Systemic and capacity barriers to female genital schistosomiasis management among healthcare workers in Ghana: a mixed-method approach.

Background Schistosomiasis causes significant morbidity in over 78 countries worldwide, including Ghana. In females, untreated urogenital schistosomiasis can lead to female genital schistosomiasis (FGS), which has a focal prevalence of 11% and 73% in Ghana and poses complex challenges for healthcare professionals. This study assessed the knowledge, attitudes, and practices of healthcare workers (HCWs) regarding FGS in two schistosomiasis-endemic districts. Methods A cross-sectional mixed-method study was conducted in 36 health facilities, involving 252 HCWs from the Lower Manya-Krobo (LMK) and Shai Osudoku districts (SOD). Quantitative data were analyzed using descriptive statistics, t-tests, and multivariable lineal regression (Stata 18). Additionally, 38 purposively selected HCWs were in interviewed, and qualitative data were analyzed thematically (NVivo 20). A joint display analysis was used to integrate findings. Results Significant gaps in FGS-related KAP were identified in both districts. HCWs in LMK had a lower mean knowledge score of 41.4 (95%CI 38.4–44.4) than those in SOD 55.9%, (95%CI 54.2–57.6). Practice scores were similarly low: 31.1% (95%CI 28.5–33.7) in LMK and 33.5% (95%CI 31.4–35.4) in SOD. HCWs reported hesitance to manage FGS due to limited knowledge, lack of training, absence of diagnostic tools, and unavailability of praziquantel. Only 4.8% of HCWs in LMK and 9.5% in SOD reported their facility could diagnose and manage FGS. KAP scores varied significantly by cadre, educational, years of experience, and work settings. Qualitative findings confirmed lack of FGS-specific interventions, including clinical guidelines and facility-level support. Participants recommended in-service training, integration of FGS into routine health education, and improved community sensitization. Conclusion The study reveals substantial gaps in HCWs KAP and preparedness to manage FGS in both districts exacerbated by a lack of systemic support, training, and resources. Addressing these gaps requires integrating FGS in health training curricula; regular in-service training for frontline HCWs; improved diagnostic and treatment capacity; community education; and strengthening district-level supervision. A multi-sectoral approach involving government, academia, civil society, and the private sectors is essential to improving FGS prevention and management in Ghana.

Female Genital Schistosomiasis (FGS) remains a critical and yet neglected topics in Neglected Tropical Diseases (NTDs), significantly affecting the health of women and girls worldwide. Health workers' knowledge of FGS is vital to the prevention and management of the disease. This study adopted an implementation research approach to identify and address the existing knowledge gap regarding FGS among healthcare workers in Ghana. This study was a 3-year (2020-2022) implementation research applying a pragmatic uncontrolled quasi-experimental study design. The study involved a baseline assessment, FGS training intervention for health workers and student nurses, distribution of FGS educational materials, and an endline assessment. A mixed-method approach was applied to data collection involving health workers from two schistosomiasis endemic districts and across the country. NVIVO 12 and STATA 14 were used for qualitative and quantitative data analysis, respectively. Prior to the intervention, the level of awareness about FGS among health workers was less than 8%, and most participants only understood FGS as merely urogenital schistosomiasis in females. In response to this gap, an FGS education intervention in the form of training of health workers, student nurses alongside the distribution of FGS educational materials were carried out. The intervention enhanced health workers' awareness of FGS to more than 61%, encompassing an enhanced understanding of the disease's signs and symptoms to more than 60%, as well as its management strategies. However, access to praziquantel, the primary treatment, remained a significant challenge. The FGS intervention effectively raised healthcare workers' awareness and knowledge. Expanding training and improving praziquantel access are essential for optimal FGS management. A multi-faceted approach involving individuals, communities, and the healthcare system is necessary for comprehensive FGS prevention and control.

