Strengthening health system for the management of cases of female genital schistosomiasis in a highly endemic schistosomiasis region in Ogun State, Nigeria

• To build the capacity of health workers to provide care, treatment and referral for women and girls affected by female genital schistosomiasis (FGS)

Schistosomiasis is one of the neglected tropical diseases (NTDs) targeted for elimination by 2030 as part of the UN’s Sustainable Development Goal 3.  A recent global interest in schistosomiasis is due to the impact it has on the reproductive system, particularly for women, when it is known as FGS. FGS has great public health implications and consequences for women and girls affected. The current strategy for the control of schistosomiasis focuses only on school-aged children (5 to 15 years), leaving out some girls who do not attend school and women of reproductive age (> 15). These women and girls are at an increased risk of FGS as they do not have access to treatment.

Nigeria’s current national guidelines for schistosomiasis control have no provision for management of FGS. Hence this study aimed to raise awareness about FGS among health workers at local facilities, and provide evidence-based information on how to detect and provide treatment care for those affected by FGS. This study was carried out in two local government areas (LGAs) in Ogun State (Abeokuta North and Odeda LGA), where cases of FGS have been confirmed.

Method

A quality improvement (QI) process known as plan-do-study-act (PDSA) cycle was used to develop and pilot a diagnostic algorithm, treatment package and referral system for management of FGS within the health system structure. PDSA cycle involves health workers in assessing problems, suggesting solutions and piloting the intervention.

Plan

This step involved identifying a goal or purpose, formulating an intervention or improvement (in this case in the diagnosis, treatment and referral systems for FGS), and defining success metrics. It involved planning the intervention with a newly established FGS quality care implementation team who explored the challenges and barriers to diagnosis and treatment, and developed a diagnostic algorithm, treatment package and referral system for FGS.

Do

This is the step in which the components of the plan are implemented. The study included a participatory workshop to educate and increase awareness of frontline health workers on FGS and build their capacity to be able to diagnose and provide the needed treatment for persons affected or refer them.

Study

This step involved monitoring outcomes to test the validity of the plan for signs of progress and success, or problems and areas for improvement. This included evaluating the intervention and process (including interviews with health professionals and patients). The study included a review of the intervention process at four weeks initially and subsequently at 12 weeks and 24 weeks intervals to understand what is working well and address any barriers to the intervention. This was carried out through interviews with health workers and patients that access the care.

Act

This step closed the cycle, integrating the learning generated by the entire process. All learnings at the different phases were collected together and used to improve the quality of the intervention approach. A final process evaluation was conducted at the end of project implementation.

• Managing cases of FGS – project summary
• Guide for health workers on managing cases of FGS
• Toolkit for training health workers to manage cases of FGS