A major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers.

Vida Ami Kukula,J. Russell Stothard,Irene Honam Tsey,Margaret Gyapong,Sally Theobald,Eleanor E. MacPherson,Michael H. Hsieh

doi:10.1371/journal.pntd.0007207

Abstract

BackgroundUrogenital schistosomiasis is endemic throughout Ghana with elevated infection levels in certain areas e.g. Lake Volta Region. While the primary focus of the national control program is on mass drug administration of praziquantel to school-aged children, Female Genital Schistosomiasis (FGS), a disease-specific affliction of girls and women, has been largely overlooked. To better focus future actions, our study investigated the perceptions, knowledge and understanding of FGS amongst community members and health providers.Method/Principal findingsWe used qualitative methods including 12 focus group discussions and 34 in-depth interviews. We purposively selected 16 communities along the Lake Volta in the Shai-Osudoku District. Participant selection was based on gender, age and occupation; providing an opportunity to explore community understanding of FGS through participants own words and perceptions. Awareness of schistosomiasis was reported and is commonly experienced among children (12–17 years) and younger adults (18–25 years) in the study communities but is typically considered a boy’s disease. Knowledge of FGS was lacking in women, girls and front-line health workers. There was a general misconception that FGS may be the result of sexual promiscuity. Adolescent girls reporting vaginal discharge and itching were often stigmatized by health workers and treated for sexually transmitted infections. Limited alternatives to the river as key source of water meant that all members of the community faced the regular risk of schistosomiasis.Conclusion/SignificanceThere is a clear imperative for the national control program to better engage on FGS and implement interventions to meet girls and women’s needs. The key consideration is to integrate more adequately preventive services with sexual and reproductive primary health care with future training of health workers for improved management of FGS cases. More broadly, harmonizing the portfolio of all actions on FGS is needed, especially with a call for improved access to safe water and sanitation for all those at current or future risk.

Highlights

Schistosomiasis is an important parasitic disease that affects the health and well-being of over 200 million people throughout the world [1], causing some 3.3 million disability-adjusted lifeyears [2]
We explored the knowledge and understanding of girls and women on Female Genital Schistosomiasis (FGS), as well as, local health care providers’ knowledge and practice relating to FGS
Our work found that FGS was rarely on the radar of suspicion for health workers, more importantly, adolescent girls were often stigmatized by health care workers when they sought care in public health facilities owing to misdiagnosis of the disease as sexually transmitted infections

Summary

Introduction

Schistosomiasis is an important parasitic disease that affects the health and well-being of over 200 million people throughout the world [1], causing some 3.3 million disability-adjusted lifeyears [2]. Urogenital schistosomiasis is caused by infection with Schistosoma haematobium, a dioecious blood fluke that utilizes specific freshwater snails of the genus Bulinus as obligate intermediate hosts. The eggs that perforate and cross the bladder wall, co-transit with leakage of venous blood. This leads to the cardinal sign of urogenital schistosomiasis known as macro-hematuria or red urine. After sufficient development within the infected snail, to complete its lifecycle, a different larval stage emerges, the cercaria, often produced in enumerable amounts each day, and is able to cross unbroken skin directly. While the primary focus of the national control program is on mass drug administration of praziquantel to school-aged children, Female Genital Schistosomiasis (FGS), a disease-specific affliction of girls and women, has been largely overlooked. To better focus future actions, our study investigated the perceptions, knowledge and understanding of FGS amongst community members and health providers

Objectives

Results

Discussion

Conclusion