Knowledge, attitudes and practices toward female genital schistosomiasis among community women and healthcare professionals in Kimpese region, Democratic Republic of Congo

ABSTRACT Background Chronic infection with Schistosoma haematobium causes female genital schistosomiasis (FGS), which leads to diverse lesions in the female genital tract and several complications, including women infertility and a higher risk for HIV transmission. This study, therefore, aims to understand the knowledge, attitudes, and practices (KAP) toward FGS and associated factors among women and health professionals in the schistosomiasis endemic focus of Kimpese, western Democratic Republic of Congo (DRC). Methods In January 2022, a semi-quantitative questionnaire was administered to randomly selected community women in Kifua II village and health professionals (nurses and doctors) from Kimpese Health Zone. KAP statements were coded and summarized as frequencies and percentages. Association between the socio-demographic characteristics of respondents and KAP was assessed using Pearson chi-square (χ2) test, Cramer’s V (φ) and gamma (γ) coefficients. Results A total of 262 participants were included (201 community women, 20 nurses and 41 doctors). Overall, respondents had high knowledge of schistosomiasis in general but low FGS- specific knowledge (91% versus 45%). Some misconceptions regarding FGS transmission were even higher among healthcare professionals compared to the community women. Almost a third (30%) of the community women and 20% of the nurses believe that FGS is transmitted by drinking untreated water, while 27% of the doctors believe that sexual contact is a mode of FGS transmission. Additionally, 30% of the doctors do not link FGS with urinating in the water. Furthermore, many community women (60%) practice open defecation or urination and do not consider avoiding contact with contaminated water sources important (72%), especially the younger ones. Finally, diagnostic technologies for FGS are lacking, with only 57% of healthcare workers having a microscope in their facilities. Conclusion This study reveals insufficient knowledge about FGS and existing negative attitudes toward FGS among community women associated with socio-demographic factors. Additionally, health professionals lack the means (equipment) and specialised knowledge to diagnose FGS correctly, which probably leads to underreporting as this region is endemic for urinary schistosomiasis. AUTHOR’S SUMMARY Schistosomiasis is a disease caused by parasitic worms and it is contracted through contact with contaminated water. Female genital schistosomiasis (FGS) is a form of the disease that affects the female reproductive organs and can lead to infertility, but also stigma and discrimination. This study used a quantitative research approach to explore community women and healthcare workers’ knowledge, attitudes and practices on and health-seeking behaviour of the women regarding FGS in Kongo Central, DRC. While both groups had high knowledge of schistosomiasis, they had a limited understanding of FGS specifically. Misconceptions about its cause and prevention were common, particularly among medical doctors. Many community members engaged in risky water contact and hygiene practices. Healthcare workers reported limited diagnostic tools and expressed interest in specialised training on FGS diagnosis, treatment, and prevention. Consequent to limited knowledge and ill- equipped laboratories, health workers are most likely underreporting the disease in the region. The study highlights the need to integrate FGS into public health education programs for both community members and healthcare workers in Kongo Central and underscores the importance of addressing misconceptions about the disease and the prevention measures.