Integrating female genital schistosomiasis services with paediatric praziquantel delivery in Tanzania: A feasibility study

Integrating female genital schistosomiasis services with paediatric praziquantel delivery in Tanzania: A feasibility study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrating female genital schistosomiasis services with paediatric praziquantel delivery in Tanzania: A feasibility study Judith Msovela, Calister Imeda, Mohamed Nyati, Otilia Gowelle, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7123493/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Female genital schistosomiasis (FGS) is a gynaecological manifestation of a chronic Schistosoma haematobium infection affecting over 40 million women and girls, mostly in sub-Saharan Africa. In low- and middle-income countries like Tanzania diagnosis and treatment of FGS is a challenge due to limited healthcare capacity for neglected tropical diseases (NTDs). This leaves many women suffering from untreated FGS and its complications. The upcoming distribution of paediatric praziquantel (arPZQ) through routine healthcare in Tanzania presents a unique opportunity to integrate FGS care. Objective: This study assessed the feasibility of integrating FGS diagnosis and treatment services with arPZQ delivery using a mother and child integrated model for schistosomiasis intervention. Methods: A cross-sectional study employed both qualitative and quantitative data collection and analysis methods. Results: Integrating FGS services with the delivery of arPZQ was supported by healthcare workers (HCW) and the communities as a feasible strategy. This is only if diagnostic and treatment capacities for FGS at the primary healthcare facilities are strengthened. The study has revealed that over 70% of HCW lacked FGS awareness and experience in its diagnosis and treatment. Consequently, there have been frequent misdiagnosis of FGS as UTI, STIs or fungal infections, resulting in ineffective treatment. Similarly, communities were unaware of FGS and its symptoms. The repeated treatment failure which has been manifested by the recurrence of heinous symptoms affected their health seeking behavior. Majority of the FGS affected women have resorted to traditional medicines, unfortunately with no success. After learning about FGS and its symptoms, women expressed their readiness to seek treatment at the nearest health facility. The healthcare workers as providers of services expressed their willingness to provide integrated services for FGS and paediatric schistosomiasis. Conclusion: The integration of healthcare services for FGS and paediatric schistosomiasis is a feasible strategy. The two diseases share a common etiology, share some diagnosis techniques, and all are new in the healthcare service delivery system therefore have similar implementation or operational gaps. Consequently, when addressing the gaps for diagnosing and treating paediatric schistosomiasis, one can easily integrate the needs of FGS. FGS paediatric praziquantel schistosomiasis integrated services Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Female genital schistosomiasis (FGS) is a chronic gynecological manifestation of Schistosoma haematobium infection affecting millions of women worldwide [1]). The disease is characterized by the deposition of parasite eggs in the female reproductive tract, which leads to chronic fibrosis and scarring [1-2]. Sub-Saharan Africa bears a big proportion of the global burden due to limited access to safe and clean water that compels communities to seek water from sources infested with S. haematobium cercariae. Consequently, sub-Saharan Africa is estimated to have over 40 million women and girls affected with FGS [3]. With the prevalence ranging between 12–87%, Tanzania ranks second after Nigeria in terms of schistosome infections in Africa [4]. The country has both Schistosoma mansoni and S. haematobium . However, S. haematobium infection accounts for two-thirds of all schistosomiasis cases in Tanzania, placing girls and women at higher risk of developing a chronic form of the disease, FGS [5]. The diagnosis and treatment of FGS in low- and middle-income countries like Tanzania is a challenge. This is due to limited capacities of healthcare workers, and inadequate health facilities infrastructure to support accurate diagnosis and treatment of the neglected tropical diseases (NTD) [4]. A compounding challenge is that some common FGS symptoms such as, leucorrhea, vaginal discharge, itching, contact bleeding, chronic abdominal pain, dyspareunia, and menstrual cycle abnormalities can be misdiagnosed and treated as sexually transmitted diseases (STI), cervical cancer or other infectious diseases [6-9]. As a result, many girls and women continue to live with a plight of untreated FGS which may lead to reproductive health consequences such as infertility, miscarriage, ectopic pregnancies and spontaneous abortions [10]. Other reported health consequences of FGS include depression, social stigma and increased susceptibility to HIV infection [11-12]. Despite limited epidemiological data on the burden of FGS, there is compelling evidence that prevalence of FGS in Tanzania is high particularly in the areas with higher S. haematobium endemicity. The lack of data leaves the health system unaware of the burden. The worst scenario is when healthcare workers continue to misdiagnose FGS due to lack of knowledge and skills thus exacerbating FGS problems in the communities. Strengthening the capacity of the health systems, particularly at the primary healthcare (PHC) level, to be able to diagnose and treat FGS is an urgent undertaking to ensure that no one is left behind in the fight against schistosomiasis. This should be done alongside the identification of service delivery platforms, which will not add an extra burden on the PHC. Thus, integrating the delivery of clinical services for FGS with another neglected tropical disease such as schistosomiasis which shares common etiology and some diagnosis methods may be an efficient and cost-effective strategy. Tanzania is among the early adopter countries for paediatric praziquantel (arPZQ). Paediatric praziquantel has been developed as an interventional drug for the treatment of paediatric schistosomiasis infection among young children. The country expects to roll out the delivery of arPZQ through test and treat (T&T) approach and community-based mass drug administration. The test and treat delivery strategy for arPZQ provide an opportunity for integrating services for FGS. This is because it is a common practice in the study sites that women take children to the clinic or hospital for healthcare services. This study was designed to investigate the feasibility of integrating FGS healthcare services in the delivery of arPZQ as a mother and child delivery model for schistosomiasis intervention. The consideration is the integrated delivery of schistosomiasis interventions through primary healthcare services. Methods Study design This was a cross-sectional study involving mixed-methods approach for qualitative and quantitative data collection and analysis. Study sites The study was conducted in three district councils that had been previously identified for a pilot deployment of paediatric praziquantel. These included Itilima DC, Kigoma DC and Sengerema DC located in Simiyu, Kigoma and Mwanza regions respectively. Sampling of Study participants A purposive sampling technique was used to recruit study participants from the community. This was guided by the following inclusion criteria: participants had to be women of reproductive age with children aged below five years; female community health worker and have lived in the areas for not less than six months. For healthcare workers, participants included the in-charge of the facilities, clinical officers, nurses and heads of laboratory services. Sampling of Health facilities A multistage purposive sampling technique was used to sample wards and health facilities. Three regions from the Great Lakes area with moderate to high prevalence of schistosomiasis were included. These regions were previously selected for the pilot delivery of arPZQ under the project “Investigating the effectiveness, feasibility, acceptability and cost of integrated delivery models for paediatric praziquantel inTanzania” (the STEPPS project). The regions included Kigoma, Mwanza and Simiyu. From each of these regions, one district previously identified for the STEPPS project was by default included in the study. They included Kigoma, Sengerema and Itilima DC respectively. From each district, two wards (sub-districts) were purposively sampled based on schistosomiasis prevalence data. From each ward, two villages were then randomly sampled for the study. A total of six wards (sub-districts) and 12 villages were involved in the study. By default, one health facility located in each sampled village was included for assessment of its capacity to diagnose and treat FGS. The sampled villages with health facilities therefore included Mulaga, Buyagu, Ishishang'holo and Sima dispensaries in Sengerema DC; Chankere, Mkongora, Chankabwimba dispensaries, and Bitale health centre in Kigoma DC; and Kashishi, Zanzui, Mitobo dispensaries, and Zagayu health centre in Itilima DC (Figure 1). Data collection Quantitative method a) Checklist The checklist was used to collect information on human resources, laboratory supplies and equipment, examination equipment, and availability of medicines (even though Praziquantel is accessed through mass drug administration (MDA), a programmatic intervention). The collected data aimed at assessing the gaps, capacity and readiness of the primary healthcare facilities to provide services for FGS as an integrated service. b) Structured Questionnaire The structured questionnaire was used to assess healthcare workers’ capacity and competence to diagnose and treat FGS. It also gathered information on their knowledge, the availability of working tools and medicines, and the readiness to provide FGS related services. The assessment targeted clinicians, midwives, nurses and laboratory technologists. Prior to engaging the healthcare workers in the interview an informed consent was sought, and those who consented were engaged in the interview. Qualitative method The FGDs were conducted using pre-prepared guiding questions to facilitate the discussions. These questions were interpreted into Kiswahili to ensure comprehension and concise responses from participants. Each FGD comprised of 8–12 women of childbearing age. To facilitate the recruitment of eligible participants, community health workers were engaged, and they were provided with the inclusion and exclusion criteria as a guide. Inclusion criteria were: women of reproductive age with children under five, female Community Health Worker, influential women such as traditional birth attendants (TBAs). Exclusion criteria were: women below the childbearing age, and women who did not have children under five years old. Prior to conducting the FGDs, informed consent was administered to the participants and only those consented participated in the discussions. The In-Depth Interviews (IDI) with healthcare workers were conducted using guiding questions. The questions were interpreted into Kiswahili to ensure accurate comprehension and concise responses. The inclusion criteria were: a healthcare worker serving at the health facility not less than six months and consented to participate. The exclusion criteria were: A healthcare worker serving at the health facility for less than six months, and/or has declined to participate. Data Analysis The qualitative coding and corresponding matrices were created and analyzed using NVivo version 10.0. The software helped to identify potential correlations between different variables. For quantitative data, descriptive statistics were used to determine the proportion of healthcare workers with knowledge of FGS and its symptoms as well as those with experience to diagnose and treat FGS. It was also used to determine the proportion of health facilities with the equipment required to diagnose FGS and the availability of praziquantel. Results Health facilities status and demographic characteristics of healthcare workers A total of 12 health facilities were covered during the study. These included Ishishang’holo, Sima, Mulaga and Buyagu Dispensaries in Sengerema DC; Chankere, Mkongora and Chankabwimba Dispensaries, and Bitale Health Centre in Kigoma DC; Kashishi, Zanzui, and Mitobo (Budalabujiga) dispensaries, and Zagayu Health Centre in Itilima DC. A total of 27 healthcare workers responded and filled in the questionnaire. Out of these 37% were facilities managers, and 14.1% were responsible for reproductive and child health (RCH). Distribution of respondents in terms of employment cadre revealed that 29.6% were clinical Officers, 37.04% registered nurses, 11.11% enrolled nurses, 3.71% medical officer while assistant clinical officer and assistant nurses constituted 11.1, and 7.41% respectively (Figure 2). The distribution of respondents based on gender showed that 51.8% of respondents were males while 48.2% were females. The study probed further on the work experience from which majority of healthcare workers had five years or less of working experience at their duty stations. Those who had been working for less than a year accounted for 22.2% of the respondents. Those with one to five years of experience constituted 29.6%, while those with six to ten years were 37%, and those with over ten years of experience were 11.1% (Figure 3). The mean working experience was 5.72 years, and the median was 5 years. Overall, the work experience clearly demonstrated that majority of the healthcare workers had been working at the health facility for less than five years (51.8%). Knowledge of FGS and its symptoms among healthcare workers The knowledge about FGS and its symptoms was investigated to establish the gap and training needs among healthcare workers. Different categories of healthcare workers were involved including; Medical Officer, Clinical Officers, Nurses and Assistant Clinical Officers. Medical laboratory technologists were not included in the study because most of the primary healthcare facilities lacked this cadre of healthcare workers. Even in the facilities where they exist, they are not involved in the clinical examination of FGS. The knowledge of FGS among healthcare workers was assessed by asking them to mention symptoms of the disease. Results show that only five clinical officers, one nurse and one assistant clinical officer, were aware of FGS (Table 1). This accounts for 30% of all healthcare workers who participated in the questionnaire. Consequently,70% of healthcare workers were unaware of FGS and had never heard about it before. Table 1: Proportion of healthcare workers with knowledge of FGS symptoms Variables Study Sites HCW Cadre Sengerema DC Kigoma DC Itilima DC Reg. Nurses (n=10) Clinical Officers(n=9) Others (n=8) Knowledge of FGS disease Yes (%) 1 (12.5) 2(25.00) 4(36.36) 1(10) 5 (55.56) 1(12.5) No (%) 7 (77.5.) 6(75.00) 7(63.63) 9(90) 4(44.44) 7(77.5) Knowledge of FGS symptoms among healthcare workers Haematuria Yes (%) 1 (12.5) 2(25.00) 4(36.36) 1(10) 5 (55.56) 1(12.5) No (%) 7 (77.5) 6(75.00) 7(63.63) 9(90) 4(44.44) 7 (87.5) Lower abdominal pain Yes (%) 1 (12.5) 1(12.5) 3(27.27) 1(10) 3(33.3) 1(12.5) No (%) 7 (77.5) 7 (87.5) 8(72.72) 9(90) 6(66.7) 7 (87.5) Lower back pain Yes (%) 1 (12.5) 1(12.5) 1(9.09) 0(0.00) 3(33.3) 0(0.00) No (%) 7 (77.5) 7 (87.5) 10(90.9) 10(100) 6(66.7) 8(100) Painful micturition Yes (%) 0(0.00) 1(12.5) 0(0.00) 0(0.00) 1(11.1) 0(0.00) No (%) 7(100) 7 (87.5) 11(100) 10(100) 8(88.9) 8(100) Dyspareunia Yes (%) 0(0.00) 1(12.5) 1(9.09) 1(10) 1(11.1) 0(0.00) No (%) 7(100) 7 (87.5) 10(90.9) 9(90) 8(88.9) 8(100) Genital itching or burning sensation Yes (%) 1 (12.5) 0(0.00) 0(0.00) 0(0.00) 1(11.1) 0(0.00) No (%) 7 (77.5) 8(100) 11(100) 10(100) 8(88.9) 8(100) Bleeding or spotting after intercourse Yes (%) 1 (12.5) 1(12.5) 0(0.00) 0(0.00) 2(22.2) 0(0.00) No (%) 7 (77.5) 7 (87.5) 11(100) 10(100) 7(77.8) 8(100) The five clinical officers who knew about or had heard of FGS demonstrated better knowledge of its symptoms. Three of them mentioned haematuria, lower abdominal pain, and lower back pain. Painful micturition, dyspareunia and genital itching or burning sensation were each mentioned by only one clinical officer (Table 1). Two clinical officers also noted bleeding or spotting after intercourse. Knowledge and capacity to diagnose FGS at the health facilities The capacity of the healthcare facility to diagnose and manage FGS was assessed in three health facilities where four clinical officers and one nurse confirmed to know FGS. The healthcare workers were from Ishishangh’olo Dispensary (Sengerema DC), Mkongora Dispensary (Kigoma DC) and Zagayu Health Centre (Itilima DC). For FGS diagnosis, respondents were expected to mention any or all the following three methods: gynecological examination, dipstick for microscopic haematuria, and urine filtration followed by microscopic visualization and counting of schistosome eggs. Results have shown that only one clinical officer (20%) from Ishishang'holo dispensary in Sengerema DC has some knowledge and has done gynaecological examination to diagnose FGS. The remaining 80% lack knowledge and skills on using gynaecological examination as a method to diagnose FGS. Additionally, none of the healthcare workers knew about or have used dipstick for microscopic haematuria to diagnose FGS (Figure 4). On the other hand, 60% of healthcare workers have some knowledge and skills of using urine filtration to visualize and count Schistosoma eggs using a microscope. The knowledge and experience on using urine filtration method to visualize and count Schistosoma eggs may be attributed to prior training received on using this method in the diagnosis of other health problems. When asked about awareness and utilization of the WHO pocket atlas for diagnosing FGS, only one healthcare worker (20%) was aware of this important job aid. These results have revealed a huge knowledge and skill gap in diagnosing FGS at the primary healthcare level. Capacity building programmes coupled with strengthening of laboratory capacity to accurately diagnose FGS are needed to support delivery of diagnosis and treatment services for FGS. Capacity to manage FGS and how comfortable healthcare workers are in providing services for FGS Despite the limited knowledge of FGS among healthcare workers, the study wanted to know the capacity of healthcare workers to manage FGS, and how comfortable and willing to provide healthcare services for FGS at their facilities. Results have shown that out of 27 healthcare workers interviewed only three (11.1%) have managed FGS before (Table 2). These were Clinical Officers from Ishishang’holo and Mkongora dispensaries in Sengerema and Kigoma DC respectively, and a nurse from Zagayu health centre in Itilima DC. Furthermore, findings have shown that only one clinical officer and one nurse (equivalent to 7.41% of all healthcare workers interviewed) have managed FGS within the past six months. This demonstrated the low capacity of healthcare workers to manage FGS. This may be attributed to a lack of knowledge and skills, as previously reported by Mazigo et al. [13], who found that healthcare workers at primary health care facilities have low capacity regarding the diagnosis, treatment and knowledge of schistosomiasis. Table 2: Capacity of healthcare workers to manage FGS and how comfortable they are in managing FGS Variables Study Sites Sengerema (N=8) Kigoma (N=8) Itilima (N=11) Ever Managed FGS before Yes (%) 1 (12.5) 1(12.5) 1(9.09) No (%) 7 (77.5) 7 (87.5) 10(90.90) Managed FGS in the past 6 Months Yes (%) 1 (12.5) 1(12.5) 1(9.09) No (%) 7 (77.5) 7(87.5) 10(90.9) Comfortability in managing FGS Very comfortable 0 7(87.5) 0 Comfortable 2 1(12.5) 8(72.72) Neutral 0 0 0 Uncomfortable 1 0 3(27.27) Very Uncomfortable - 0 0 Availability of space for gynaecological examination and stock of praziquantel The availability of private space for gynaecological examinations is a prerequisite before FGS diagnosis and treatment services can be provided at the primary healthcare level. Additionally, the availability of praziquantel a prescription drug for schistosomiasis infection and thus FGS is another important provision if FGS is to be integrated into routine healthcare services alongside the delivery of paediatric praziquantel for the treatment of Schistosoma infection in children under five years old. Results revealed that all health facilities covered during the study had spaces dedicated to gynaecological examination (Figure 5a). This was further confirmed by a physical inspection of the examination rooms. Additionally, 83% of the health facilities reported having stocks of praziquantel (PZQ), even though these stocks were likely intended for school aged children’s mass drug administration (Figure 5b). Availability of diagnostic tools and reagents for diagnosis of FGS The availability of diagnostic tools and reagents needed during the diagnosis of FGS was assessed to determine health facilities’ readiness to provide services. Results have indicated that at the time of the assessment only three (42%) out of 12 healthcare facilities had dipsticks available, 42% had a functional microscope this is irrespective of whether they were regularly used or not, whilst Lugol’s Iodine an important reagent for differentiating parasitic cysts from the other cells was available in eight (67%) of the 12 health facilities assessed. Similarly, urine sample collection containers were available in 83% of the health facilities, indicating their demand and use in collecting samples for diagnosis of other diseases (Figure 6a). We assessed the trend of commodity stockouts within a one month ago before the data collection. Results show that eight (67%) out of 12 health facilities experienced a stock out of dipsticks, six (50%) experienced stock out of Lugol’s Iodine and 25% of the health facilities experienced a stockout of urine sample collection containers (Figure 6b). Healthcare workers and community members opinions on integrating clinical services for FGS and the delivery of paediatric praziquantel The IDI and FGDs were conducted to obtain the healthcare workers and community members opinions on whether it is feasible to integrate the delivery of healthcare services for FGS with the delivery of paediatric praziquantel in the study sites. The idea of integration stemmed out of the fact that, predominantly female parents and caregivers take the under five-year-old children to the health facilities for both routine child growth and development monitoring, and to seek healthcare service whenever the children develop health problems. The motivation for integration is to enable women of reproductive age to have a reliable access to healthcare services for female genital schistosomiasis and be enlightened about the disease itself through health promotion programmes at the nearest health facility. The other interest was to see whether there will be a convergent point where healthcare workers and community members share the same opinion about the possible integrated service delivery for FGS and paediatric schistosomiasis. In-Depth Interview with healthcare workers The in-depth interview (IDI) sought to collect healthcare workers’ views on the feasibility of integrating healthcare services for FGS with the delivery of paediatric praziquantel as part of an integrated mother and childcare and treatment service for schistosomiasis infection. It also aimed to determine whether health facilities were ready for such integration, and what gaps should be addressed prior to its introduction. Feasibility of integrating clinical services for FGS and paediatric schistosomiasis All interviewed healthcare workers from 12 facilities affirmed the integration of clinical services for FGS and pediatric schistosomiasis is a feasible undertaking. The integration is being considered as the country expects to roll out the delivery of pediatric praziquantel, a new drug developed for the treatment of schistosomiasis infection in children under the age of six years. Despite the feasibility, healthcare workers identified key provisions which need to be considered before the integration is realized. HCW from Sengerema DC identified challenges related to capacities to diagnose schistosomiasis and FGS at the health facilities, raising awareness about FGS and pediatric schistosomiasis in the community, and strengthening the skills of healthcare workers to offer the services. Some attestations from HCW are as follows: “The capacity to diagnose schistosomiasis at the health facility is low, and there is a limited knowledge about schistosoma haematobium infection and its secondary complications among communities”. (CO-F1-Ishishangh’olo Dispensary). Another HCW from Sima Dispensary, Sengerema DC focused more on strengthening the capacity of staff and improving the working environment to support the integration of services: “The clinic staffs are ready if they acquire necessary skills and equipment to deliver the services for FGS. Currently, the staff have no skills to do the screening and diagnosis of FGS. Some facilities such as our own lack key amenities like washing sinks in the consultation room and necessary consumables to support diagnosis of FGS” (CO-M1-Sima Dispensary). HCW from Kigoma DC supported the integration as a feasible strategy, however there must be efforts to raise awareness about FGS and schistosomes infection among children under the age of five years and the availability of interventions. “ The integration is feasible and highly needed by the community. Despite this, there should be health education involving communities and healthcare workers. Creation of awareness about FGS and the availability of interventions is an important undertaking before the integrated service begins” . (CO-M2-Chankele Dispensary). “The proposed integration is feasible, however there is a need