Strengthening health system for the management of cases of Female Genital Schistosomiasis in a highly endemic schistosomiasis region in Ogun State, Nigeria

Female Genital Schistosomiasis is a gynaecological condition caused by the presence of Schistosome eggs in the genital tissues. Fifty-six million women and girls in sub-Saharan Africa are estimated to be living with FGS.

However, the current strategy for the control of schistosomiasis focuses only on school aged children leaving out some schools, girls who do not attend school and women of reproductive age, thereby increasing their risk of FGS. Furthermore, there are no readily available tool(s) to support clinical diagnosis at primary health care level, leaving many women and girls undiagnosed and untreated (UNAIDS 2019, Arakaki et al., 2016, Kukula et al., 2019). This worsens outcomes associated with FGS, such as infertility, anaemia, cancer, miscarriages, ectopic pregnancies and an increased infant and maternal mortality rate, all of which can lead to severe psycho-social and economic consequences (Friedman et al., 2007;Nour 2010). Thus, addressing FGS is central to supporting progress toward universal health coverage and in addressing multiple SDGs, including 3, 5, 10 in relation to well-being, human rights and sexual and reproductive health of women and girls (Ozano et al., 2019).

Nigeria has the highest burden of schistosomiasis in Sub-Sahara Africa and a study by Ekpo and colleagues in 2016 estimated that 70% of women living in highly endemic schistosomiasis areas in Ogun State, Nigeria have FGS (Ekpo et al 2016).  The Current National guideline for schistosomiasis control has no provision for management of FGS.  This study aims to strengthen the health system in the endemic state of Ogun, through information, education and capacity building of health workers to be able to provide the needed care, treatment and referral for women and girls affected by FGS. The study will be carried out in two purposively selected LGAs, Abeokuta North with 84% prevalence and Odeda with 67% prevalence of schistosomiasis. A quality improvement (QI) process known as Plan-Do-Study-Act (PDSA) cycle will be used to develop and pilot a diagnostic algorithm, treatment package and referral system for management of FGS within the health system structure. An FGS quality care implementation team will be formed in consultation with primary and secondary health care professionals and NTD implementers which will be facilitated and supported by COUNTDOWN researchers. Three learning cycles over a 24-week period will be used to inform the research, each cycle will be evaluated through qualitative and quantitative methods to support the next learning cycle.