Addressing a Silent and Neglected Scourge in Sexual and Reproductive Health in Sub-Saharan Africa by Development of Training Competencies to Improve Prevention, Diagnosis, and Treatment of Female Genital Schistosomiasis (FGS) for Health Workers

Abstract

Background Schistosomiasis 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(1–3). 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. Methods We 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. Results This 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. Conclusion Defining 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.

Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: A qualitative study on disease perception, health impairment and social impact

“…Interestingly, some of the affected women in our study mentioned STIs as one possible pathway of FGS transmission of Bibibibin-draha madinika . The knowledge gaps reflect the lack of education on FGS in national and school-based health prevention programs [ 48 ]. In rural Tanzania, knowledge of FGS was acquired at primary schools and led to a reduction of exposure to the infective agent.…”

Brave New World‡

“…And there is now a paper on the development of the competencies that's being published in the British Medical Journal of Sexual and Reproductive Health. 17 The second time my assumptions were challenged was when we took these competencies and put them into a training program. We put out a notice online that this training was going to be available in English and French, and we included those who helped identify the competencies in the invite.…”