to raise awareness among community members. Since women will be deploying their children for the routine clinic services, a good number of mothers will have access to diagnosis and treatment of FGS ”. (CO-F2-Chankabwimba Dispensary). The Itilima DC HCW had similar responses to those recorded in Sengerema and Kigoma DC. A slight difference was documented from Kashishi Dispensary and Zagayu Health Centre, where the interviewed clinical officers focused more on the strengthening of human resources, laboratory services and supplies of reagents and commodities required in the delivery of integrated clinical services for FGS and peadiatric schistosomiasis interventions. “The integration is possible especially with training and addition of healthcare workers. The tools and laboratory equipment are available to support the initiative. It is therefore important to work on the improvements to ensure that health facilities are ready to provide the services”. (CO-M3-Zanzui Dispensary, and CO-M4-Zagayu Health Centre). Readiness of the health facilities to integrate clinical services for FGS and paediatric schistosomiasis infection All health facilities visited are ready to integrate clinical services for FGS and pediatric schistosomiasis infection. However, there are improvements needed for the integration to be effective. This includes increasing the staffing levels, providing the on-the-job training courses, procure and supplying the missing equipment such as head lamps and speculums, and reagents. The majority of HCW had the same opinion, but a clinical officer from Mkongora Dispensary in Kigoma DC had a succinct comment: “There is no problem for the health facility staffs to be involved in the provision of the new intervention, especially through integrated approach. This is because already there are services such as family planning and cervical cancer screening that have been integrated and are being offered with no problem. All that is needed is to increase the number of healthcare workers coupled with appropriate training as the demand increases. Furthermore, equipment such as head lamps and speculums needs to be supplied to support gynaecological examinations” . (CO-M5-Mkongora Dispensary). Identified gaps which may affect the integration of clinical services for FGS and paediatric schistosomiasis HCW identified gaps which are grouped in five thematic areas as follows: Staffing, Equipment and Supplies; Space and privacy for gynecological examination, Community awareness, Social and Cultural factors, and Resources constraint (Table 3). Table 3: Gaps which may affect effective integration of clinical services for FGS and pediatric schistosomiasis infection Thematic area Gap or bottleneck Staffing, equipment and supplies a) Inadequate trained staff. b) Lack of medical equipment and consumables. c) There are no guidelines for screening and treatment of FGS. d) Limited examination kits for use during the provision of services. Infrastructure, tools and space with privacy a) Some health facilities have limited spaces for gynaecological examinations. b) The available space has limited privacy to support gynaecological examination. c) FGS not included in the Standard Treatment Guideline (STG). Community awareness a) Limited awareness about FGS and its interventions among the communities. b) Lack of data on how big the FGS problem is in the community due to privacy nature of the problem. Social and Cultural factors a) Women prefer female clinicians or nurses than men to examine them. This may affect the uptake of FGS services in some areas. b) Addressing myth, stigma and cultural barriers must be considered. Resource constraints a) Resources to support supplies of PZQ, training of HCW and supplies reagents are limited. b) FGS is not well known among supervisors and implementers of healthcare services, hence not prioritized in the comprehensive council health plans (CCHP). Focus groups discussions with communities A total of 12 focus groups discussions were conducted in the study sites, whereby each site had four FGDs. The inclusion criteria for FGD participants were: Women of reproductive age who have children under the age of five, Community health worker, Traditional Birth Attendants. The FGD tool had three key thematic areas for soliciting information: Knowledge or awareness about FGS, health seeking behavior for those struggling with FGS symptoms, and the readiness of the affected women to utilize the FGS clinical services when integrated with the delivery of the intervention for pediatric schistosomiasis. Knowledge or awareness about FGS Participants from all study sites had no knowledge of FGS, despite most of them being aware of schistosome infections in school aged children, and adults. They could mention a few symptoms of both intestinal and urogenital schistosomiasis. Results show that most participants heard of FGS for the first time during the focus group discussions. Some of participants’ attestation confirmed this: “ We have only heard about the schistosomiasis that affects children especially when they pass through waters while going to school, and mothers and fathers when they get in contact with infested waters” (R3-F-Budalabujiga, Itilima DC). “I have never heard of it” (R7-F-Mkongora, and R2-F-Mkongora, Kigoma DC). “I have seen a small child who was scratching her private parts a lot and it was very red, I don't know what disease it was” (R5-F-Zanzui, Itilima DC). Interviewers provided clarification on what is FGS, and how it develops from Schistosoma haematobium infection. After clarification, participants were able to mention some symptoms of FGS, with some having lived with it while unaware that it was FGS. Some narratives on the symptoms of FGS and negative outcomes include: “Itching in the private parts, discharges, sometimes headache, and when I go to the pharmacy, they tell me it's a UTI, because I sometimes feel pain during urination. And during intercourse with my partner, it's painful” (R3-F-Mkongora, Kigoma DC). “I've heard that if one has such symptoms is likely to have a miscarriage especially when you experience pain below the abdomen” (R2-F-Mkongora, Kigoma DC) “I’ve only heard that it damages the uterus, and even when urinating you feel pain and discomfort in the stomach, that’s what I’ve heard” (R9-F-Mitobo, Itilima DC). Additionally, participants were asked to explain how big the problem is in their community. It was clear that many women in the schistosomiasis endemic regions are struggling quietly with FGS symptoms. Some attestations confirm: “Many women suffer, they just don't know it is FGS. The name is not familiar, they don't know about schistosomiasis infections in the reproductive organs, if you explain it to someone, they say it's UTI and many cannot say or disclose until they see blood in the urine and have lower abdominal pains” (R4-F-Bitale, Kigoma DC). “I’m not sure because you can’t follow up on people’s privacy. Someone may have FGS, but they don’t talk about it, it might be small or even a significantly big problem in the community” (R7-F-Mitobo, Itilima DC). “This problem is huge, but people just associate it with UTI and sexually transmitted diseases, they often suffer like young children” (R8-F-Chankabwimba, Kigoma DC). “Yes, it does exist. Even adult women silently struggle with it. Those working in pharmacies have heard a lot, they know many secrets of the women, as they struggle with symptoms of FGS. But they are told it is either fungal infection or UTI” (R9-F-Chankabwimba, Kigoma DC). The health seeking behaviour of the FGS affected Results from FGD revealed that women with FGS symptoms have been seeking care from the nearest health facilities. Unfortunately, lack of knowledge about FGS among healthcare workers which is manifested through wrong diagnosis and treatment has been driving the health-seeking behaviour of the FGS affected. Most have consulted for traditional medicines or pharmacies to consult and access some medicines, unfortunately these have also been the failing options. One of the challenges the FGS affected women face as they seek medical attention has been a repeated UTI diagnosis, which after a course of treatment with cocktails of antibiotics the symptoms do not disappear. Additionally, some have been wrongly diagnosed with fungal infection or sometimes sexually transmitted infection, and treatment hasn’t been successful. Consequently, majority of the affected women live with the FGS problem for a long time. Furthermore, it was interesting to note that UTI was mentioned in all the 12 FGDs, confirming the knowledge and capacity gaps at the healthcare facilities to diagnose and treat FGS. Some attestations from participants are as follows: “We usually go to the hospital and if we see that hospital services are inadequate, we seek traditional remedies at home, we're told this problem isn't treated with hospital medicine but with traditional medicine” (R3-F-Bitale, Kigoma DC). “Another thing is, is it possible for the community get health education on FGS? Because when a girl experiences the symptoms of FGS, she feels ashamed to go to the hospital. Because if she says she has that disease, the community will say she has started bad habits as one cannot get that disease without starting sexual intercourse. Many community members associate the symptoms of FGS with STI” (R7-F-Ishishangh’olo, Sengerema DC). “This problem is huge, but people just associate it with UTI and sexually transmitted diseases. They often suffer like young children” (R2-F-Chankabwimba, Kigoma DC). “It is a problem as when one goes to the pharmacy or hospital, describes the symptoms, they're told it's a fungus infection or UTI” (R10-F-Mkongora, Kigoma DC). “Normally, you must go to the hospital and get instructions there. But often we first start with a traditional healer before going to the hospital” (R7-F-Zanzui, Itilima DC). “When you urinate and feel pain or when urine comes out with some blood, and you go to the hospital they just test you for UTI. So, what should one do so that the doctors can be able to diagnose female genital schistosomiasis (FGS)? Because most of the time they will say you have UTI and prescribe medicine for UTI. However, when one uses the medicines, the symptoms do not stop or just decreases and later recurs” ( R2-F-Zagayu, Itilima DC) Readiness of the community to utilize integrated clinical services for FGS and paediatric schistosomiasis during the delivery of arPZQ. Results indicates that all FGD participants expressed their readiness to utilize the FGS services should the integration with the delivery of paediatric praziquantel be realized. It was further suggested that health education coupled with local advocacy need to be conducted to raise awareness about the FGS problem in the communities. Participants requested that HCW need training to address the misdiagnosis problem which has plagued the primary healthcare facilities for a long time. Some assertions from participants are as follows: “Women in the community will be ready, FGS bothers many women, they will come. The community in general is bothered by this problem” (R5-F-Bitale, Kigoma DC). “The community is ready, FGS bothers many women, they will come” (R4-F-Mkongora, Kigoma DC). “We are very ready, because we've suffered a lot” (R10-F-Chankabwimba, Kigoma DC). “Just by announcing to the women that there is a test and treatment for FGS, many will come, but also some will refuse” (R4-F-Zanzui, Itilima DC). Discussion Tanzania is among the early adopters of arPZQ, a new drug developed for the treatment of schistosomiasis infection among children aged 24 to 59 months. ArPZQ has been developed for delivery through health facilities, a strategy which coincided with the recently published WHO guideline for control and eliminations of human schistosomiasis [ 14 ]. The guideline has recommended expanding access to interventions for schistosomiasis by including it in the routine healthcare services. Before delivering arPZQ through test and treat approach (routine healthcare service), assessing capacities of health facilities to correctly diagnose and treat schistosomiasis is a prime undertaking. It is within this premise that, the integration of clinical services for FGS with the delivery of arPZQ in Tanzania was considered as a possible entry point. The relevance of the proposed integration is based on the context whereby, mothers or caregiver (women) are predominantly responsible for taking children to the health facilities for health care services. Under the same platform, they can have access to clinical services for FGS. This study aimed to investigate how feasible it is to integrate clinical services for FGS and paediatric schistosomiasis infection at the primary healthcare level. The assessment criteria were grouped into two categories: First category was the health facilities capacity which included human resources knowledge and experience, infrastructure and laboratory services. Additionally, gaps and bottlenecks which need to be addressed before the integration is