The WHO atlas for female-genital schistosomiasis: Co-design of a practicable diagnostic guide, digital support and training

Santiago Gil Martinez; Pamela S Mbabazi; Motshedisi H Sebitloane; Bellington Vwalika; Sibone Mocumbi; Hashini N Galaphaththi-Arachchige; Sigve D Holmen; Bodo Randrianasolo; Borghild Roald; Femi Olowookorun; Francis Hyera; Sheila Mabote; Takalani G Nemungadi; Thembinkosi V Ngcobo; Tsakani Furumele; Patricia D Ndhlovu; Martin W Gerdes; Svein G Gundersen; Zilungile L Mkhize-Kwitshana; Myra Taylor; Roland E E Mhlanga; Eyrun F Kjetland

doi:10.1371/journal.pgph.0002249

The WHO atlas for female-genital schistosomiasis: Co-design of a practicable diagnostic guide, digital support and training

PLOS Glob Public Health. 2024 Mar 18;4(3):e0002249. doi: 10.1371/journal.pgph.0002249. eCollection 2024.

Authors

Santiago Gil Martinez¹, Pamela S Mbabazi², Motshedisi H Sebitloane³, Bellington Vwalika⁴, Sibone Mocumbi⁵, Hashini N Galaphaththi-Arachchige⁶, Sigve D Holmen⁶, Bodo Randrianasolo⁷, Borghild Roald⁸, Femi Olowookorun⁹, Francis Hyera¹⁰, Sheila Mabote¹¹, Takalani G Nemungadi¹², Thembinkosi V Ngcobo¹², Tsakani Furumele¹², Patricia D Ndhlovu¹³, Martin W Gerdes¹⁴, Svein G Gundersen¹⁵, Zilungile L Mkhize-Kwitshana^{16

17}, Myra Taylor¹⁶, Roland E E Mhlanga¹⁸, Eyrun F Kjetland^{6

16}

Affiliations

¹ Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.
² National Planning Authority of the Government of the Republic of Uganda, Kampala, Uganda.
³ Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
⁴ Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia.
⁵ Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
⁶ Department of Infectious Diseases Ullevaal, Norwegian Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway.
⁷ Association K'OLO VANONA, Antananarivo, Madagascar.
⁸ Center for Paediatric and Pregnancy Related Pathology, Department of Pathology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway.
⁹ Ugu District Office, Port Shepstone, South Africa.
¹⁰ Department of Public Health Medicine, Faculty of Health Sciences, Walter Sisulu University (WSU), Mthatha, South Africa.
¹¹ Instituto Nacional de Saúde-INS (National Health Institute), Marracuene, Mozambique.
¹² National Department of Health, Pretoria, Communicable Diseases Control Directorate, Pretoria, South Africa.
¹³ BRIGHT Academy, Centre for Bilharzia and Tropical Health Research, Ugu District, KwaZulu-Natal, South Africa.
¹⁴ Department of Information and Communication Technologies, University of Agder, Kristiansand, Norway.
¹⁵ Institute for Global Development and Planning, University of Agder, Kristiansand, Norway.
¹⁶ School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
¹⁷ Research Capacity Division, South African Medical Research Council, Tygerberg, South Africa.
¹⁸ Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

Abstract

Up to 56 million young and adult women of African origin suffer from Female Genital Schistosomiasis (FGS). The transmission of schistosomiasis happens through contact with schistosomiasis infested fresh water in rivers and lakes. The transmission vector is the snail that releases immature worms capable of penetrating the human skin. The worm then matures and mates in the blood vessels and deposits its eggs in tissues, causing urogenital disease. There is currently no gold standard for FGS diagnosis. Reliable diagnostics are challenging due to the lack of appropriate instruments and clinical skills. The World Health Organisation (WHO) recommends "screen-and-treat" cervical cancer management, by means of visual inspection of characteristic lesions on the cervix and point-of-care treatment as per the findings. FGS may be mistaken for cervical cancer or sexually transmitted diseases. Misdiagnosis may lead to the wrong treatment, increased risk of exposure to other infectious diseases (human immunodeficiency virus and human papilloma virus), infertility and stigmatisation. The necessary clinical knowledge is only available to a few experts in the world. For an appropriate diagnosis, this knowledge needs to be transferred to health professionals who have minimal or non-existing laboratory support. Co-design workshops were held with stakeholders (WHO representative, national health authority, FGS experts and researchers, gynaecologists, nurses, medical doctors, public health experts, technical experts, and members of the public) to make prototypes for the WHO Pocket Atlas for FGS, a mobile diagnostic support tool and an e-learning tool for health professionals. The dissemination targeted health facilities, including remote areas across the 51 anglophone, francophone and lusophone African countries. Outcomes were endorsed by the WHO and comprise a practical diagnostic guide for FGS in low-resource environments.

Copyright: © 2024 Martinez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The research leading to these results received funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/2007-2013/ERC Grant agreement no. PIRSES-GA-2010-269245 - HNGA, SDH, BRO, FO, SGG), the University of Copenhagen with the support from the Bill and Melinda Gates Foundation (Grant agreement no. OPPGH5344 - BR, MT, SDH, HNGA, EFK), and South-Eastern Norway Regional Health Authority (SERH, Grant agreement no. 2011073 - HNGA, SDH, BRO, TGN, TVN, TF, PDN, ZLMK, EFK). The WHO Department of Control of Neglected Tropical Disease provided financial support for convening the workshop for development of the female genital schistosomiasis Pocket Atlas (PSM, MHS, BV, SMO, BR, FH, SMA, EFK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.