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 (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). 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.
RéSUMé: INTRODUCTION: La bilharziose ou schistosomiase est une maladie aiguë et chronique causée par des parasites, qui peut prendre deux formes principales: intestinale ou urogénitale. Si elle n'est pas traitée, la forme urogénitale peut conduire à une bilharziose génitale féminine (BGF) entraînant fréquemment de graves complications en matière de santé reproductive chez les femmes et les jeunes filles. Les séquelles physiques causées par la BGF sont souvent mal diagnostiquées et fréquemment confondues avec celles causées par des infections sexuellement transmissibles (IST) ou des cancers du col de l'utérus. Malgré son impact sur la santé reproductive des femmes, la BGF est généralement négligée dans la formation médicale et reste méconnue, avec une faible sensibilisation à la fois dans les communautés touchées et chez les professionnels de la santé. La BGF a été décrite comme l'un des problèmes de santé sexuelle et reproductive les plus négligés en Afrique subsaharienne (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). Une meilleure connaissance et une plus grande sensibilisation à la BGF sont nécessaires pour mettre fin à cette négligence, améliorer la santé reproductive des femmes et diminuer le fardeau de cette maladie tropicale négligée évitable et traitable. MéTHODE: Nous avons organisé des ateliers virtuels interactifs en collaboration avec l'Organisation mondiale de la santé (OMS), réunissant 64 participants du monde entier formés en médecine ou santé publique, afin d'établir des aptitudes (ou compétences) requises pour la prévention, le diagnostic et le traitement des BGF à tous les niveaux du système de santé. Les compétences ont été rédigées en petits groupes, révisées par des pairs et finalisées par les participants eux-mêmes. RéSULTATS: Ce processus participatif a permis d'identifier 27 compétences nécessaires à la prévention, au diagnostic et au traitement de la BGF pour deux catégories de professionnels de santé: ceux travaillant dans un cadre clinique et ceux travaillant dans un cadre communautaire. Parmi celles qui concernent le milieu clinique, dix compétences sont liées au diagnostic de la BGF, dont trois impliquant un examen pelvien et sept n'en impliquant pas. Six se réfèrent aux comportements requis pour traiter adéquatement la BGF. Parmi les onze compétences qui concernent le milieu communautaire, six ont trait à l'identification des femmes à risque et cinq à la prévention. CONCLUSION: Définir les compétences nécessaires à la prise en charge de la BGF est une étape essentielle qui permettra de progresser vers un diagnostic et un traitement adéquat des femmes et des filles en Afrique subsaharienne par des professionnels de santé qualifiés. Les compétences suggérées peuvent dès à présent servir de base à la création d'outils éducatifs et de programmes d'enseignement pour mieux former les travailleurs de la santé à la prévention, au diagnostic et au traitement de la BGF.
Resumo: CONTEXTO: A esquistossomose é uma doença aguda e crônica causada por vermes parasitas, que se apresenta de duas formas principais: intestinal ou urogenital. Se não for tratada, a forma urogenital pode resultar em mulheres e meninas à esquistossomose genital feminina (EGF); frequentemente resultando em graves complicações na saúde reprodutiva que são por vezes mal diagnosticadas como doenças sexualmente transmissíveis (DSTs) ou podem ser confundidas com câncer cervical. Apesar de seu impacto na saúde reprodutiva da mulher, a EGF é normalmente negligenciada no treinamento de saúde e permanece pouco reconhecida, com baixa conscientização tanto nas comunidades afetadas, como para os profissionais de saúde. A EGF tem sido descrita como uma das questões de saúde sexual e reprodutiva mais negligenciadas na África Subsaariana (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). Um maior conhecimento e conscientização da EGF é necessário para acabar com esta negligência, melhorar a saúde reprodutiva das mulheres e diminuir o peso desta doença tropical negligenciada que é previnível e tratável.
Metodologia: Realizamos workshops virtuais interativos, em colaboração com a Organização Mundial da Saúde (OMS), envolvendo 64 participantes com formação médica e de saúde pública de todo o mundo para estabelecer as habilidades (ou competências) padronizadas para prevenção, diagnóstico e tratamento de EGF em todos os níveis do sistema de saúde. As competências foram redigidas em pequenos grupos, revisadas por pares e concluídas pelos participantes.
Resultados: Este processo participativo levou à identificação de 27 habilidades necessárias para a prevenção, diagnóstico e gestão da EGF para duas categorias de trabalhadores da saúde; aqueles que trabalham em um ambiente clínico, e aqueles que trabalham em um ambiente comunitário. Entre elas, dez estão relacionadas ao diagnóstico da EGF, incluindo três que envolvem um exame pélvico e sete que não o realizam. Seis constituem as condutas adequadas necessárias para tratar a EGF em um ambiente clínico. Onze tratam do ambiente comunitário, sendo seis relacionados à identificação de mulheres em risco e cinco relacionados à prevenção. CONCLUSãO: Definir as habilidades necessárias para a administração da EGF é um passo crítico para proporcionar o diagnóstico e tratamento adequado de mulheres e meninas na África Subsaariana por profissionais de saúde treinados. As competências sugeridas podem agora servir como base para criar ferramentas educativas e currículos para melhor treinar os profissionais de saúde na prevenção, diagnóstico e gestão da EGF.
Keywords: Cervical cancer; Colposcopy; Female genital schistosomiasis (FGS); HIV; Health equity; Neglected tropical diseases (NTD); Reproductive health; Schistosomiasis; Sub-Saharan Africa.
Schistosomiasis belongs to the group of neglected tropical diseases (NTDs) found in tropical and subtropical countries, disproportionately affecting poor populations with limited access to safe water and adequate sanitation. Female genital schistosomiasis (FGS) is a chronic disease caused by parasitic worms, schistososomes, transmitted by contact with infested fresh water. When left untreated, FGS can lead to severe reproductive health complications, such as sub-or infertility and ectopic pregnancy. FGS is a leading neglected issue in sexual and reproductive health in sub-Saharan Africa; however, health professionals are not familiar with it, leading to misdiagnosis and improper treatment. A critical challenge in addressing the burden of FGS is the knowledge gap about the disease in communities and health professionals in endemic areas and the world at large. As part of an FGS Accelerated Scale Together (FAST) package, and in an attempt to address the knowledge gap in health professionals, we organized an interactive workshop bringing together a group of 64 participants working in sexual and reproductive health generally, and/or FGS specifically. Together, we developed a comprehensive set of required skills for health workers training on FGS. The workshop participants drafted 27 skills (or competencies) to diagnose, treat, and prevent FGS. Establishing what health workers must know is a crucial first step towards the integration of FGS into women’s health care. The competencies are now available and can be used as a framework in the development of training for health professionals, opening the doors to better reproductive health for women.
© 2022. The Author(s).