Misconceptions delay hydrocele treatment along Tanzania’s coast

Dar/ Coast. Misconceptions about hydrocele persist along Tanzania’s coast, despite available treatment, with fear and stigma preventing many from seeking medical care, subjecting an estimated 778,415 people to remain at risk.

Bagamoyo is among five districts where hydrocele sufferers continue to live with the condition, often turning to traditional remedies or local healers.

Tanzania ranks eighth globally and fourth in Africa among countries most affected by neglected tropical diseases (NTDs).

In 2023, more than 36 million Africans required treatment for at least one NTD, including trachoma, intestinal worms, schistosomiasis, hydrocele, or lymphoedema.

Living with a hydrocele

A resident of Rudiga village in Talanda Ward, Bagamoyo District, Coast Region, Shabanni Ramadhan, 46, lived with hydrocele, commonly known as “busha”, for nearly 14 years without treatment.

He relied on traditional medicine, and at times his condition was viewed by the community as a special gift (“mwinyi”), conferring unique status.

Although he did not welcome the attention, Mr Ramadhan endured the condition since 2010, which gradually weakened him and became a serious burden.

Working in agriculture to support his family, he struggled with persistent pain.

His extended family attempted to raise funds for treatment, but the money was insufficient.

“In April 2024, I underwent surgery and treatment with support from Sightsavers. I am now fully healthy, can farm my land without difficulty, and hope to build a permanent home for my children and invest in a motorcycle,” Mr Ramadhan told The Citizen.

Similarly, a Standard Seven pupil from Fukayosi village, in Bagamoyo District, Tito Ibrahim, was born with hydrocele and received treatment in 2023 at Bagamoyo District Hospital.

Surgery was made possible through support from the END Fund and Sightsavers, which implement global NTD treatment and prevention programmes in the district.

Before surgery, Ibrahim frequently missed school, especially during cold and rainy periods.

His grandmother and primary caregiver, Ms Rosemary Masanja, known locally as Grandma Tito, said the condition caused him constant discomfort, preventing him from playing or attending school regularly.

“Even when he played, he would return home complaining of stomach pain and go inside to rest,” she recalled.

She explained that traditional and herbal remedies had failed.

“They told me there was a local remedy to dig and treat him, but it didn’t work. Since birth, one of his scrotal sacs has been filled with fluid. We took him to the hospital and were told he would need surgery at age five. But due to financial constraints, we couldn’t proceed,” she said.

After hospital treatment, she noted major improvement as Ibrahim now participates in sports, attends school consistently, and has since improved his academic performance.

“After surgery, he attends school every day, moving up from 34th place to 10th or 8th in class,” said Grandma Tito.

Ibrahim described life before surgery as unbearable due to constant pain, which forced him to sleep to cope.

“I experienced severe pain that worsened over time. The only relief was sleeping, as the pain would subside while I rested,” he said.

Aspiring to be a professional footballer, Ibrahim previously struggled to participate fully in sports.

His teacher, Ms Neema Msuya, noted that his attendance and academic performance were poor before treatment.

“After treatment, he has shown remarkable improvement in attendance, has not missed school, and his academic performance has improved significantly,” she said.

Understanding hydrocele

Lymphatic Filariasis and Hydrocele Control Manager at the National NTD Control Programme at the Ministry of Health, Dr Faraja Lyamuya, explained that Ibrahim was born with hydrocele.

The condition arises when parts of the body or vessels that should close remain open, causing fluid accumulation, sometimes with organs descending abnormally into the scrotum, referred to locally as “ngiri kokoto” (hydrocele and hernia).

A parent may notice one scrotal sac filling with fluid, swelling intermittently, then returning to normal when lying down.

“This indicates hydrocele or hernia. Ibrahim was born with both, which explains his pain while playing. Only a few children are born with this condition,” clarified Dr Lyamuya.

He added that surgery is typically recommended at age five, though the condition causes considerable discomfort beforehand.

“As hydrocele and hernia enlarge over time, children suffer physically and psychologically. Tanzania faces this problem, but the exact number of affected children is unknown,” he said.

Government efforts

Dr Lyamuya said many health centres now perform hernia surgeries successfully.

The Ministry of Health, working with partners, continues to educate communities to dispel misconceptions that hydrocele is a mark of pride or a special gift.

“Hydrocele is treatable. Untreated hydrocele can cause pain, social stigma, reduced mobility, isolation, and economic challenges,” he explained.

The National NTD Control Programme Manager, Dr Clarer Mwansasu, said by 2024, over 19,774 patients had received treatment, with 12,660 undergoing surgery between 2009 and 2024.

Tanzania targets five treatable NTDs: schistosomiasis, intestinal worms, hydrocele, lymphoedema, and trachoma, aiming for eventual eradication.

“These successes are due to coordinated approaches involving community outreach, mass drug administration, improved healthcare access, monitoring, and research,” he said.

“These achievements result from strong coordination between communities, the Ministry of Health, and development partners, including Sightsavers, the END Fund, and others,” added Dr Mwansasu.

He said NTD funding is included in council health plans and national budgets, alongside exploration of innovative financing methods.