Prevalence of un-operated umbilical hernias and factors leading to non-operation among primary school children in Mulago Parish, A cross-sectional study

Abstract

Introduction Un-operated umbilical hernias are common among school going children in Mulago parish. Complications include incarceration, intestinal obstruction and strangulation. This affects their concentration at school due to the painful episodes and is also a threat to life. Their care is further worsened by the inadequate health infrastructure, poverty and lack of knowledge of umbilical hernias. Objective: We determined the prevalence of un-operated umbilical hernias and factors leading to non-operation among school going children in Mulago Parish, Kampala City. Methods This was a cross-sectional study in six schools in Mulago parish, Kampala conducted between March and June 2023. Stratified sampling technique was used to select the study population and participants were recruited through systematic sampling. Parents or guardians provided informed consent for all the participants while those 8 year and older provided assent as well. Data was collected using pretested questionnaires and entered electronically using Microsoft excel document. Presence of un-operated umbilical hernia was measured as a binary outcome either present of absent. Logistic regression was used to determine factors non-operation of umbilical hernias. Results We recruited 691 participants. Age range was 6-17 years, median age of 11 years (IQR=8-13). 8.54% (n=59) of the participants had palpable whereas 6.22% (n=43) had umbilical hernias which were visible. The umbilical hernias were classified as Small (n=2), Medium (n=37) and Large (n=20). Non-operation of umbilical hernias were; didn’t know of the hernia (n=30), never sought care (n=25), feared surgery (n=11), couldn’t afford surgery (n=6), no pain (n=6), no surgeons (n=6), taking herbs (n=1) and hospital inaccessible (n=0). Pupil’s class was significantly associated with presence of umbilical hernia and age was a confounder. Conclusion and recommendations Unoperated umbilical hernia is common among school going children in Mulago parish. Most care takers are not aware of it and do not seek care. This suggests a need for active case finding and provision of safe, accessible, and affordable surgical care.