This blog was originally published by the Schistosomiasis Control Initiative Foundation on their website:https://schistosomiasiscontrolinitiative.org/fgs-research-cdi.

Female genital schistosomiasis (FGS) is a neglected gynaecological condition affecting 56 million women and girls across Africa. Without treatment, FGS can lead to complications, such as bleeding during or after sexual intercourse, abortion, genital lesions, tumours or infertility. Women who suffer from FGS also have an increased risk of HIV transmission, which is three times greater than that of those living without FGS. Furthermore, women are disproportionately affected by HIV, with rates of new infections in young women (15-24 years old) triple those of young men. Therefore, there is a need to urgently address the problems associated with FGS.

Despite the severe impact of this condition, awareness of FGS amongst the medical profession remains low because it is not usually included in medical textbooks or training programmes. As a result, FGS is often misdiagnosed as a sexually transmitted infection. In addition, low awareness amongst the population in general means that women affected are stigmatised. 

Addressing the unmet need

In some areas of Côte d’Ivoire, even though the risk of FGS infection remains high*, preventive services are not routinely available to women. 

This pilot study is taking place in seven health centres in Soubré district and aims to incorporate preventive treatment for FGS into the national health system. This strategy would ensure that women attending routine services for HIV/AIDS and female reproductive health, who are aged between 15 to 29 years old, are routinely offered FGS preventive treatment. 

The study looks to improve preventive treatment coverage in this at-risk group and to find the best approach for integration; this involves training the health workers to offer preventive treatment and to raise awareness of FGS prevention during routine consultations.  

Key Information

Country: Côte d’Ivoire

Implementing partners: Programme National de Lutte Contre les Maladies Tropicales Negligees a Chimiotherapie Preventive (PNLMTN-CP), the NTD programme within the Ministry of Health of Côte d’Ivoire

Timescale: April 2020 – August 2021

Funder: UK AID via the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), within the Task Force for Global Health

FGS pilot integration study programme objectives

• To determine the processes and resources needed for sustainable integration

• To measure if integration of FGS preventive treatment into different routine health services can reach at-risk women (15-29 years old)

• To evaluate if training and resources effectively enhance awareness of FGS amongst health workers

• To evaluate if trained health workers can effectively enhance awareness of FGS amongst at-risk women (15-29 years old)

Achievements of the project so far:

• In partnership with the PNLMTN-CP, the integration processes and tools were developed using a “systems thinking” approach. This method recognises that health systems are complex and constantly changing. Once developed, further improvements were made with the health workers involved in the study, ensuring that the resources created are fit for purpose in the given context.

• 56 health workers have been trained to provide FGS services including: 1) providing patients with information about FGS, the risks, how it can be contracted, prevented in the community and treated; 2) Offering preventive treatment; and 3) recording the appropriate information in the health registers

• 30 community health workers have been trained – they are the link between the community and the health centres and therefore play an important role in raising awareness within the community

• Ongoing monitoring and evaluation is being conducted to gather evidence on the effectiveness of the integration phase

Next steps:

The PNLMTN-CP and SCIF will continue to work closely together to analyse the results from the study, using the evidence to consider next steps and plan for future scale-up. As FGS remains neglected, it is essential to continue gathering evidence to effectively reach women at-risk with preventive treatment and help to reach the World Health Organization’s goal of universal health coverage by 2030.  

You can find more information about this study at: https://www.ntdsupport.org/cor-ntd/ntd-connector/integrating-preventive-....

*The World Health Organization classifies ‘high risk’ as a prevalence greater than 50%.