A Stakeholder Analysis of Schistosomiasis Diagnostic Landscape in South-West Nigeria: Insights for Diagnostics Co-creation

Abstract

Background: Schistosomiasis, one of the neglected tropical diseases, is a water-based parasitic disease of public health importance. Currently, tests for Schistosoma haematobium infection either demonstrate poor specificity, are expensive or too laborious for use in endemic countries, creating a need for more sensitive, cheaper, and easy to use devices for the diagnosis of schistosomiasis. To ensure engagement during the process of device development; and effective acceptance and use after the introduction of diagnostics devices for S. haematobium, there is a need to involve stakeholders with varying power, interest, and stakes in device co-creation, as well as those relevant for later use situation in the diagnostic landscape. The main goal of this study is to identify and analyze relevant stakeholders for co-creation using a power-interest matrix. Materials and Methods:The study was based on an action research methodology using a case study approach. A contextual inquiry approach consisting of 2 stages: stakeholder identification and interview; and stakeholder analysis was used. The field part of the study was carried out in Oyo State, Nigeria using a multistage cluster purposive sampling technique based on the category of stakeholders to be interviewed predicated on the organizational structure within the state and communities. A mix of qualitative research techniques was used. Identified themes related to power and interest were mapped and analyzed.Results: We identified 17 characteristics of stakeholders across 7 categories of stakeholders important for schistosomiasis diagnostics. Most of the stakeholders were important for both the co-creation and adoption phase of the device development for diagnostics. However, not all stakeholders were relevant to co-creation. Key Stakeholders relevant for diagnostics co-creation demonstrated significant social power, organization power, and legitimate power bases. Most of the stakeholders showed significant interest in the device to be created. Discussion:The power and interest of these stakeholders reveal some insight into how each stakeholder may be engaged for both co-creation and device usage.

Stakeholders’ Perspectives on the Application of New Diagnostic Devices for Urinary Schistosomiasis in Oyo State, Nigeria: A Q-Methodology Approach

“…Second, the health care system and community stakeholders in Nigeria (Figure 1) should continuously participate and collaborate with the design industry in the human-centered design process of new diagnostic devices, thus ensuring stakeholder needs and viewpoints are considered in the design process. It is crucial to ensure that diagnostic devices are available at the point of need, are designed to function best within the local endemic health care context, and support stakeholders in performing tasks targeting control and eventual elimination of schistosomiasis 5,20,25,30 In conclusion, the findings from this study will guide the development of new diagnostic devices for schistosomiasis that match the contextual landscape and stakeholder diagnostic strategies in Oyo.…”

“…This support will ensure that new diagnostic devices are accepted and used by many end users in Oyo. 5 Q-methodology served as a rigorous tool in this study because it is scientifically valid and reproducible in the domain of human-centered design. Human-centered design, or participatory Q-methodology served as a rigorous tool in this study because it is scientifically valid and reproducible in the domain of human-centered design.…”

“…This disease is prevalent in Nigeria, especially in rural areas, and affects approximately 30 million people annually. [1][2][3][4][5][6][7] In specific regions, such as Oyo State, urinary schistosomiasis has an estimated prevalence of more than 50%. 2,8,9 Many studies on S. haematobium are predominately school based and report a disease prevalence of 17%-21% in urban areas and 32.7% in rural areas.…”

“…[15][16][17] In the control and elimination approach, the procedure involves the surveillance of high-risk groups and areas, followed by treatment to the entire group. 18,19 Onasanya et al identified different stakeholders within 4 levels of the health care system in Oyo that are involved in diagnosing, controlling, and eliminating schistosomiasis: 5 (1) policy and economic, (2) organizational, (3) health care, and (4) community (Figure 1). Stakeholders at the policy and economic level include financing organizations, nongovernmental organizations (NGOs), and researchers.…”

“…[26][27][28][29][30][31][32][33][34][35] However, these devices are currently not deployable or commercially available and are therefore not available at the point of need. 5,30 The World Health Organization estimates that 70% of medical devices in health care facilities in low-resource settings do not function well given that they were designed for the health care context in high-resource countries and were therefore not optimized for other settings. 20 According to the United to Combat NTDs report on Delivering on Promises and Driving Progress, effective devices for urinary schistosomiasis remain an unmet need.…”