implemented; the second category was the community which focused on the knowledge of FGS and its symptoms, health seeking behaviour for the FGS affected, and willingness to accept the clinical services for FGS when introduced at the nearest health facilities. Results have shown a strong intersection between the interrogated variables for service providers and those of the communities. Eighty three percent (83%) of the health facilities involved in this study were dispensaries and 17% health centres. Both are primary healthcare facilities which provide basic healthcare services to majority of the local population. The most common health problems presented at this level of healthcare services are infectious diseases and maternal and child health issues. The findings have clearly shown that over 70% of HCW lack the knowledge of FGS and its symptoms. Despite having worked in the area endemic to urogenital schistosomiasis, where haematuria is one of commonly observed symptoms, healthcare workers could not associate this as one of the symptoms of schistosomiasis in adult women. The implication of the knowledge gap is that most of the time when patients are presented with symptoms of FGS at the health facilities, they are misdiagnosed and prescribed with wrong treatment. This was confirmed during the FGD when participants described the ordeal of having repeated treatment of urinary tract infection (UTI) or other suspected infectious diseases with no cure success. Like reports from other studies, some women have even been treated of STI and fungal infections, unfortunately with no cure [ 15 – 17 ]. This left the FGS affected women in despair and agony of living with a disease which has been largely affected their quality adjusted life years (QALYs). Most of the health facilities were lacking a functional microscope (58.3%) and dipsticks (66.7%). Some did not have head lamps and speculums, the key tools for gynaecological examinations. On the other hand, reagents such as Lugol Iodine and equipment like urine samples collection containers were available at > 67% of the health facilities covered. The dedicated spaces or rooms for gynaecological examination were available at all the assessed facilities, however some had challenges of privacy. The assessment of diagnosis and examination capacity for FGS was important in identifying operational gaps which need to be addressed before the integration is activated. There is a strong link between the availability of diagnosis and examination tools with the experience of healthcare workers who have used or are aware of any of the diagnosis methods for FGS. Over 70% of the healthcare workers have no experience of diagnosing FGS or schistosomiasis because these diseases have not been managed at their health facilities. The level of awareness about FGS among healthcare workers in the study sites is low, while in the community it was found to be completely non-existent. These findings corroborate previous reports which revealed lack of knowledge of FGS among healthcare workers and communities [ 18 – 19 ]. It was intriguing to find out that all FGD participants heard of FGS for the first time during the discussion. This calls for implementing health promotion activities focusing on FGS across all regions with moderate to high prevalence of Schistosoma haematobium . This will raise awareness about FGS and the interventions for it within the communities and the healthcare workers as well. Additionally, only two out of 27 healthcare workers have heard about the WHO pocket atlas for diagnosing FGS. This demonstrated clearly that FGS is not a priority disease, despite all conditions and community’s affirmation that the problem is big among women in the study sites. It is likely that the absence of FGS in the standard treatment guideline (STG) and lack of surveillance data contributes to the incompetence of healthcare workers in addressing this chronic NTD. The healthcare workers and communities in the study sites supported the integration of clinical services for FGS with the delivery of paediatric praziquantel as a feasible strategy. However, the gaps and bottlenecks identified during the discussions need to be addressed if this strategy is to be realized and effective. One of the critical gaps is the limited number of staff with knowledge of FGS and schistosomiasis in general which may affect access and delivery of the integrated service. Schistosomiasis and FGS share a common etiology, with the latter being a secondary and chronic form of the former (urogenital schistosomiasis). Thus, integrating clinical services for paediatric schistosomiasis and FGS will not be complex from the diagnosis and treatment points of view. Complex proposals for integration have been made before. For instance, there have been proposals to integrate FGS and sexual and reproductive health (SRH) services [ 17 , 20 ]. SRH services are diverse and complex, however it seemed feasible to integrate FGS with it. Furthermore, there have been proposals to integrate clinical services for FGS, cervical cancer and HIV as FGS increases risks for HIV infection, and there have been misdiagnosis of FGS as cervical cancer [ 4 , 21 ]. Furthermore, it was encouraging to note that healthcare workers welcomed the idea and over 80% of them were ready and comfortable to deliver an integrated service. This study has confirmed that integrating FGS into the delivery of clinical services for paediatric schistosomiasis is a feasible undertaking. This is irrespective of several improvements required to be made at the health facility level and provision of health education at the community level, including linkages between the intermediate freshwater snails host and schistosomiasis. Conclusion There have been several recommendations to integrate FGS with the existing health programmes. Unfortunately, FGS remains a neglected disease despite the increasing voices on the negative impacts and risks this NTD poses. The proposed integration discussed in this work brings to light a completely new focus. The introduction of arPZQ for the treatment of paediatric schistosomiasis is a viable platform for integration of clinical services for FGS. It offers a promising opportunity to get FGS introduced in the routine clinical care coupled with the development of necessary tools required to support the integration. The proposed integration is feasible due to various reasons, however two are worth mentioning: the two diseases share a common etiology, they share some diagnosis techniques, and all are new in healthcare service delivery hence share similar gaps thus while addressing the needs for paediatric schistosomiasis, one can easily integrate the needs of FGS. The critical and common gaps for both include: training needs for healthcare workers, developing STG for FGS and paediatric schistosomiasis, health promotion to raise community’s awareness about FGS and paediatric schistosomiasis infection, and strengthening supportive environment for the provision of integrated services. Additionally, praziquantel (PZQ) a drug needed for the treatment of FGS should be a prescription drug available at the health facilities, and not only for mass drug distribution (MDA) campaigns targeting programmatic interventions for schistosomiasis. Implications and recommendations To address the burden of FGS in endemic district councils covered in the current study, these findings recommend increased public knowledge of early symptoms of FGS in order to seek timely health care interventions. Furthermore, there is a need for the integration of FGS interventions with the roll out of arPZQ to enhance early recognition of the disease and promote the understanding of the general population on its severity and mode of transmission. For a comprehensive and integrated approach in addressing FGS problem and other secondary schistosomiasis health problems, the health authorities should undertake snails survey at the community freshwater contact points to establish the presence or absence of the intermediate host snails and undertake appropriate control and community awareness measures. Strengths and limitations The sample size used for the study allows for the findings from the study to be generalized to the study areas. Moreover, the sampling techniques and analysis used in the study minimized the possibility of participant selection bias with positive implications for the study findings. In terms of limitations, due to the cross-sectional nature of the study, causality cannot be established. While our findings are generalizable to the district councils, they may not necessarily reflect the situation in other regions of Tanzania. Furthermore, the study did not assess the participants’ knowledge on the relationship between schistosomiasis and the intermediate host snails, an additional risk factor that would influence their health seeking behavior. Declarations Ethical consideration (Human Ethics) The study was reviewed and approved by the Lake Zone Institutional Review Board of the National Institute for Medical Research with the approval No. MR/53/100/788. Furthermore, the study was conducted according to the ethical principles established by the World Medical Association in the Helsinki declaration of Ethical Principles for Medical Research Involving Human Subjects. Consent to participate Informed Consent was sought from all participants (healthcare workers and the community members) before the administration of questionnaires and conducting FGDs. Consent for publication Permission to publish this paper was obtained from the Director General of the National Institute for Medical Research (NIMR), Tanzania. All the authors have scrutinized the script and given their consent for publication . Availability of data and study resources All data generated or analyzed during this study are included in this published article. Competing interests The authors declare no conflicts of interest. Authors’ contributions All authors meet the criteria for authorship as stated in the International Committee of Medical Journal Editors (ICMJE) authorship guidelines. PEK, EMK and MN conceived and designed the study. EMK secured the grant funding. PEK and JO analysed the data. JM and PEK designed the data collection tools. CI and OG provided methodological insights. PEK, JO and MN oversaw data curation. OG, JM and CI collected the data. PEK, JM, JO, CI and EMK drafted the initial manuscript. PEK, MN, sand JO supervised the research. All authors reviewed and commented on the manuscript and approved the final draft for publication. Funding This research was supported by the Access and Delivery Partnership (ADP). ADP is funded by the Government of Japan and led by the United Nations Development Programme, in collaboration with the World Health Organization, the Special Programme for Research and Training in Tropical Diseases (TDR) and PATH through NIMR [TDR APW-PO 203308093]. Acknowledgements We acknowledge the participants for the time spent answering our questionnaires and their participation in the FGDs and IDI. Conflict of Interests Authors declares no conflict of interests associated with the implementation of the study in the study sites. References Orish VN, Komla E, Morhe S, Azanu W, Alhassan RK, Gyapong M. The parasitology of female genital schistosomiasis. Curr Res Parasitol Vector-Borne Dis. 2022;2:100093. Masong MC, Godlove BW, Marlene NT, Gamba V, Mengue M, Kouokam E et al. Female Genital Schistosomiasis (FGS) in Cameroon: A formative epidemiological and socioeconomic investigation in eleven rural fishing communities. PLos Global Public Health. 2021;1–23. Hotez PJ, Engels D, Gyapong M, Ducker C, Malecela MN. Female genital schistosomiasis. N Engl J Med. 2019;381:2493–5. Mbwanji G, Mazigo HD, Maganga JK, Downs JA. Female genital schistosomiasis is a neglected public health problem in Tanzania: Evidence from a scoping review. PLoS Negl Trop Dis. 2024;18(3):e0011954. Lwambo NJS, Savioli L, Kisumku UM, Alawi KS, Bundy DAP. Control of Schistosoma haematobium morbidity on Pemba Island: Validity and efficiency of indirect screening tests. Bull World Health Organ. 1997;75:247–52. Jacobson J, Pantelias A, Williamson M, Kjetland EF, Krentel A, Gyapong M et al. Addressing a silent and neglected scourge in sexual and reproductive health in Sub-Saharan Africa by development of training competencies to improve prevention, diagnosis, and treatment of female genital schistosomiasis (FGS) for health workers. Reproductive Health. 2022;1–15. Kaizilege GK, Kiritta R, Chuma C, Ndaboine E, Ottoman O, Elias E, Zinga MM, et al. Female Genital Schistosomiasis, a Neglected Differential of Cervical Precancerous and Cancerous Lesion: a Wake-up Call for on-Job Training for Healthcare Workers in Endemic Areas. Austin J Clin Case Rep. 2022;9(1):1241. Jin E, Noble JA, Gomes M. A Review of Computer-Aided Diagnostic Algorithms for Cervical Neoplasia and an Assessment of Their Applicability to Female Genital Schistosomiasis. Mayo Clin Proc Digit Health. 