Female Genital Schistosomiasis is a gynecological disease that is a complication of parasitic Schistosoma haematobium infection and affects at least 40 million girls and women, mostly in sub-Saharan Africa. Little is known about how healthcare workers in endemic areas perceive and manage (diagnose and treat) Female Genital Schistosomiasis. We conducted cross-sectional focus group discussions and key informant interviews among healthcare workers in northwestern Tanzania. Healthcare workers, particularly those working in areas where S. haematobium is highly endemic, were purposively sampled to participate in the study. Discussions and interviews were digitally recorded, transcribed, and analyzed using NVivo version 12. Most healthcare workers lacked knowledge and skills to manage Female Genital Schistosomiasis. They also had multiple misconceptions about its aetiology, modes of transmission, symptoms, and management. Healthcare workers did not consider Female Genital Schistosomiasis in differential diagnoses of women presenting with gynecologic symptoms except sometimes in patients who did not respond to the initial therapy for sexually transmitted infections. Healthcare facilities had limited capacity to manage Female Genital Schistosomiasis. Our findings show critical gaps in both the knowledge of healthcare workers to manage Female Genital Schistosomiasis and in the capacity of healthcare facilities to manage it. To fill these gaps, two urgent needs must be fulfilled: first, training healthcare workers (particularly those working in schistosomiasis-endemic settings) on Female Genital Schistosomiasis, and second, stocking healthcare facilities with necessary medical equipment and supplies for managing this disease.

Female Genital Schistosomiasis is a gynecological disease that is a complication of parasitic Schistosoma haematobium infection and affects at least 40 million girls and women, mostly in sub-Saharan Africa. Little is known about how healthcare workers in endemic areas perceive and manage (diagnose and treat) Female Genital Schistosomiasis. We conducted cross-sectional focus group discussions and key informant interviews among healthcare workers in northwestern Tanzania. Healthcare workers, particularly those working in areas where S. haematobium is highly endemic, were purposively sampled to participate in the study. Discussions and interviews were digitally recorded, transcribed, and analyzed using NVivo version 12. Most healthcare workers lacked knowledge and skills to manage Female Genital Schistosomiasis. They also had multiple misconceptions about its aetiology, modes of transmission, symptoms, and management. Healthcare workers did not consider Female Genital Schistosomiasis in differential diagnoses of women presenting with gynecologic symptoms except sometimes in patients who did not respond to the initial therapy for sexually transmitted infections. Healthcare facilities had limited capacity to manage Female Genital Schistosomiasis. Our findings show critical gaps in both the knowledge of healthcare workers to manage Female Genital Schistosomiasis and in the capacity of healthcare facilities to manage it. To fill these gaps, two urgent needs must be fulfilled: first, training healthcare workers (particularly those working in schistosomiasis-endemic settings) on Female Genital Schistosomiasis, and second, stocking healthcare facilities with necessary medical equipment and supplies for managing this disease.

BackgroundSchistosomiasis is an acute and chronic disease caused by parasitic worms, that can take two main forms: intestinal or urogenital. If left untreated, the urogenital form can lead to female genital schistosomiasis (FGS) in women and girls; frequently resulting in severe reproductive health complications which are often misdiagnosed as sexually-transmitted infections (STIs) or can be confused with cervical cancer. Despite its impact on women’s reproductive health, FGS is typically overlooked in medical training and remains poorly recognized with low awareness both in affected communities and in health professionals. FGS has been described as the one of the most neglected sexual and reproductive health issues in sub-Saharan Africa (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). Increased knowledge and awareness of FGS is required to end this neglect, improve women’s reproductive health, and decrease the burden of this preventable and treatable neglected tropical disease.MethodsWe conducted interactive virtual workshops, in collaboration with the World Health Organization (WHO), engaging 64 participants with medical and public health backgrounds from around the world to establish standardized skills (or competencies) for prevention, diagnosis, and treatment of FGS at all levels of the health system. The competencies were drafted in small groups, peer-reviewed, and finalized by participants.ResultsThis participatory process led to identification of 27 skills needed for FGS prevention, diagnosis, and management for two categories of health workers; those working in a clinical setting, and those working in a community setting. Among them, ten relate to the diagnosis of FGS including three that involve a pelvic exam and seven that do not. Six constitute the appropriate behaviors required to treat FGS in a clinical setting. Eleven address the community setting, with six relating to the identification of women at risk and five relating to prevention.ConclusionDefining the skills necessary for FGS management is a critical step to prepare for proper diagnosis and treatment of women and girls in sub-Saharan Africa by trained health professionals. The suggested competencies can now serve as the foundation to create educative tools and curricula to better train health care workers on the prevention, diagnosis, and management of FGS.

