Prevalence, Primary Health Care Diagnosis, and Challenges Encountered by Health Care Workers in the Control of Schistosomiasis, in the Tiko Health District, South Western Cameroon

Abstract

One approach to the control of schistosomiasis recommended by the World Health Organization (WHO) is for endemic countries to integrate schistosomiasis control measures into their primary health care (PHC) services. Assessment of their capacity to accommodate such control measures is of utmost importance. This study had as objectives to assess the capacity of the PHC system in the Tiko Health District to diagnose schistosomiasis and to evaluate health care workers’ perspectives of potential challenges to schistosomiasis control in the district. A total of 13 primary healthcare facilities were randomly selected and their laboratory records on schistosomiasis diagnosis were evaluated for quality (availability, documentation of key aspects and presentation), diagnostic methods used and parameters recorded (egg counts, haematuria). At each institution, more than 60% of health personnel participated in a survey in which a semi-structured questionnaire was used to collect data. A total of 170 healthcare workers working at various stations (laboratory, pharmacy, nurses, out-patient section) were interviewed. Out of the 13 health institutions, only 8(61.5%) had any data on diagnosis of the disease and used the sedimentation technique for diagnosis. One institution used the Syringe Filtration Technique (7.7%) in the diagnosis of S. haematobium and recorded the presence or absence of haematuria. No institution recorded key parameters like egg count for any patient. Five (38.5%) of the institutions, found mainly in the suburbs, had no laboratory services. Most of the healthcare workers (46.5%) were of the opinion that lack of knowledge of the disease is a major setback in the implementation of control. With respect to the different professions, it was observed that amongst the medical doctors (83.3%) and nurses (58.2%) this opinion was more popular. Pharmacy technicians (67.7%) and community directed distributors (52.2%) cited the poor sanitary conditions of homesteads as the greatest challenge in the implementation of any form of control. The primary healthcare system of the Tiko Health District lacks the capacity to accommodate control measures; all the hospital laboratories fall short of WHO recommendations for diagnosis of the disease. The control of schistosomiasis in this health district is likely to be hampered by several factors ranging from poor sanitation, poor knowledge of the diseases, lack of commitment of stakeholders and poor diagnostic techniques and reporting methods.