Hydrocelectomy As An Indicator For The Occurrence And Spread Of Lymphatic Filariasis In Kano State, Nigeria
M Dogara, H Nock, R Agbede, I Ndams
endemic, hydrocelectomy, hydrocoele, lymphatic filariasis, prevalence
M Dogara, H Nock, R Agbede, I Ndams. Hydrocelectomy As An Indicator For The Occurrence And Spread Of Lymphatic Filariasis In Kano State, Nigeria. The Internet Journal of Tropical Medicine. 2012 Volume 8 Number 1.
Lymphatic filariasis is endemic in Nigeria, but the level of endemicity is unknown because many areas in the country remain unstudied. The Nigeria Lymphatic Filariasis Elimination Program (NLFEP) has set an ambitious target of 2015 to eliminate this disease. The success of this program depends on the use of an inexpensive, easy, and simple method to both identify and treat endemic communities. Hydrocoele is one of the chronic symptoms of lymphatic filariasis that is surgically treated in major hospitals in areas where the disease is endemic. Hydrocelectomy has been used as an index to determine the prevalence of lymphatic filariasis in certain endemic communities. The aim of this work is to determine the prevalence of hydrocelectomy in hospitals to assess the occurrence and spread of lymphatic filariasis in Kano State, Nigeria. To accomplish this goal, the prevalence of hydrocelectomy was investigated from 1994–2003 in 20 hospitals spread across eight of the nine Zonal Health Centers (ZHCs) in Kano State. The data obtained were analyzed using simple frequencies and percentages with respect to the specific hospital examined, patient age and type of hydrocoele on which hydrocelectomy was performed. Of 54,943 surgeries performed in 20 hospitals, 1,271 (2.31%) were hydrocelectomies. The prevalence of hydrocelectomy among the hospitals and ZHC cases ranged from 59 (0.16%) to 121 (29.4%) and from 59 (0.16%) to 325 (12.9%), respectively. The frequency of hydrocelectomy cases showed an initial rise with patient age, reaching a peak at the older age groups and then dropping thereafter. Although the overall prevalence of hydrocelectomy is generally low, its prevalence in all the hospitals surveyed strongly suggests that lymphatic filariasis may be prevalent and widespread throughout the state. However, none reflection of the domicile of the patients coupled with poor record taking/keeping and storage made it impossible to use the results in selecting villages for further epidemiological studies. Therefore there is need to develop a standard and sustainable system of taking and keeping records; and storage in Kano State hospitals for effective planning and research.
Lymphatic filariasis resulting from infection with the mosquito borne nematode parasite
The hydrocoele associated with lymphatic filariasis in males, causes physical, psychological, social and economic distress (Mwobobia et al; 2000). The associated scrotal pain may be sufficiently severe to make work impossible (Wijers, 1997), and large hydrocoeles may prevent sexual intercourse and so weaken marriages (Gyapong
Since hydrocoeles correlates well with the prevalence of microfilaraemia, the prevalence of hydrocoele can be used to assess the prevalence of lymphatic filariasis in a community rapidly (Gyapong
Materials And Methods
The Study Area
Kano State is located in the north western Nigeria. The state is situated between 100° 33'N - 100° 33'N and 70' 34'E - 90° 29' E respectively. The State is boarded in the east by Jigawa State, on the west by Katsina State, to the south by Kaduna and Bauchi States. It covers a total area of 20,760SqKm with 1,754,200 hectares of arable land and 75,000 hectares of forest vegetation and grazing lands. The topography is generally flat. The main river is the Kano River on which the second largest dam in Nigeria, the Tiga was built. Minor rivers include Challawa, Watari, Tomas and Kafin-Chiri. The state has an estimated population of about 9,383,332 million people (NPC, 2006).
The state is situated in the Sahel savannah region of West Africa and its climatic condition is tropical having rainy and dry seasons. The length of the wet season is about 100-150 days or five months (from mid-May to mid-October of each year). Rainfall pattern is unimodal; with an average rainfall of 600mm. The dry season lasts for about seven months (from mid-October to mid-May of each year). However, there is the dominance of North Easterly winds, the harmattan which is cold and dry that extends from November to February of each year. The average maximum and minimum temperature fluctuates throughout the year. The annual mean ranges from 30°C to 35°C. High temperatures are recorded during March to May annually while the lowest 13°C (sometimes it goes down as low as 10°C is from December to January.
The State Ministry of Health is concerned with preventive aspect of the health care while the State Health Management Board deals with curative medicine. The board delivers its health care services through about forty five General and Cottage Hospitals spread across the state. Of this number about 24 hospitals are managed by the State’s Health Management Board.
Retrospective Survey of Hydrocelectomy in Kano State
The Health Management Board, a parasatal of the Kano State Ministry of Health manages all the General Hospitals and some Cottage Hospitals in the state. For ease of administration, the hospitals are grouped into nine Zonal Health Centres (ZHC). Permission to undertake the proposed study was sought and obtained from the Executive Secretary of the board. Thereafter, eight ZHCs were selected to conduct the work in order to adequately cover the entire state. The ZHCs selected include; Municipal (Zone I), Rano (Zone II), Danbatta (Zone III), Gwarzo (Zone IV), Gaya (Zone V), Sheik Jidda (Zone VI), Sir Muhammadu Sunusi (Zone VII) and Sheikh Muhammadu Gidado (Zone VIII).
