PEDIATRIC INGUINAL HERNIA SURGERY IN URBAN AND RURAL SIERRA LEONE: PRELIMINARY RESULTS FROM A MULTICENTER PROSPECTIVE COHORT johan.ahlback@gmail.com

 

PEDIATRIC INGUINAL HERNIA SURGERY IN URBAN AND RURAL SIERRA LEONE: PRELIMINARY RESULTS FROM A MULTICENTER PROSPECTIVE COHORT

4

Norway

Oral only

Pediatric inguinal hernia (PIH) affects 1–4% of children and may lead to complications if untreated. In Sierra Leone, with only one pediatric surgeon serving 8.8 million people, the unmet need for PIH repair remains high. Although the Free Healthcare Initiative (a subsidy scheme for children under five and pregnant women) has improved access, disparities persist. This study compares access, surgical practices, and outcomes between the national referral hospital and three rural public hospitals.

This is an ongoing prospective multicenter observational study including all children (0–18 years) undergoing PIH repair at four public hospitals from October 2023 to October 2025. Intraoperative data were recorded by hospital staff. Early (~2 months) and late (~1 year) follow-up data are collected via home visits by a research assistant performing standardized clinical assessments.

Preliminary data from 139 patients reveal marked disparities. Children in rural hospitals were older (8.6 vs. 4.4 years, p<0.001) and had longer diagnostic delays (5.9 vs. 2.5 years, p<0.001). Delays were commonly due to financial barriers (68% vs. 44%) and fear of surgery (37% vs. 54%). Intraoperative complications occurred in 4.5% vs. 3.2%. The pediatric surgeon performed 73% of capital operations, while 76% of rural cases were handled by clinical officers. Gas anesthesia was common in the capital; ketamine dominated in rural sites. Pediatric instruments were used in 91% of capital cases and 49% in provinces. Activity levels improved after surgery (2.1 to 3.6, p<0.001).

Preliminary findings highlight substantial inequities in access, workforce, and equipment for PIH care in Sierra Leone.