Objectives: This study was conducted to explore healthcare workers’ knowledge of female genital schistosomiasis (FGS) and describe proposed interventions to raise awareness about FGS and strengthen healthcare facilities’ capacity to manage FGS cases. Methods: We conducted four cross-sectional focus group discussions and 16 key informant interviews with purposively selected healthcare workers in Zanzibar. Discussions and interviews were digitally recorded, transcribed, and analyzed using NVivo software. Results: Most participants had limited or no knowledge of FGS and lacked skills for managing it. They confused FGS with urogenital schistosomiasis and thought it was sexually transmitted. A few participants knew about FGS and associated it with Human Immunodeficiency Virus (HIV), ectopic pregnancy, cervical cancer, and infertility. To prevent and control FGS, participants proposed interventions targeting communities (including community-based health education) and the healthcare system (including training healthcare workers on FGS). Conclusion: Healthcare workers lacked knowledge of and skills for managing FGS. Besides, healthcare facilities had no diagnostic capacity to manage FGS. Along with on-going interventions to break S. haematobium transmission and eventually eliminate urogenital schistosomiasis in Zanzibar, we recommend training healthcare workers on FGS and equip healthcare facilities with medical equipment and supplies for managing FGS.

BackgroundHealthcare-associated infections (HCAIs) are a common challenge faced in healthcare facilities, particularly in low- and middle-income countries (LMICs). Evaluating the level of knowledge, attitude, and practice (KAP) among healthcare personnel regarding HCAI prevention and identifying the relevant factors is important for handling and controlling these infections. Therefore, this study aimed to assess the direct and indirect effects of knowledge, attitude, and practices of healthcare workers (HCW) towards HCAIs prevention in Jimma University Medical Center (JUMC).MethodAn institutional cross-sectional study was conducted from March to April 2022. A total of 262 was sampled from 1354 health professionals working in JUMC using the population proportion stratified random sampling method. The data were collected using a self-administered questionnaire. Structural equation modeling (SEM) was used to identify the direct and indirect effects of KAP of HCWs on HCAIs.ResultsOf the 262 participants, 55% (n = 144) were nurses and 52.7% were female. The study found that HCW occupational skills (os) had a direct effect on knowledge (k) and attitudes (a) in preventing HCAIs (βos→k = 1.43, Pos→k = 0.004, and βos→a = 0.65, Pos→a = 0.004). HCWs’ practice on HCAIs had an effect (βos→p = -0.79; Pos→p = 0.004). HCWs’ attitudes toward HCAI preventive practice (p) and knowledge had an effect, p-values Pa→p = .002 and Pa→k = .003, respectively. Indirect effects revealed that HCWs’ attitudes towards preventing HCAIs through practice had an impact (γa→k = .426, Pa→k = .003). HCWs’ occupational skills and attitudes towards preventing HCAIs had an effect (γos→p = .523, Pos→p = .002).ConclusionThe finding indicated that attitude and occupational skills can be improved through practice which finally brings a significant improvement in the knowledge of HCWs about HCAIs prevention. Besides, there were direct effects of occupational skills on the practices of HCAIs prevention. This highlights ongoing training and mentoring of HCWs during practice is essential to enhance HCAIs prevention.

Female genital schistosomiasis in Ghana: An exploration of knowledge, attitudes, and practice among women of reproductive age.

