statistics". Coley
himself found one direct to fourteen indirect hernias in 1383 cases of inguinal hernia in
adults. In some regions of East Africa direct hernia was found to be more than indirect
hernia. In Jinja Hospital, Uganda, among the Busoga people direct inguinal hernia was found
to be more than the indirect type (O'Rourke,2013).

A study at Kenyatta National Hospital showed that indirect inguinal hernia was most
common forming 93.4% of the cases studied. This gave a ratio indirect to direct hernia as
13:1, which compares well with many studies elsewhere. The relative incidence for male to
female was quoted by Connel in 1930 as reported in a series of 202 cases of inguinal hernia
in Africans, which did not include a single case in a female. He was led to believe that
African women must be practically immuned to the malady. However, Asley showed in a
total of 649 inguinal hernias a proportion of one female to every 7.65 males. This figure
compares well with generally accepted figures for other races. Watson gave the proportion of
one female to nine males (Ruhl and Everhart, 2007).

Factors which are found to be associated with inguinal hernia in adults include physical
exertion and weight lifting, constipation, straining during urination, smoking, obesity, ageing,
positive family history of hernia, Alcohol drinkers, chronic obstructive airway disease
(COAD), muscle deficiency following previous appendectomy and abdominal surgery, pelvic
fractures and trauma and connective tissue disease (O'Rourke,2013).

The condition of inguinal hernia is a condition that many adult male in East Africa are
vulnerable to this disease. There is a significant number of male who have suffered the
condition and have lived with it for many years. Reports from Uganda show that about nine
in 10 males are affected. According to the Demographic and Health Survey of Uganda
(2006), an estimated 2.6% (n=199,725) of male of age (15-49 years) had experienced
Inguinal hernia. From available literature, risk of Inguinal hernia in Uganda is aggravated by
poverty, Male's low socio- status in society and lack of education, preventing them from
getting services to avert or cure the condition (UNFPA, 2012).
1.2 PROBLEM STATEMENT

In Somalia's Inguinal hernia ratio stands at 1,044 per 100,000 of adult males, making it one of
the highest in the world and contributes to raising the regional and global averages for the
indicator. Moreover, this situation is from analysis conducted by UNFPA in early 2009
(TBAs) (UNFPA 2012). In spite of these, Inguinal hernia has not been acknowledged as a
priority health issue for a long time. Health system factors especially in rural areas like
inadequate facilities and a poor referral system, inadequate skilled staff to handle the hernia,
low awareness of the problem of the community to the hernia level and certain cultural
practices increases the vulnerability to disease (UNFPA 2012). The study therefore will
focus on risk factor for inguinal hernia in adult male.

1.3 THE PURPOSE OF THE STUDY

The purpose of the study is to investigate the awareness of risk factor for inguinal hernia in
adult male in some selected hospital in Mogadishu.

1.4 RESEARCH OBJECTIVES

1.5.1 Major objectives:


To examine the awareness of risk factor for inguinal hernia in adult male in some selected
hospitals Banadir in Mogadishu - Somalia:

1.5.2 Specific object


a. To identify the risk factors related to health conditions which contribute to inguinal
hernia in adult male.
b. To determine lifestyle factors associated with inguinal hernia in adult male.
c. To identify occupational factor associated with inguinal hernia in adult male.

1.5 RESEARCH QUESTIONS

a. What are the risk factors related to health conditions which contribute to inguinal
hernia in adult male?
b. What are the lifestyle factors associated with inguinal hernia in adult male?
c. What are the occupational factors associated with inguinal hernia in adult male?
1.6 SCOPE OF THE STUDY

1.6.1 Content of the Scope


To examine the awareness of risk factor for inguinal hernia in adult male in Banadir hospital
in Mogadishu.

1.6.2 Geographical scope:

The Study will be held in Banadir hospital in Mogadishu.

1.6.3 Time scope

In terms of time this study will limited through June to September 2018.

1.7 SIGNIFICANCE OF THE STUDY

This study has great significance concerning the way to improve the awareness of risk factors
associated with inguinal hernia in adult male in some selected hospital in Mogadishu.
Moreover, the findings may have great importance for policy makers and may help them to
design programs that are intended to help men to prevent inguinal hernia. This research will
also help student researchers and medical researchers as a reference for those who will
conduct a research on the same issue.

1.8 OPERATIONAL DEFINITION

 Elective surgery: Planned surgical procedure for a condition that does not require
immediate surgical intervention Emergency surgery Surgical procedure for a
condition that requires immediate surgical intervention.
 Epidemiology: The study of the distribution and determinants of health-related states
or events (including disease), and the application of this study to the control of
diseases and other health problems.
 Global health: The area of study, research and practice that places a priority on
improving and achieving equity in health globally Global surgery An area of study,
research, practice, and advocacy that seeks to improve health outcomes and achieve
health equity for all people who need surgical and anaesthesia care.
 Groin hernia: A collective term for inguinal and femoral hernia Health system All
activities whose primary purpose is to promote, restore, and maintain health.
 Hernia: The projection of an organ or part through the lining of the cavity in which it
is normally situated.
1.9 Conceptual Framework

DEPENDENT VARIABLE
INDEPENDENT VARIABLE

Health related factors

Lifestyle factors The Risk Factor for


Inguinal Hernia in
Adult Male

Occupational factor

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