2023;1(3):247–57. Rossi B, Previtali L, Salvi M, Gerami R, Tomasoni LR, Quiros-Roldan E. Female genital schistosomiasis: A neglected among the Neglected Tropical Diseases. Microorganisms. 2024;12. 458.https://doi.org/10.3390/microorganisms12030458 . Steben M, Kjetland EF, Ndao M. Global Library of Women's medicine: Female genital schistosomiasis, August 2023.ISSN:1756–2228;Doi10.3843/GLOWM.419983. Preston A, Vitolas CT, Kouamin AC, Nadri J, Lavry SL, Dhanani N, et al. Improved prevention of female genital schistosomiasis: piloting integration of services into the national health system in Cote d’Ivoire. Front Trop Dis. 2023;4:1308660. Patel P, Rose CE, Kjetland EF, Downs JA, Mbabazi PS, Sabing K, et al. Association of schistosomiasis and HIV infections: A systematic review and meta-analysis. Int J Infect Dis. 2021;102:544–53. Mazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, et al. We know about schistosomiasis, but we know nothing about FGS: A qualitative assessment of knowledge gaps about female genital schistosomiasis among communities living in Schistosoma haematobium endemic districts of Zanzibar and Northwestern Tanzania. PLoS Negl Trop Dis. 2021;15(9):e0009789. WHO guideline on control and elimination of human schistosomiasis. Geneva: World Health Organization. 2022;Licence:CC BY-NC-SA 3.0 IGO. Mazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, et al. Healthcare Workers’ Low Knowledge of Female Genital Schistosomiasis and Proposed Interventions to Prevent, Control, and Manage the Disease in Zanzibar. Int J Public Health. 2022;67:1604767. Kayuni SA, Cunningham LJ, Kumwenda D, Mainga B, Lally D, Chammudzi P, et al. Challenges in the diagnosis and control of female genital schistosomiasis in sub-Saharan Africa: an exemplar case report associated with mixed and putative hybrid schistosome infection in Nsanje District, Southern Malawi. Front Trop Dis. 2024;5:1354119. 10.3389/fitd.2024.1354119 . Lamberti O, Bozzani F, Kiyoshi K, Bustinduy AL. Time to bring female genital schistosomiasis out of neglect. Br Med Bull. 2024;149:45–59. https://doi.org/10.1093/bmb/ldad034 . Mazigo HD, Uisso C, Kazyoba P, Mwingira UJ. Primary health care facilities capacity gaps regarding diagnosis, treatment and knowledge of schistosomiasis among healthcare workers in North-western Tanzania: a call to strengthen the horizontal system. BMC Health Serv Res. 2021;21:529. Mazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, et al. Female genital schistosomiasis is a sexually transmitted disease: Gaps in healthcare workers’ knowledge about female genital schistosomiasis in Tanzania. PLOS Global Public Health. 2022;2(3):e0000059. https://doi.org/10.1371/journal.pgph.0000059 . Pillay LN, Umbelino-Walker I, Schlosser D, Kalume C, Karuga R. Minimum service package for the integration of female genital schistosomiasis into sexual and reproductive health and rights interventions. Front Trop Dis. 2024;5:1321069. Engels D, Hotez PJ, Ducker C, Gyapong M, Bustinduy AL, Secor WE et al. Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer. Bull World Health Organ (Policy & Practice). 2020;98:615–624. http://dx.doi.org/10.2471/BLT.20.252270 Additional Declarations No competing interests reported. Supplementary Files TOOL3LABChecklist.pdf TOOL1HealthcareProviders.pdf TOOL2FGDguide.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 10 Sep, 2025 Reviewers agreed at journal 02 Sep, 2025 Reviews received at journal 02 Sep, 2025 Reviewers agreed at journal 31 Aug, 2025 Reviews received at journal 28 Aug, 2025 Reviewers agreed at journal 25 Aug, 2025 Reviewers agreed at journal 21 Aug, 2025 Reviewers invited by journal 18 Aug, 2025 Editor assigned by journal 13 Aug, 2025 Editor invited by journal 23 Jul, 2025 Submission checks completed at journal 22 Jul, 2025 First submitted to journal 22 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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07:11:10","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":157190,"visible":true,"origin":"","legend":"","description":"","filename":"TOOL1HealthcareProviders.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7123493/v1/ff5ac0d98ea22753e9fb7dee.pdf"},{"id":89988162,"identity":"a6c8128c-922d-4e3b-91b2-cf1344d562b1","added_by":"auto","created_at":"2025-08-27 07:03:11","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":205612,"visible":true,"origin":"","legend":"","description":"","filename":"TOOL2FGDguide.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7123493/v1/efd8cea71fe3b898f22444bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integrating female genital schistosomiasis services with paediatric praziquantel delivery in Tanzania: A feasibility study","fulltext":[{"header":"Background","content":"\u003cp\u003eFemale genital schistosomiasis (FGS) is a chronic gynecological manifestation of \u003cem\u003eSchistosoma haematobium\u003c/em\u003e infection affecting millions of women worldwide [1]). The disease is characterized by the deposition of parasite eggs in the female reproductive tract, which leads to chronic fibrosis and scarring [1-2]. Sub-Saharan Africa bears a big proportion of the global burden due to limited access to safe and clean water that compels communities to seek water from sources infested with \u003cem\u003eS. haematobium\u003c/em\u003e cercariae. Consequently, sub-Saharan Africa is estimated to have over 40 million women and girls affected with FGS [3]. With the prevalence ranging between 12–87%, Tanzania ranks second after Nigeria in terms of schistosome infections in Africa [4]. The country has both \u003cem\u003eSchistosoma mansoni\u003c/em\u003e and \u003cem\u003eS. haematobium\u003c/em\u003e. However, \u003cem\u003eS. haematobium\u003c/em\u003e infection accounts for two-thirds of all schistosomiasis cases in Tanzania, placing girls and women at higher risk of developing a chronic form of the disease, FGS [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe diagnosis and treatment of FGS in low- and middle-income countries like Tanzania is a challenge. This is due to limited capacities of healthcare workers, and inadequate health facilities infrastructure to support accurate diagnosis and treatment of the neglected tropical diseases (NTD) [4]. A compounding challenge is that some common FGS symptoms such as, leucorrhea, vaginal discharge, itching, contact bleeding, chronic abdominal pain, dyspareunia, and menstrual cycle abnormalities can be misdiagnosed and treated as sexually transmitted diseases (STI), cervical cancer or other infectious diseases [6-9]. As a result, many girls and women continue to live with a plight of untreated FGS which may lead to reproductive health consequences such as infertility, miscarriage, ectopic pregnancies and spontaneous abortions [10]. Other reported health consequences of FGS include depression, social stigma and increased susceptibility to HIV infection [11-12].\u003c/p\u003e\n\u003cp\u003eDespite limited epidemiological data on the burden of FGS, there is compelling evidence that prevalence of FGS in Tanzania is high particularly in the areas with higher \u003cem\u003eS. haematobium\u003c/em\u003e endemicity. The lack of data leaves the health system unaware of the burden. The worst scenario is when healthcare workers continue to misdiagnose FGS due to lack of knowledge and skills thus exacerbating FGS problems in the communities. Strengthening the capacity of the health systems, particularly at the primary healthcare (PHC) level, to be able to diagnose and treat FGS is an urgent undertaking to ensure that no one is left behind in the fight against schistosomiasis. This should be done alongside the identification of service delivery platforms, which will not add an extra burden on the PHC. \u0026nbsp;Thus, integrating the delivery of clinical services for FGS with another neglected tropical disease such as schistosomiasis which shares common etiology and some diagnosis methods may be an efficient and cost-effective strategy. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTanzania is among the early adopter countries for paediatric praziquantel (arPZQ). Paediatric praziquantel has been developed as an interventional drug for the treatment of paediatric schistosomiasis infection among young children. The country expects to roll out the delivery of arPZQ through test and treat (T\u0026amp;T) approach and community-based mass drug administration. The test and treat delivery strategy for arPZQ provide an opportunity for integrating services for FGS. This is because it is a common practice in the study sites that women take children to the clinic or hospital for healthcare services. This study was designed to investigate the feasibility of integrating FGS healthcare services in the delivery of arPZQ as a mother and child delivery model for schistosomiasis intervention. The consideration is the integrated delivery of schistosomiasis interventions through primary healthcare services.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study involving mixed-methods approach for qualitative and quantitative data collection and analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy sites\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in three district councils that had been previously identified for a pilot deployment of paediatric praziquantel. These included Itilima DC, Kigoma DC and Sengerema DC located in Simiyu, Kigoma and Mwanza regions respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eStudy participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA purposive sampling technique was used to recruit study participants from the community. This was guided by the following inclusion criteria: participants had to be women of reproductive age with children aged below five years; female community health worker and have lived in the areas for not less than six months. For healthcare workers, participants included the in-charge of the facilities, clinical officers, nurses and heads of laboratory services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSampling of Health facilities\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multistage purposive sampling technique was used to sample wards and health facilities. Three regions from the Great Lakes area with moderate to high prevalence of schistosomiasis were included. These regions were previously selected for the pilot delivery of arPZQ under the project \u0026ldquo;Investigating the effectiveness, feasibility, acceptability and cost of integrated delivery models for paediatric praziquantel inTanzania\u0026rdquo; (the STEPPS project).\u003c/p\u003e\n\u003cp\u003eThe regions included Kigoma, Mwanza and Simiyu. From each of these regions, one district previously identified for the STEPPS project was by default included in the study. They included Kigoma, Sengerema and Itilima DC respectively. From each district, two wards (sub-districts) were purposively sampled based on schistosomiasis prevalence data. \u0026nbsp;From each ward, two villages were then randomly sampled for the study. A total of six wards (sub-districts) and 12 villages were involved in the study. By default, one health facility located in each sampled village was included for assessment of its capacity to diagnose and treat FGS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sampled villages with health facilities therefore included Mulaga, Buyagu, Ishishang\u0026apos;holo and Sima dispensaries in Sengerema DC; Chankere, Mkongora, Chankabwimba dispensaries, and Bitale health centre in Kigoma DC; and Kashishi, Zanzui, Mitobo dispensaries, and Zagayu health centre in Itilima DC (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuantitative method\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ea) \u0026nbsp;Checklist\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe checklist was used to collect information on human resources, laboratory supplies and equipment, examination equipment, and availability of medicines (even though Praziquantel is accessed through mass drug administration (MDA), a programmatic intervention). The collected data aimed at assessing the gaps, capacity and readiness of the primary healthcare facilities to provide services for FGS as an integrated service.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eb) \u0026nbsp;Structured Questionnaire\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe structured questionnaire was used to assess healthcare workers\u0026rsquo; capacity and competence to diagnose and treat FGS. It also gathered information on their knowledge, the availability of working tools and medicines, and the readiness to provide FGS related services. The assessment targeted clinicians, midwives, nurses and laboratory technologists. Prior to engaging the healthcare workers in the interview an \u003cstrong\u003einformed consent\u003c/strong\u003e was sought, and those who consented were engaged in the interview. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQualitative method\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FGDs were conducted using pre-prepared guiding questions to facilitate the discussions. These questions were interpreted into Kiswahili to ensure comprehension and concise responses from participants. Each FGD comprised of 8\u0026ndash;12 women of childbearing age. To facilitate the recruitment of eligible participants, community health workers were engaged, and they were provided with the inclusion and exclusion criteria as a guide. \u0026nbsp;Inclusion criteria were: women of reproductive age with children under five, female Community Health Worker, influential women such as traditional birth attendants (TBAs). Exclusion criteria were: women below the childbearing age, and women who did not have children under five years old. Prior to conducting the FGDs, \u003cstrong\u003einformed consent\u003c/strong\u003e was administered to the participants and only those consented participated in the discussions.\u003c/p\u003e\n\u003cp\u003eThe In-Depth Interviews (IDI) with healthcare workers were conducted using guiding questions. The questions were interpreted into Kiswahili to ensure accurate comprehension and concise responses. The inclusion criteria were: a healthcare worker serving at the health facility not less than six months and consented to participate. The exclusion criteria were: A healthcare worker serving at the health facility for less than six months, and/or has declined to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative coding and corresponding matrices were created and analyzed using NVivo version 10.0. The software helped to identify potential correlations between different variables. For quantitative data, descriptive statistics were used to determine the proportion of healthcare workers with knowledge of FGS and its symptoms as well as those with experience to diagnose and treat FGS. \u0026nbsp;It was also used to determine the proportion of health facilities with the equipment required to diagnose FGS and the availability of praziquantel.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eHealth facilities status and demographic characteristics of healthcare workers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 12 health facilities were covered during the study. These included Ishishang\u0026rsquo;holo, Sima, Mulaga and Buyagu Dispensaries in Sengerema DC; Chankere, Mkongora and Chankabwimba Dispensaries, and Bitale Health Centre in Kigoma DC; Kashishi, Zanzui, and Mitobo (Budalabujiga) dispensaries, and Zagayu Health Centre in Itilima DC. A total of 27 healthcare workers responded and filled in the questionnaire. Out of these 37% were facilities managers, and 14.1% were responsible for reproductive and child health (RCH). Distribution of respondents in terms of employment cadre revealed that 29.6% were clinical Officers, 37.04% registered nurses, 11.11% enrolled nurses, 3.71% medical officer while assistant clinical officer and assistant nurses constituted 11.1, and 7.41% respectively (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe distribution of respondents based on gender showed that 51.8% of respondents were males while 48.2% were females. The study probed further on the work experience from which majority of healthcare workers had five years or less of working experience at their duty stations. Those who had been working for less than a year accounted for 22.2% of the respondents. \u0026nbsp;Those with one to five years of experience constituted 29.6%, while those with six to ten years were 37%, and those with over ten years of experience were 11.1% (Figure 3). The mean working experience was 5.72 years, and the median was 5 years. Overall, the work experience clearly demonstrated that majority of the healthcare workers had been working at the health facility for less than five years (51.8%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge of FGS and its symptoms among healthcare workers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe knowledge about FGS and its symptoms was investigated to establish the gap and training needs among healthcare workers. Different categories of healthcare workers were involved including; Medical Officer, Clinical Officers, Nurses and Assistant Clinical Officers. Medical laboratory technologists were not included in the study because most of the primary healthcare facilities lacked this cadre of healthcare workers. Even in the facilities where they exist, they are not involved in the clinical examination of FGS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe knowledge of FGS among healthcare workers was assessed by asking them to mention symptoms of the disease. Results show that only five clinical officers, one nurse and one assistant clinical officer, were aware of FGS (Table 1). This accounts for 30% of all healthcare workers who participated in the questionnaire. Consequently,70% of healthcare workers were unaware of FGS and had never heard about it before.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Proportion of healthcare workers with knowledge of FGS symptoms\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Sites\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 267px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCW Cadre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSengerema\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKigoma DC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItilima DC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReg. Nurses (n=10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Officers(n=9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOthers (n=8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of FGS disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4(36.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (77.5.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6(75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7(63.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e9(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4(44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of FGS symptoms among healthcare workers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaematuria \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4(36.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e5 (55.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6(75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7(63.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e9(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e4(44.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower abdominal pain\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e3(27.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e8(72.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e9(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e6(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 195px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower back pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1(9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp; 0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e10(90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e6(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePainful micturition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e11(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyspareunia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1(9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e10(90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e9(90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenital itching or burning sensation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;11(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e8(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 602px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding or spotting after intercourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u0026nbsp;0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e11(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e7(77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e8(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe five clinical officers who knew about or had heard of FGS demonstrated better knowledge of its symptoms. Three of them mentioned haematuria, lower abdominal pain, and lower back pain. Painful micturition, dyspareunia and genital itching or burning sensation were each mentioned by only one clinical officer (Table 1). Two clinical officers also noted bleeding or spotting after intercourse.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge and capacity to diagnose FGS at the health facilities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe capacity of the healthcare facility to diagnose and manage FGS was assessed in three health facilities where four clinical officers and one nurse confirmed to know FGS. The healthcare workers were from Ishishangh\u0026rsquo;olo Dispensary (Sengerema DC), Mkongora Dispensary (Kigoma DC) and Zagayu Health Centre (Itilima DC). For FGS diagnosis, respondents were expected to mention any or all the following three methods: gynecological examination, dipstick for microscopic haematuria, and urine filtration followed by microscopic visualization and counting of schistosome eggs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults have shown that only one clinical officer (20%) from Ishishang\u0026apos;holo dispensary in Sengerema DC has some knowledge and has done gynaecological examination to diagnose FGS. The remaining 80% lack knowledge and skills on using gynaecological examination as a method to diagnose FGS. Additionally, none of the healthcare workers knew about or have used dipstick for microscopic haematuria to diagnose FGS (Figure 4). On the other hand, 60% of healthcare workers have some knowledge and skills of using urine filtration to visualize and count Schistosoma eggs using a microscope. The knowledge and experience on using urine filtration method to visualize and count Schistosoma eggs may be attributed to \u0026nbsp; prior training received on using this method in the diagnosis of other health problems. When asked about awareness and utilization of the WHO pocket atlas for diagnosing FGS, only one healthcare worker (20%) was aware of this important job aid. These results have revealed a huge knowledge and skill gap in diagnosing FGS at the primary healthcare level. Capacity building programmes coupled with strengthening of laboratory capacity to accurately diagnose FGS are needed to support delivery of diagnosis and treatment services for FGS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCapacity to manage FGS and how comfortable healthcare workers are in providing services for FGS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the limited knowledge of FGS among healthcare workers, the study wanted to know the capacity of healthcare workers to manage FGS, and how comfortable and willing to provide healthcare services for FGS at their facilities. Results have shown that out of 27 healthcare workers interviewed only three (11.1%) have managed FGS before (Table 2). These were Clinical Officers from Ishishang\u0026rsquo;holo and Mkongora dispensaries in Sengerema and Kigoma DC respectively, and a nurse from Zagayu health centre in Itilima DC. Furthermore, findings have shown that only one clinical officer and one nurse (equivalent to 7.41% of all healthcare workers interviewed) have managed FGS within the past six months. This demonstrated the low capacity of healthcare workers to manage FGS. This may be attributed to a lack of knowledge and skills, as previously reported by Mazigo et al. [13], who found that healthcare workers at primary health care facilities have low capacity regarding the diagnosis, treatment and knowledge of schistosomiasis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Capacity of healthcare workers to manage FGS and how comfortable they are in managing FGS\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Sites\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSengerema (N=8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eKigoma (N=8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eItilima (N=11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 567px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver Managed FGS before\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10(90.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 567px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eManaged FGS in the past 6 Months\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1(9.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10(90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 567px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComfortability in managing FGS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVery comfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eComfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8(72.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eNeutral\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eUncomfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3(27.