Improving Access to Diagnostics for Schistosomiasis Case Management in Oyo State, Nigeria: Barriers and Opportunities

Abstract

Schistosomiasis is one of the Neglected Tropical Diseases that affects over 200 million people worldwide, of which 29 million people in Nigeria. The principal strategy for schistosomiasis in Nigeria is a control and elimination program which comprises a school-based Mass Drug Administration (MDA) with limitations of high re-infection rates and the exclusion of high-risk populations. The World Health Organization (WHO) recommends guided case management of schistosomiasis (diagnostic tests or symptom-based detection plus treatment) at the Primary Health Care (PHC) level to ensure more comprehensive morbidity control. However, these require experienced personnel with sufficient knowledge of symptoms and functioning laboratory equipment. Little is known about where, by whom and how diagnosis is performed at health facilities within the case management of schistosomiasis in Nigeria. Furthermore, there is a paucity of information on patients’ health-seeking behaviour from the onset of disease symptoms until a cure is obtained. In this study, we describe both perspectives in Oyo state, Nigeria and address the barriers using adapted health-seeking stages and access framework. The opportunities for improving case management were identified, such as a prevalence study of high-risk groups, community education and screening, enhancing diagnostic capacity at the PHC through point-of-care diagnostics and strengthening the capability of health workers.

Rethinking the Top-Down Approach to Schistosomiasis Control and Elimination in Sub-Saharan Africa

“…There is also a need to manage information and promote research into drivers of regional and local hotspots of schistosomiasis ( 21 , 22 , 28 ). Service delivery has been one of the problems of schistosomiasis control in several sub-Saharan African countries with praziquantel mainly available during MDAs and the difficulty of identifying non-acute cases of urinary schistosomiasis ( 18 ). As such, we propose seeing schistosomiasis in the same light as malaria and adding regular screening at the primary care level for regions with a high prevalence to help capture those who are not covered by the MDA programmes.…”

“…First, despite efforts at making praziquantel available to those at-need and Merck KGaA's commitment to praziquantel donations, targets for MDA coverage have still not reached all people at risk who require treatment ( 14 ). This may indicate an under-representation or undercounting of cases based on low-level awareness ( 11 , 17 , 18 ), migratory patterns in which the disease is introduced to new or previously eliminated areas ( 19 , 20 ), and an assumption of homogeneity of the disease transmission context across different regions and countries. For example, some countries such as Nigeria have prioritized praziquantel for school-aged children leaving adults and pre-school children uncovered during MDA ( 18 ).…”

Target product profiles for devices to diagnose urinary schistosomiasis in Nigeria

“…The TPP should be supported by knowledge transfer on disease characteristics and context of use for designers. Since the development of target product profiles is an iterative process, it is essential to continue to interact with stakeholder research [23].…”

Point-of-Care Diagnostic Services as an Integral Part of Health Services during the Novel Coronavirus 2019 Era

“…Factors such as infrastructure, resources, values and the characteristics of the participants can influence the implementation, scalability and sustainability of health interventions. A study conducted in Nigeria calls for community education, screening for schistosomiasis, and the enhancement of diagnostic capacity and strengthening of the capability of health workers through point-of-care diagnostics [2]. Our previous research demonstrates the need for improving the accessibility of Glucose-6-Phosphate Dioxygenase Deficiency [7] and blood-group and rhesus-type tests [8] as part of antenatal care services in malaria regions.…”

“…POC testing is performed using various POC diagnostics to enable the near-patient detection and monitoring of disease conditions in order to inform prognoses, guide treatment choices and predict treatment responses [1]. The advent of POC diagnostics in resource-limited settings has enhanced diagnostic capacity and helped to improve access to healthcare in areas where disease burden is high and diagnosis remains a weak point in the healthcare system [2][3][4]. The most commonly used and accessible POC diagnostics in most of these settings are pathology tests such as HIV and malaria tests [5,6].…”