Female genital schistosomiasis (FGS) prevention in Côte d'Ivoire

Research pilot to effectively and sustainably integrate FGS preventive treatment into the national health system

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.

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 Côte d’Ivoire the risk of FGS infection is high* however preventive services are not routinely available to women. Recognising this challenge, Unlimit Health and our partners in the PNLMTN-CP, Ministry of Health in Côte d’Ivoire established a pilot study to assess if preventive treatment for FGS could be incorporated 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 and also FGS prevention education to raise greater awareness of this disease.

The study took place in seven health centres in Soubré district in the country, and aimed to improve preventive treatment coverage in young women and find the best approach for integration of FGS services in the health system. The project trained the health workers within the centres to offer preventive treatment and to raise awareness of FGS prevention during routine consultations.

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 FGS pilot project:

• 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 were fit for purpose in the given context
• 56 health workers were 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 (CHWs) were trained – they are the link between the community and the health centres and therefore play an important role in raising awareness within the community
• Over 8500 women were reached during the six months of integrated service delivery, indicating that women at-risk can be effectively reached in this way
• Awareness of key FGS topics was effectively raised amongst all health workers trained, and the longevity of this was supported by the training and learning resources package, validated during the study
• Women were effectively engaged and sensitised around FGS and how to prevent it, indicating that trained health workers could effectively provide health education, leading to improved understanding and increased health seeking behaviour
• An FGS working group was formed, consisting of key members of the Ministry of Health from the NTD and HIV programmes, and other stakeholders from research institutes and health data reporting. This working group is engaged to continue the work and develop the national strategy for FGS in Côte d’Ivoire.

Next steps:

Unlimit Health is working closely with the PNLMTN-CP while they develop their National Strategy for FGS Prevention. Next steps will include scaling up of the integration services and securing funding to support this.

This pilot research has highlighted the lack of awareness and lack of services for FGS. Therefore, expanding the integration of service delivery in the health system, whilst considering innovative ways to overcome the challenges of increased health worker workload and reaching hard-to-reach women in the community, will be essential to effectively reach all women at-risk with preventive treatment and help to achieve the World Health Organization’s goal of universal health coverage by 2030.

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