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVery Uncomfortable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of space for gynaecological examination and stock of praziquantel\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe availability of private space for gynaecological examinations is a prerequisite before FGS diagnosis and treatment services can be provided at the primary healthcare level. Additionally, the availability of praziquantel a prescription drug for schistosomiasis infection and thus FGS is another important provision if FGS is to be integrated into routine healthcare services alongside the delivery of paediatric praziquantel for the treatment of \u003cem\u003eSchistosoma\u003c/em\u003e infection in children under five years old.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults revealed that all health facilities covered during the study had spaces dedicated to gynaecological examination (Figure 5a). This was further confirmed by a physical inspection of the examination rooms. Additionally, 83% of the health facilities reported having stocks of praziquantel (PZQ), even though these stocks were likely intended for school aged children\u0026rsquo;s mass drug administration (Figure 5b).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of diagnostic tools and reagents for diagnosis of FGS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe availability of diagnostic tools and reagents needed during the diagnosis of FGS was assessed to determine health facilities\u0026rsquo; readiness to provide services. Results have indicated that at the time of the assessment only three (42%) out of 12 healthcare facilities had dipsticks available, 42% had a functional microscope this is irrespective of whether they were regularly used or not, whilst Lugol\u0026rsquo;s Iodine an important reagent for differentiating parasitic cysts from the other cells was available in eight (67%) of the 12 health facilities assessed. Similarly, urine sample collection containers were available in 83% of the health facilities, indicating their demand and use in collecting samples for diagnosis of other diseases (Figure 6a).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe assessed the trend of commodity stockouts within a one month ago before the data collection. Results show that eight (67%) out of 12 health facilities experienced a stock out of dipsticks, six (50%) experienced stock out of Lugol\u0026rsquo;s Iodine and 25% of the health facilities experienced a stockout of urine sample collection containers (Figure 6b).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealthcare workers and community members opinions on integrating clinical services for FGS and the delivery of paediatric praziquantel\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe IDI and FGDs were conducted to obtain the healthcare workers and community members opinions on whether it is feasible to integrate the delivery of healthcare services for FGS with the delivery of paediatric praziquantel in the study sites. The idea of integration stemmed out of the fact that, predominantly female parents and caregivers take the under five-year-old children to the health facilities for both routine child growth and development monitoring, and to seek healthcare service whenever the children develop health problems. The motivation for integration is to enable women of reproductive age to have a reliable access to healthcare services for female genital schistosomiasis and be enlightened about the disease itself through health promotion programmes at the nearest health facility. The other interest was to see whether there will be a convergent point where healthcare workers and community members share the same opinion about the possible integrated service delivery for FGS and paediatric schistosomiasis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIn-Depth Interview with healthcare workers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe in-depth interview (IDI) sought to collect healthcare workers\u0026rsquo; views on the feasibility of integrating healthcare services for FGS with the delivery of paediatric praziquantel as part of an integrated mother and childcare and treatment service for schistosomiasis infection. It also aimed to determine whether health facilities were ready for such integration, and what gaps should be addressed prior to its introduction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFeasibility of integrating clinical services for FGS and paediatric schistosomiasis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll interviewed healthcare workers from 12 facilities affirmed the integration of clinical services for FGS and pediatric schistosomiasis is a feasible undertaking. The integration is being considered as the country expects to roll out the delivery of pediatric praziquantel, a new drug developed for the treatment of schistosomiasis infection in children under the age of six years. Despite the feasibility, healthcare workers identified key provisions which need to be considered before the integration is realized.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHCW from Sengerema DC identified challenges related to capacities to diagnose schistosomiasis and FGS at the health facilities, raising awareness about FGS and pediatric schistosomiasis in the community, and strengthening the skills of healthcare workers to offer the services. Some attestations from HCW are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The capacity to diagnose schistosomiasis at the health facility is low, and there is a limited knowledge about schistosoma haematobium infection and its secondary complications among communities\u0026rdquo;.\u003c/em\u003e (CO-F1-Ishishangh\u0026rsquo;olo Dispensary).\u003c/p\u003e\n\u003cp\u003eAnother HCW from Sima Dispensary, Sengerema DC focused more on strengthening the capacity of staff and improving the working environment to support the integration of services:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The clinic staffs are ready if they acquire necessary skills and equipment to deliver the services for FGS. Currently, the staff have no skills to do the screening and diagnosis of FGS. Some facilities such as our own lack key amenities like washing sinks in the consultation room and necessary consumables to support diagnosis of FGS\u0026rdquo;\u003c/em\u003e (CO-M1-Sima Dispensary).\u003c/p\u003e\n\u003cp\u003eHCW from Kigoma DC supported the integration as a feasible strategy, however there must be efforts to raise awareness about FGS and schistosomes infection among children under the age of five years and the availability of interventions. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe integration is feasible and highly needed by the community. Despite this, there should be health education involving communities and healthcare workers. Creation of awareness about FGS and the availability of interventions is an important undertaking before the integrated service begins\u0026rdquo;\u003c/em\u003e. (CO-M2-Chankele Dispensary).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The proposed integration is feasible, however there is a need to raise awareness among community members. Since women will be deploying their children for the routine clinic services, a good number of mothers will have access to diagnosis and treatment of FGS\u003c/em\u003e\u0026rdquo;. (CO-F2-Chankabwimba Dispensary).\u003c/p\u003e\n\u003cp\u003eThe Itilima DC HCW had similar responses to those recorded in Sengerema and Kigoma DC. A slight difference was documented from Kashishi Dispensary and Zagayu Health Centre, where the interviewed clinical officers focused more on the strengthening of human resources, laboratory services and supplies of reagents and commodities required in the delivery of integrated clinical services for FGS and peadiatric schistosomiasis interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The integration is possible especially with training and addition of healthcare workers. The tools and laboratory equipment are available to support the initiative. It is therefore important to work on the improvements to ensure that health facilities are ready to provide the services\u0026rdquo;.\u003c/em\u003e (CO-M3-Zanzui Dispensary, and CO-M4-Zagayu Health Centre).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReadiness of the health facilities to integrate clinical services for FGS and paediatric schistosomiasis infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll health facilities visited are ready to integrate clinical services for FGS and pediatric schistosomiasis infection. However, there are improvements needed for the integration to be effective. This includes increasing the staffing levels, providing the on-the-job training courses, procure and supplying the missing equipment such as head lamps and speculums, and reagents. The majority of HCW had the same opinion, but a clinical officer from Mkongora Dispensary in Kigoma DC had a succinct comment:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There is no problem for the health facility staffs to be involved in the provision of the new intervention, especially through integrated approach. This is because already there are services such as family planning and cervical cancer screening that have been integrated and are being offered with no problem. All that is needed is to increase the number of healthcare workers coupled with appropriate training as the demand increases. Furthermore, equipment such as head lamps and speculums needs to be supplied to support gynaecological examinations\u0026rdquo;\u003c/em\u003e. (CO-M5-Mkongora Dispensary).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIdentified gaps which may affect the integration of clinical services for FGS and paediatric schistosomiasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHCW identified gaps which are grouped in five thematic areas as follows: Staffing, Equipment and Supplies; Space and privacy for gynecological examination, Community awareness, Social and Cultural factors, and Resources constraint (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Gaps which may affect effective integration of clinical services for FGS and pediatric schistosomiasis infection\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThematic area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGap or bottleneck\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStaffing, equipment and supplies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003ea) \u0026nbsp; Inadequate trained staff.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eb) \u0026nbsp; Lack of medical equipment and consumables.\u003c/p\u003e\n \u003cp\u003ec) \u0026nbsp; There are no guidelines for screening and treatment of FGS.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ed) \u0026nbsp;\u0026nbsp;\u003c/strong\u003eLimited examination kits for use during the provision of services.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfrastructure, tools and space with privacy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003ea) \u0026nbsp; Some health facilities have limited spaces for gynaecological examinations.\u003c/p\u003e\n \u003cp\u003eb) \u0026nbsp; The available space has limited privacy to support gynaecological examination.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ec) \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFGS not included in the Standard Treatment Guideline (STG).\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity awareness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003ea) \u0026nbsp; Limited awareness about FGS and its interventions among the communities.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eb) \u0026nbsp; Lack of data on how big the FGS problem is in the community due to privacy nature of the problem.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial and Cultural factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003ea) \u0026nbsp; Women prefer female clinicians or nurses than men to examine them. This may affect the uptake of FGS services in some areas.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eb) \u0026nbsp;\u0026nbsp;\u003c/strong\u003eAddressing myth, stigma and cultural barriers must be considered.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResource constraints\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 412px;\"\u003e\n \u003cp\u003ea) \u0026nbsp; Resources to support supplies of PZQ, training of HCW and supplies reagents are limited.\u003c/p\u003e\n \u003cp\u003eb) \u0026nbsp; \u0026nbsp;FGS is not well known among supervisors and implementers of healthcare services, hence not prioritized in the comprehensive council health plans (CCHP).