BackgroundIn Sub-Saharan Africa (SSA), HIV infection is the main factor contributing to adult premature death. The prevalence of HIV in the region could also be associated with recent increases in Female Genital Schistosomiasis (FGS) globally. The fast-rising prevalence of FGS in SSA nations including Ghana, which has led to the emergence of dual HIV-FGS conditions, provides evidence of the trend. As such the WHO is advocating for integrated services of HIV and FGS care. This study explored stakeholders’ perspectives of the integration of prevention and control measures for Female Genital Schistosomiasis and HIV care in FGS endemic settings in Ghana.MethodsThe study was conducted in the Ga South Municipality in the Greater Accra region of Ghana. Using qualitative research methods, Focus Group Discussion was conducted with Community Health Officers (n=9) and Key Informant Interviews with stakeholders including health care professionals and providers at the Regional, District and community levels (n=13) to explore the feasibility, challenges, and opportunities of integrating FGS prevention and control package with HIV continuum of care in communities. In-depth interviews were also conducted among Persons with FGS and HIV (n=13), Female Households (n=10), Community Health Management Committee members and Community leader (n=7) to explore their views on the facilitators and barriers of the integration of FGS into HIV care into the Primary Health Care (PHC) in Ghana. All study participants were purposively sampled to achieve the study objective. All audio-recorded data were transcribed verbatim, a codebook developed, and the data was thematically analysed with the aid of NVivo software version 13.ResultsThe study identified a knowledge gap regarding Female Genital Schistosomiasis (FGS) compared to HIV. The majority of Community Health Officers (CHOs) exhibited limited knowledge about FGS. Additionally, health workers misconstrued FGS as sexually transmitted infections. Community members who expressed knowledge of FGS were about gynecological symptoms of FGS. Three main health outlets; health facilities, herbal centers, and spiritual centers are utilized either concurrently or in sequence. This health seeking behaviour negatively affected the early detection and management of FGS among HIV clients. Integration of HIV and FGS may be affected by the limited awareness and knowledge, resource constraints, stigma and discrimination, healthcare providers’ attitudes and practices, and cultural beliefs.ConclusionsThe study finds that knowledge of FGS was usually low among both community members and Community Health Officers. This was having a detrimental effect on regular screening of females for genital schistosomiasis. Integration of FGS and HIV has the potential to help Ghana achieve HIV eradication; however, before such a program is launched, implementation barriers such as stigma, knowledge gap, unavailability of needed logistics at health facilities, shortage of FGS and HIV drugs and issues of accessibility of drugs must be addressed. The results also imply that forming alliances and working together with various community health care professionals may help with early HIV and FGS diagnosis and treatment. Finally, there is the pressing need to develop a clinical protocol for FGS and HIV integration and training of community health workers on how to apply the protocol.

Background Female Genital Schistosomiasis (FGS) is a gynaecological manifestation of persistent infection with Schistosoma haematobium, which can lead to severe consequences, such as miscarriage and infertility. It is estimated to affect 56 million women globally, mostly in sub-Saharan Africa (SSA). Most migrants in Europe are female, often from SSA and therefore at risk of FGS, hence healthcare workers (HCWs) knowledge of FGS is essential for the provision of adequate care. This study aims to assess awareness and knowledge of FGS among European HCWs to inform strategies to improve the management of migrant health. Methods In June 2023 - January 2024 we conducted a cross-sectional online survey targeting medical doctors (MDs), nurses and midwives (NMs) working in fields of infectiology, gynaecology, urology, family, travel, internal or occupational medicine. The prevalence of FGS awareness and knowledge was estimated, Poisson regression was used to identify factors associated with MDs’ awareness of FGS. Results Among 922 surveyed HCWs, 43.7% (CI95%: 39.6-47.9) of MDs and 12.0% (CI95%: 8.8-16.0) NMs have heard about FGS. FGS awareness among MDs was associated with work in clinics for migrants (prevalence ratio (PR)=1.33, CI95%: 1.10-1.59) and specialization, being lower for gynaecology (PR = 0.67; CI95%:0.51-0.88), and family medicine (PR = 0.42, CI95%:0.30-0.59). Among MDs, 7.1% (CI95%: 5.1- 9.5) had medium knowledge, while 25.3% (CI95%: 21.8-29.0) had low, and 67.6% (CI95%: 63.7-71.4) no knowledge on symptoms, complications or diagnostic tools for FGS. FGS knowledge was mostly acquired through academic curricula (34.7%), scientific literature (28.4%) and conferences (25.6%). Conclusions The study shows limited awareness of FGS among European MDs and NMs, and highlights that European HCWs may not be adequately prepared to deal with diseases that are gaining relevance on the European continent due to the global connectivity and the dynamic nature of our societies. Key messages • In Europe, the health specialities that are the first point of patient access to the health system show a low level of awareness and knowledge of Female Genital Schistosomiasis. • Rising knowledge of FGS among European HCWs through academic curricula and continuous medical education is important to ensure adequate diagnosis and management of disease in migrant populations.

