COUNTDOWN researchers from Ghana and LSTM have published a paper today in PLoS NTDs that highlights the need for more focused work on Female Genital Schistosomiasis (FGS). FGS is a chronic gynaecological condition that affects up to 56 million African women and girls.
To date, FGS has been mostly overlooked within national Neglected Tropical Disease (NTD) control programmes and associated health systems in sub-Saharan Africa. Furthermore, knowledge and understanding of FGS within affected communities themselves are often incomplete and confused ailments.
The paper, titled ‘A Major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and health workers’ follows three years of research by COUNTDOWN researchers from the Dodowa Health Research Centre in Ghana and the Liverpool School of Tropical Medicine.
Ghana carries one of the highest burdens of schistosomiasis in sub-Saharan Africa. The Schistosoma haematobium, which causes urinary (FGS) schistosomiasis, is the predominant human schistosome species in Ghana, and is widely distributed in the country. However, there is scarcity of information and knowledge on prevention, causes, diagnosis and treatment of FGS.
FGS is a manifestation of schistosomiasis, which occurs when adult worms or ova are deposited in any part of the female reproductive system. The main symptoms include painful or difficult urination, vaginal discharge, vaginal bleeding and discomfort, including pain during sex. If left untreated, FGS can cause infertility, miscarriage, ectopic pregnancies, spontaneous abortions and cervical lesions which can lead girls and women to be susceptible to HIV contraction and HPV (Human Papillomavirus) – posing a high risk for cervical cancer.
As part of a comprehensive response by the NTD prevention and control program, the COUNTDOWN project working with partners from Dodowa Health Research Centre, used qualitative research methods to explore the knowledge and understanding of girls and women on FGS, as well as local health care providers’ knowledge and practice relating to FGS. Initial studies on FGS were boosted by a COUNTDOWN symposium in 2014 that brought many stakeholders together for the first time see www.fgsworkshop.org”.
The work found that FGS was rarely on the radar of suspicion for health workers. More importantly, adolescent girls were often stigmatized by health care workers when they sought care in public health facilities owing to misdiagnosis of the disease as a sexually transmitted infection (STI). The study was conducted in the Shai-Osudoku sub-district in the South-Eastern part of Greater Accra region.
The lead author of the paper, Vida Kukula said: “It was very disappointing and disheartening to witness the level of stigma some young women and girls experienced whenever they visited the health facilities with their painful and uncomfortable symptoms. Our work highlights the pressing need to improve training of health providers particularly gynaecologists and midwives delivering care to women/girls living in schistosomiasis endemic areas. It also calls for action by all stakeholders to create general awareness on FGS and its debilitating effects to women/girls when left undiagnosed and untreated.”
The research speaks to the urgent need for national control programmes to expand their remit outside current focus of annual provision of praziquantel to in-school children and to advocate for the integration of FGS treatment within sexual and reproductive health services in Ghana. Ultimately, urogenital and intestinal schistosomiasis is a disease of poverty and there is an urgent need to extend access to improved water and sanitation facilities to all affected communities.