Primary health care facilities capacity gaps regarding diagnosis, treatment and knowledge of schistosomiasis among healthcare workers in North-western Tanzania: a call to strengthen the horizontal system

Humphrey Deogratias Mazigo,Paul Kazyoba,Upendo J Mwingira,Cecilia Uisso

doi:10.1186/s12913-021-06531-z

Abstract

BackgroundThe World Health Organization (WHO) calls for schistosomiasis endemic countries to integrate schistosomiasis control measures into the primary health care (PHC) services; however, in Tanzania, little is known about the capacity of the primary health care system to assume this role. The objective of this study was to assess the capacity of the primary health care system to diagnose and treat schistosomiasis in endemic regions of north-western Tanzania.MethodsA total of 80 randomly-selected primary health care facilities located in the Uyui, Geita and Ukerewe districts of North-western Tanzania participated in the study. At each facility, the in-charge clinician, or any other healthcare worker appointed by the in-charge clinician, participated in the questionnaire survey. A quantitative questionnaire installed in a Data Tool Kit software was used to collect data. Healthcare workers working at various stations (laboratory, pharmacy, data clerks, outpatient section) were interviewed. The questionnaire collected information related to healthcare workers’ knowledge about urogenital and intestinal schistosomiasis symptoms, human and material resources, laboratory services, data capture, and anti-schistosomiasis treatment availability.ResultsA total of 80 healthcare workers were interviewed. Bloody stool (78.3 %) and haematuria (98.7 %) were the most common symptoms of intestinal and urogenital schistosomiasis mentioned by healthcare workers. Knowledge on the chronic symptoms such as hepatosplenomegaly and hematemesis for intestinal schistosomiasis, and oliguria and dysuria for urogenital schistosomiasis, were inadequate. Laboratory services were only available in 33.8 % (27/80) of the health facilities and direct wet preparation was the most common diagnostic technique used for both urine and stool samples. All healthcare workers knew that praziquantel was the drug of choice for the treatment of schistosomiasis and the drug was available in 91.3 % (73/80) of the health facilities.ConclusionsThe capacity of the primary health care facilities included in the current study is inadequate in terms of diagnosis, treatment, reporting and healthcare workers’ knowledge of schistosomiasis. Thus, the integration of schistosomiasis control activities into the primary healthcare system requires these gaps to be addressed.

Highlights

The World Health Organization (WHO) calls for schistosomiasis endemic countries to integrate schistosomiasis control measures into the primary health care (PHC) services; in Tanzania, little is known about the capacity of the primary health care system to assume this role
The capacity of the primary health care facilities included in the current study is inadequate in terms of diagnosis, treatment, reporting and healthcare workers’ knowledge of schistosomiasis
To achieve the elimination goals, this vertical approach needs to be supplemented with a horizontal approach which will focus on integrating the control measures into the Primary Health Care (PHC) system in order to reach remote rural populations suffering from the disease, populations that are often not reached by mass drug administration (MDA) [8]

Summary

Introduction

The World Health Organization (WHO) calls for schistosomiasis endemic countries to integrate schistosomiasis control measures into the primary health care (PHC) services; in Tanzania, little is known about the capacity of the primary health care system to assume this role. Because of the wide distribution of schistosomiasis, the entire Tanzanian population of approximately 60 million people remains at risk of the disease, and in 2012 it was estimated that 52 % of the population was infected [2, 4] Both S. mansoni and S. haematobium are highly endemic and prevalent among communities living along the southern end of the Lake Victoria basin and its islands in the Northwestern region [5, 6]. In 2020, the World Health Organization (WHO) announced its new goals and vision for controlling and eliminating a number of neglected tropical diseases (NTDs) including schistosomiasis [7] To achieve this goal, the main strategy recommended for schistosomiasis is periodic preventive chemotherapy using the anti-schistosomal drug praziquantel (PZQ). In Tanzania, this situation is exacerbated by the decision to carry out targeted chemotherapy [9], addressing only school aged children, reducing the coverage of the infected population [9]

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