BackgroundAdequate knowledge and awareness regarding diseases are essential for appropriate, high-quality healthcare. Female Genital Schistosomiasis (FGS) is a non-sexually transmitted gynaecological disease that is caused by the presence of Schistosoma haematobium eggs in the female genital tract and the resulting immune response that causes tissue damage. It is estimated to affect 56 million women, mostly in sub-Saharan Africa (SSA), where healthcare workers (HCWs) have limited awareness and knowledge of FGS. Most migrants in Europe are female, often from SSA and therefore at risk of FGS. This study investigated awareness and knowledge of FGS among European HCWs with the aim of informing strategies to improve the management of migrant health.MethodsWe conducted a cross-sectional survey using a self-administered, closed, multilingual, anonymous online questionnaire between 1st June 2023 to 31st January 2024. Medical doctors (MDs) (n = 581) and nurses or midwives (NMs) (n = 341) working in infectiology, gynaecology, urology and general, travel, internal or occupational medicine in European countries were enrolled in the survey. A Poisson regression was used to identify factors associated with MDs’ knowledge and awareness of FGS and adjusted prevalence ratios (aPR) were estimated. Practices related to FGS were described using counts and proportions for a subsample of MDs aware of FGS.ResultsAmong the 922 eligible participants, FGS awareness was 43.7% (CI95%: 39.6; 47.9) for MDs and 12.0% (CI95%: 8.8; 16.0) for NMs. FGS awareness among MDs was higher among men (50.0%; CI95%: 43.7; 56.3), working in clinics for migrants (72.0%, CI95%: 63.2; 79.7) and among infectiologists/travel medicine specialists (68.9%, CI95%: 62.2; 75.0). No knowledge was reported by 67.6% (95% CI 63.7–71.4) of MDs, while 25.3% (CI95%: 21.8; 29.0) had low and 7.1% (CI95%: 5.1; 9.5) medium knowledge. Working in healthcare for migrants was positively associated with medium knowledge (aPR = 3.49; CI95% 1.67;7.28), which was lower for general practitioners (aPR = 0.23, CI95%:0.07;0.81).ConclusionsOur study highlights that HCWs in Europe might not be adequately prepared to manage FGS patients, resulting in a high risk of neglect. We believe that the promotion of existing medical networks could improve knowledge about FGS and thus the health of migrant women.

IntroductionIn Sub-Saharan Africa (SSA), HIV remains the leading cause of adult premature death. The rising prevalence of Female Genital Schistosomiasis (FGS) in SSA, including Ghana, has led to a growing dual burden of HIV-FGS cases. This trend has prompted the WHO to advocate for integrated HIV and FGS services. This study examined stakeholder perspectives on integrating FGS prevention and control with HIV care in endemic areas of Ghana.MethodsThe study took place in Ga South Municipality, Greater Accra Region, Ghana. A qualitative approach combining narrative and phenomenological designs was used. Data collection included Focus Group Discussions with Community Health Officers (CHOs) (n = 9), and Key Informant Interviews with healthcare providers at regional, district, and community levels (n = 13). In-depth interviews were also conducted with individuals affected by FGS and HIV (n = 13), female household members (n = 10), Community Health Management Committee members, and community leaders (n = 7). Participants were purposively selected. Audio-recorded interviews were transcribed, coded, and thematically analyzed using NVivo version 13.ResultsThere was a notable knowledge gap on FGS among CHOs and community members. Many health workers mistook FGS for sexually transmitted infections, while community members primarily recognized it through gynecological symptoms. Healthcare was sought from a mix of formal health facilities, herbalists, and spiritual centers, often delaying accurate diagnosis and management. Barriers to integrating HIV and FGS services included limited awareness, stigma, cultural beliefs, provider attitudes, and resource shortages.ConclusionsBoth CHOs and community members lacked sufficient knowledge about FGS, hindering regular screening and timely diagnosis. While integrating FGS and HIV care could support Ghana’s HIV eradication goals, success depends on addressing stigma, improving awareness, ensuring drug availability, and equipping health facilities. Collaboration among healthcare professionals and developing standardized clinical protocols are essential. Training community health workers on these protocols is urgently needed to support effective integration.

