The social context of reproductive health in an Egyptian hamlet: a pilot study to identify female genital schistosomiasis

Abstract

This pilot study is the first to identify female genital schistosomiasis (FGS) in an Egyptian community setting. The year-long interdisciplinary study, in a small hamlet ( ezba), combined clinical assessment with an in-depth study of the social context of reproductive health. Schistosoma haematobium ova were found in 16.7% of women in the study (21/126). Half of the women who agreed to a full gynecological examination (43 of 86) had evidence of reproductive morbidity due to schistosomiasis, either schistosome eggs in the cervix or sandy patches, tissue changes in the reproductive tract. Other reproductive tract morbidities included infections (vaginitis 40%, chronic cervicitis 75%, pelvic inflammation 9%) and prolapse (54%). FGS was associated with dysparunia, abnormal vaginal discharge, vaginal or cervical polyps, contact bleeding, vulval itching and chronic cervicitis. Community members recognized S. haematobium as a health problem, but did not believe that it affected reproductive health. Indeed, they had little awareness of reproductive health and the possible impact of reproductive morbity on women's arduous daily tasks. There was no discussion of any reproductive health issues (except infertility) between women or between spouses. The study identified a number of factors that would affect the identification and treatment of FGS, and reproductive health care in general; (1) the neglect of women's health: (2) misconceptions about reproductive health and family planning; and (3) limited access to, and use of formal health care. The paper ends with a brief discussion of the significance of our findings about FGS, strategies to increase awareness of FGS, and the need for future research.