A rough and ready solution to the problem of inguinal hernias has been shown to be safe and effective, opening the way to treatment for tens of millions of people who can't afford surgical mesh. The finding is another reason why anti-malarial bed nets save lives.
Inguinal hernias occur in the abdominal wall around the groin. Fat, intestines, and sometimes other bodily organs can be pressed through weaknesses or holes. The result is painful, can prevent most forms of physical exertion, and complications cause tens of thousands of deaths each year.
In much of the world, hernia surgery is routine, with approximately 20 million operations occurring a year. On the other hand, almost 200 million people are estimated to have untreated hernias resulting from being unable to afford surgery. The cost of meshes produced to repair hernias can be as much as the surgeon's fees in Africa, taking operations out of the reach of many who need them most.
Hernia surgery being performed in Sweden, where the cost of the surgical mesh is a minor consideration. Stefan Zimmerman
"Commercial hernia meshes cost 100 dollars or more, which is too much for the health services and people living in poor countries," said Dr. Jenny Löfgren of Umeå University, Sweden, in a statement. "So instead, doctors and surgeons in several countries have been using mosquito nets, but whether they are effective and safe hasn't been given sufficient study until now."
Löfgren conducted a randomized double-blind clinical trial on 302 men from eastern Uganda, half of whom were given commercial meshes. The rest received sterilized pieces cut from nets used to keep off malarial mosquitoes. In the New England Journal of Medicine, Löfgren reports that outcomes were equally good irrespective of treatment, measured both by self-assessment and ratings of complications by the four experienced surgeons who performed the operations.
A year later, only one of the men who had pieces of bed nets placed inside their abdomens had suffered a recurrence, and complications were equally rare in both groups. The findings are consistent with those from earlier studies that, while positive, were regarded as too small to settle the question.
Entire bed nets treated with insecticides cost between £1.4 and £3.5 ($2 and $5), so the small pieces required to fix a hernia are affordable even in the poorest places.
Bed nets have been proven to be the most cost effective method for malarial control in Africa. Indeed, distributing nets has been found to be among the cheapest ways for aid programs to save lives from any disease. However, while the pyrethroids used in modern nets are long lasting, they don't stay potent forever. The nearly 300 million nets distributed in Sub-Saharan Africa between 2008 and 2010 have passed their expiry dates.
Replacing these nets with newly treated versions is an urgent priority (you can help here). Using replaced nets to cure hernias could be a world-beating form of upcycling.