In Sub-Saharan Africa (SSA), HIV remains the leading cause of adult premature death. The rising prevalence of Female Genital Schistosomiasis (FGS) in SSA, including Ghana, has led to a growing dual burden of HIV-FGS cases. This trend has prompted the WHO to advocate for integrated HIV and FGS services. This study examined stakeholder perspectives on integrating FGS prevention and control with HIV care in endemic areas of Ghana. The study took place in Ga South Municipality, Greater Accra Region, Ghana. A qualitative approach combining narrative and phenomenological designs was used. Data collection included Focus Group Discussions with Community Health Officers (CHOs) (n = 9), and Key Informant Interviews with healthcare providers at regional, district, and community levels (n = 13). In-depth interviews were also conducted with individuals affected by FGS and HIV (n = 13), female household members (n = 10), Community Health Management Committee members, and community leaders (n = 7). Participants were purposively selected. Audio-recorded interviews were transcribed, coded, and thematically analyzed using NVivo version 13. There was a notable knowledge gap on FGS among CHOs and community members. Many health workers mistook FGS for sexually transmitted infections, while community members primarily recognized it through gynecological symptoms. Healthcare was sought from a mix of formal health facilities, herbalists, and spiritual centers, often delaying accurate diagnosis and management. Barriers to integrating HIV and FGS services included limited awareness, stigma, cultural beliefs, provider attitudes, and resource shortages. Both CHOs and community members lacked sufficient knowledge about FGS, hindering regular screening and timely diagnosis. While integrating FGS and HIV care could support Ghana's HIV eradication goals, success depends on addressing stigma, improving awareness, ensuring drug availability, and equipping health facilities. Collaboration among healthcare professionals and developing standardized clinical protocols are essential. Training community health workers on these protocols is urgently needed to support effective integration.

An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now.

Background: Coronavirus disease-2019 (COVID-19) is an emerging public health problem threatening the life of over 2.4 million people globally. The present study sought to determine knowledge, attitude and practices (KAP) of health care workers (HCWs) toward COVID-19 in Makerere University Teaching Hospitals (MUTHs) in Uganda.Methods: An online cross sectional, descriptive study was undertaken through WhatsApp Messenger among HCWs in four MUTHs. HCWs aged 18 years and above constituted the study population. KAP toward COVID-19 was assessed by using a pre-validated questionnaire. Bloom's cut-off of 80% was used to determine sufficient knowledge (≥80%), positive attitude (≥4), and good practice (≥2.4). All analyses were performed using STATA 15.1 and GraphPad Prism 8.3.Results: Of the 581 HCWs approached, 136 (23%) responded. A vast majority of the participants were male (n = 87, n = 64%), with a median age of 32 (range: 20–66) years. Eighty-four (62%) were medical doctors and 125 (92%) had at least a bachelor's degree. Overall, 69% (n = 94) had sufficient knowledge, 21% (n = 29) had positive attitude, and 74% (n = 101) had good practices toward COVID-19. Factors associated with knowledge were age >40 years (aOR: 0.3; 95% CI: 0.1–1.0; p = 0.047) and news media (aOR: 4.8; 95% CI: 1.4–17.0; p = 0.015). Factors associated with good practices were age 40 years or more (aOR: 48.4; 95% CI: 3.1–742.9; p = 0.005) and holding a diploma (aOR: 18.4; 95% CI: 1–322.9; p = 0.046).Conclusions: Continued professional education is advised among HCWs in Uganda to improve knowledge of HCWs hence averting negative attitudes and promoting positive preventive and therapeutic practices. We recommend follow up studies involving teaching and non-teaching hospitals across the country.