The aim of the survey was to determine the prevalence of hydrocelectomy and types documented in the hospitals records and/or presently admitted cases in the hospitals as well as its burden on the hospital resources. It was also aimed at providing background information for the selection of endemic areas where further detailed study will be carried out. In each of the eight zones, all the hospitals were visited except in Municipal (Zone I) where only the leprosarium at Yadakunya was visited, because the other two are a Psychiatric and a Paediatric hospital and do not undertake hydrocelectomy. Data was also not collected at Sheikh Muhammadu Gidado Hospital because it is a Maternity Hospital.
In each of the hospitals, records for a period of ten years (1994-2003) were obtained and examined from the Medical Records and Theatre. Medical records were examined to determine the number of cases diagnosed for hydrocelectomy. The theatre registers were also examined to determine the number of hydrocelectomies performed during the period under review. The information obtained was recorded in a data collection form. Records of hydrocelectomy were obtained from twenty hospitals.
Permission to carry out the work was approved by the Kano State Hospital Management Board, a parasatal in the State’s Ministry of Health via a letter dated 26 th March, 2003. The work was also reviewed and approved by the Postgraduate Research Committee of the Department of Biological Sciences, Ahmadu Bello University, Nigeria.
The data of records of hydrocelectomies was analyzed using simple frequencies and percentages with respect to hospitals, age and type of hydrocoele and then presented in tabular forms. The hydrocelectomies were categorized into right; left, bilateral and unspecified (which are cases not indicated as either right, left and bilateral in the Physician’s Register).
Retrospective Survey of Hydrocelectomy in Selected Health Centres in Kano State
In the process of data collection, most hospitals visited did not have up to date records in their Medical Record Units. For example, in Tudun-Wada Dankadai, the Medical Record Unit was none existent at the time of the visit. In addition many of these units have poor storage facilities and therefore past records of many years in some hospitals were not available. Where record files were available, documents were either missing or information incomplete. However, records with respect to the statistic of some inpatient, outpatient, paediatric cases and surgeries performed were usually found kept in good order.
Cases diagnosed as hydrocoeles were encountered in the Medical Records, which were usually referred to the theatre for hydrocelectomies. The records in the theatre registers were properly kept in most hospitals, although there were few instances of missing pages in some registers. Every case of hydrocoele recorded in the Medical Record Unit was also reflected in the theatre register, in view of this duplication, only the results of cases of hydrocoeles from the theatre registers are reported since the records were more accurate and properly kept. However, most of the records from the registers had the fault of none reflection of ages and domicile of the patients. This made the selection of villages or areas where further detailed epidemiological study was to be done impossible. That is why the analysis of hydrocelectomies on the basis of age was done only in instances where such information was available. In addition, the aetiology of the hydrocoeles was not reflected both in the theatre registers and the patients file folder, thus making it impossible to know those that were due to lymphatic filariasis.
Hydrocelectomies were encountered in all the hospitals visited except at Sheikh Muhammadu Gidado, but the number of cases varied from one hospital to another. However, no clear pattern of the distribution was discernible.
Of the 54,943 surgeries performed 1,271 (2.31%) were hydrocelectomies (Table, 1). Of the total number of hydrocelectomies, 291 (22.9%) were done on the right type, 203 (15.9%) on the left, 368 (28.9%) on the
Age Distribution of Cases of Hydrocelectomies
Ages of the patients on which hydrocelectomies were performed were reflected in the records of only in five of the hospitals surveyed. The general pattern showed an initial rise with age reaching a peak in the older age groups and then began to drop thereafter in the older age group (Table, 2). In fact, the pattern revealed an increase with age reaching a peak at 50 – 59 year age group and then it begins to decrease up to the 80+ year age group.
In spite of the problems associated with record keeping encountered in most of the hospitals surveyed, the prevalence of hydrocelectomy (an index of filariasis) suggest that lymphatic filariasis is endemic in different parts of Kano State. Hydrocelectomy has been used as a proxy for the prevalence of hydrocoeles in coastal Kenya endemic for filariasis by (Mwobobia
In fact, thelow prevalence of hydrocelectomy of 59(0.16%) recorded in this study is from a specialized hospital, the Yadakunya leprosarium where most of the surgical cases are concerned with medical ailments of leprosy. However, in all the conventional hospitals with exception of Sir Muhammadu Sunusi 24(1.19%) and Wudil 28(1.98%), the prevalence of hydrocelectomy ranged from 4% to 29.4%. The low prevalence of hydrocelectomy in Wudil General Hospital may be due to unavailability of data for a period of three years (1996, 2002 and 2003). At Sir Muhammadu Sunusi (a major General Hospital located in the state capital), the low prevalence may be explained by the fact that many hydrocelectomy patients that would have normally gotten their surgeries done in the hospital do so at either Gezawa or Minjibir hospitals that are located around that axis of the state capital. In spite of the overall low prevalence of hydrocelectomy, 1,272(2.3%) and the review covered a period of ten years, the results compares favourably well with that obtained by (Mwobobia
The distribution of hydrocelectomy in relation to age in this study was shown to increase with age reaching a peak in the older age groups and then to a downward trend. This is because children are less exposed to predisposing factors to infection and also the possession of immunity against the infection. This result is in agreement with previous findings such as those of Onapa
The results of this study underscores the need to develop a reliable and sustainable system of standard method of collecting, recording and storing both inpatient and outpatient data in hospitals managed by the Kano State Health Management Board.
The authors are grateful to the management of Kano State Health Management Board for permission to carry out the work. We also appreciate the support given to us by staff of all the hospitals visited during the course of data collection. Financial support in aid of this research by the Management of Federal College of Education, Kano is duly acknowledged.