Malawi becomes the first country to incorporate genital schistosomiasis into national guidelines

By Caroline Pensotti

In late January, the UK Parliament’s International Development Committee released their report on UK aid impact on sexual and reproductive health. One of the report’s key recommendations was for the integration of and care for people affected by female genital schistosomiasis (FGS) – a little known but painful and debilitating disease affecting millions of women – into broader sexual and reproductive health (SRH) programming.

This is a welcome announcement by all organisations that have been advocating and working in this area. 

Integration of both male and female genital schistosomiasis -referred to here as genital schistosomiasis (GS), into other health services is a priority given the low awareness of the disease among health workers and its detrimental impact on affected communities. In January 2024, Unlimit Health and Frontline AIDS supported a 3-day workshop by Lake Malawi to facilitate the integration of GS into Malawi’s National Guidelines for Syndromic Management of Sexually Transmitted Infections.  

Unlimit Health has been working across sectors for several years to raise the profile of FGS – a chronic complication of schistosomiasis infection which is also associated with an increased risk of HIV and Human Papillomavirus (HPV) infection and can lead to infertility and social isolation for those affected. 

As a result of the workshop, Malawi becomes the first country in sub–Saharan Africa to include GS in its national guidelines– marking a key milestone in recognising the importance of multi-sectoral coordination, integrated approaches and country owned solutions in the fight to eliminate NTDs.  

Facilitated by Pakachere, a local health communication and development NGO, and Malawi’s Ministry of Health, the workshop included representation from organisations working in both the SRH, HIV and NTD space including Malawi | FHI 360, UNC Project-Malawi, Partners in Hope, and Malawi Liverpool Welcome Programme (MLW), Queen Elizabeth Central Hospital, Blantyre.

Misdiagnosis and mismanagement of GS is common as symptoms can mimic those of sexually transmitted infections (STIs) often resulting in stigma and social isolation. To date, the disease is not part of training programmes for clinicians and health workers in endemic countries.  

Incorporating GS into the guidelines lifts the profile of this disease by raising awareness and including GS in diagnostic pathways and treatment across all sexual health, HIV, reproductive health and cervical cancer services in Malawi.  

The guidelines will be used by health workers providing STI services in both public and private sectors including medical doctors, clinical officers, medical assistants, nurses, midwives, and trainees.

It is expected that the inclusion of GS in Malawi’s National STI Guidelines will also drive the demand for increased and equitable access to praziquantel – the medicine of choice for the treatment of schistosomiasis. 

Working alongside the Ministry of Health in Malawi, Unlimit Health supports the delivery of treatment for all school aged children as well as adults through mass drug administration in high prevalence areas of the country via the World Health Organization (WHO) drug donation programme. However, the drug is not always available or affordable to those affected by GS.  

Integrated services play a pivotal role in the collective effort to combat NTDs, as these diseases present a multifaceted challenge requiring comprehensive and interconnected solutions.  

By combining efforts to address GS, Malawi will not only optimise resource allocation, but also enhance community engagement and awareness, fostering a holistic strategy that goes beyond individual disease silos.