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFocus groups discussions with communities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 12 focus groups discussions were conducted in the study sites, whereby each site had four FGDs. The inclusion criteria for FGD participants were: Women of reproductive age who have children under the age of five, Community health worker, Traditional Birth Attendants. The FGD tool had three key thematic areas for soliciting information: Knowledge or awareness about FGS, health seeking behavior for those struggling with FGS symptoms, and the readiness of the affected women to utilize the FGS clinical services when integrated with the delivery of the intervention for pediatric schistosomiasis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge or awareness about FGS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants from all study sites had no knowledge of FGS, despite most of them being aware of schistosome infections in school aged children, and adults. They could mention a few symptoms of both intestinal and urogenital schistosomiasis. Results show that most participants heard of FGS for the first time during the focus group discussions. Some of participants\u0026rsquo; attestation confirmed this:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eWe have only heard about the schistosomiasis that affects children especially when they pass through waters while going to school, and mothers and fathers when they get in contact with infested waters\u0026rdquo;\u003c/em\u003e (R3-F-Budalabujiga, Itilima DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I have never heard of it\u0026rdquo;\u003c/em\u003e (R7-F-Mkongora, and R2-F-Mkongora, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I have seen a small child who was scratching her private parts a lot and it was very red, I don\u0026apos;t know what disease it was\u0026rdquo;\u003c/em\u003e (R5-F-Zanzui, Itilima DC).\u003c/p\u003e\n\u003cp\u003eInterviewers provided clarification on what is FGS, and how it develops from \u003cem\u003eSchistosoma haematobium\u003c/em\u003e infection. After clarification, participants were able to mention some symptoms of FGS, with some having lived with it while unaware that it was FGS. Some narratives on the symptoms of FGS and negative outcomes include:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Itching in the private parts, discharges, sometimes headache, and when I go to the pharmacy, they tell me it\u0026apos;s a UTI, because I sometimes feel pain during urination. And during intercourse with my partner, it\u0026apos;s painful\u0026rdquo;\u003c/em\u003e (R3-F-Mkongora, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026apos;ve heard that if one has such symptoms is likely to have a miscarriage especially when you experience pain below the abdomen\u0026rdquo;\u003c/em\u003e (R2-F-Mkongora, Kigoma DC)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve only heard that it damages the uterus, and even when urinating you feel pain and discomfort in the stomach, that\u0026rsquo;s what I\u0026rsquo;ve heard\u0026rdquo;\u003c/em\u003e (R9-F-Mitobo, Itilima DC).\u003c/p\u003e\n\u003cp\u003eAdditionally, participants were asked to explain how big the problem is in their community. It was clear that many women in the schistosomiasis endemic regions are struggling quietly with FGS symptoms. Some attestations confirm:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Many women suffer, they just don\u0026apos;t know it is FGS. The name is not familiar, they don\u0026apos;t know about schistosomiasis infections in the reproductive organs, if you explain it to someone, they say it\u0026apos;s UTI and many cannot say or disclose until they see blood in the urine and have lower abdominal pains\u0026rdquo;\u003c/em\u003e (R4-F-Bitale, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;m not sure because you can\u0026rsquo;t follow up on people\u0026rsquo;s privacy. Someone may have FGS, but they don\u0026rsquo;t talk about it, it might be small or even a significantly big problem in the community\u0026rdquo;\u003c/em\u003e (R7-F-Mitobo, Itilima DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;This problem is huge, but people just associate it with UTI and sexually transmitted diseases, they often suffer like young children\u0026rdquo;\u003c/em\u003e (R8-F-Chankabwimba, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, it does exist. Even adult women silently struggle with it. Those working in pharmacies have heard a lot, they know many secrets of the women, as they struggle with symptoms of FGS. But they are told it is either fungal infection or UTI\u0026rdquo;\u003c/em\u003e (R9-F-Chankabwimba, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe health seeking behaviour of the FGS affected\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults from FGD revealed that women with FGS symptoms have been seeking care from the nearest health facilities. Unfortunately, lack of knowledge about FGS among healthcare workers which is manifested through wrong diagnosis and treatment has been driving the health-seeking behaviour of the FGS affected. Most have consulted for traditional medicines or pharmacies to consult and access some medicines, unfortunately these have also been the failing options.\u003c/p\u003e\n\u003cp\u003eOne of the challenges the FGS affected women face as they seek medical attention has been a repeated UTI diagnosis, which after a course of treatment with cocktails of antibiotics the symptoms do not disappear. Additionally, some have been wrongly diagnosed with fungal infection or sometimes sexually transmitted infection, and treatment hasn\u0026rsquo;t been successful. Consequently, majority of the affected women live with the FGS problem for a long time. Furthermore, it was interesting to note that UTI was mentioned in all the 12 FGDs, confirming the knowledge and capacity gaps at the healthcare facilities to diagnose and treat FGS. Some attestations from participants are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We usually go to the hospital and if we see that hospital services are inadequate, we seek traditional remedies at home, we\u0026apos;re told this problem isn\u0026apos;t treated with hospital medicine but with traditional medicine\u0026rdquo;\u003c/em\u003e (R3-F-Bitale, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Another thing is, is it possible for the community get health education on FGS? Because when a girl experiences the symptoms of FGS, she feels ashamed to go to the hospital. Because if she says she has that disease, the community will say she has started bad habits as one cannot get that disease without starting sexual intercourse. Many community members associate the symptoms of FGS with STI\u0026rdquo;\u003c/em\u003e (R7-F-Ishishangh\u0026rsquo;olo, Sengerema DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;This problem is huge, but people just associate it with UTI and sexually transmitted diseases. They often suffer like young children\u0026rdquo;\u003c/em\u003e (R2-F-Chankabwimba, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It is a problem as when one goes to the pharmacy or hospital, describes the symptoms, they\u0026apos;re told it\u0026apos;s a fungus infection or UTI\u0026rdquo;\u003c/em\u003e (R10-F-Mkongora, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Normally, you must go to the hospital and get instructions there. But often we first start with a traditional healer before going to the hospital\u0026rdquo;\u003c/em\u003e (R7-F-Zanzui, Itilima DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When you urinate and feel pain or when urine comes out with some blood, and you go to the hospital they just test you for UTI. So, what should one do so that the doctors can be able to diagnose female genital schistosomiasis (FGS)? Because most of the time they will say you have UTI and prescribe medicine for UTI. However, when one uses the medicines, the symptoms do not stop or just decreases and later recurs\u0026rdquo; (\u003c/em\u003eR2-F-Zagayu, Itilima DC)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReadiness of the community to utilize integrated clinical services for FGS and paediatric schistosomiasis during the delivery of arPZQ.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults indicates that all FGD participants expressed their readiness to utilize the FGS services should the integration with the delivery of paediatric praziquantel be realized. It was further suggested that health education coupled with local advocacy need to be conducted to raise awareness about the FGS problem in the communities. Participants requested that HCW need training to address the misdiagnosis problem which has plagued the primary healthcare facilities for a long time. Some assertions from participants are as follows:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Women in the community will be ready, FGS bothers many women, they will come. The community in general is bothered by this problem\u0026rdquo;\u003c/em\u003e (R5-F-Bitale, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The community is ready, FGS bothers many women, they will come\u0026rdquo;\u003c/em\u003e (R4-F-Mkongora, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We are very ready, because we\u0026apos;ve suffered a lot\u0026rdquo;\u003c/em\u003e (R10-F-Chankabwimba, Kigoma DC).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Just by announcing to the women that there is a test and treatment for FGS, many will come, but also some will refuse\u0026rdquo;\u003c/em\u003e (R4-F-Zanzui, Itilima DC).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTanzania is among the early adopters of arPZQ, a new drug developed for the treatment of schistosomiasis infection among children aged 24 to 59 months. ArPZQ has been developed for delivery through health facilities, a strategy which coincided with the recently published WHO guideline for control and eliminations of human schistosomiasis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The guideline has recommended expanding access to interventions for schistosomiasis by including it in the routine healthcare services. Before delivering arPZQ through test and treat approach (routine healthcare service), assessing capacities of health facilities to correctly diagnose and treat schistosomiasis is a prime undertaking. It is within this premise that, the integration of clinical services for FGS with the delivery of arPZQ in Tanzania was considered as a possible entry point. The relevance of the proposed integration is based on the context whereby, mothers or caregiver (women) are predominantly responsible for taking children to the health facilities for health care services. Under the same platform, they can have access to clinical services for FGS.\u003c/p\u003e\u003cp\u003eThis study aimed to investigate how feasible it is to integrate clinical services for FGS and paediatric schistosomiasis infection at the primary healthcare level. The assessment criteria were grouped into two categories: First category was the health facilities capacity which included human resources knowledge and experience, infrastructure and laboratory services. Additionally, gaps and bottlenecks which need to be addressed before the integration is implemented; the second category was the community which focused on the knowledge of FGS and its symptoms, health seeking behaviour for the FGS affected, and willingness to accept the clinical services for FGS when introduced at the nearest health facilities. Results have shown a strong intersection between the interrogated variables for service providers and those of the communities.\u003c/p\u003e\u003cp\u003eEighty three percent (83%) of the health facilities involved in this study were dispensaries and 17% health centres. Both are primary healthcare facilities which provide basic healthcare services to majority of the local population. The most common health problems presented at this level of healthcare services are infectious diseases and maternal and child health issues. The findings have clearly shown that over 70% of HCW lack the knowledge of FGS and its symptoms. Despite having worked in the area endemic to urogenital schistosomiasis, where haematuria is one of commonly observed symptoms, healthcare workers could not associate this as one of the symptoms of schistosomiasis in adult women. The implication of the knowledge gap is that most of the time when patients are presented with symptoms of FGS at the health facilities, they are misdiagnosed and prescribed with wrong treatment. This was confirmed during the FGD when participants described the ordeal of having repeated treatment of urinary tract infection (UTI) or other suspected infectious diseases with no cure success. Like reports from other studies, some women have even been treated of STI and fungal infections, unfortunately with no cure [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This left the FGS affected women in despair and agony of living with a disease which has been largely affected their quality adjusted life years (QALYs).\u003c/p\u003e\u003cp\u003eMost of the health facilities were lacking a functional microscope (58.3%) and dipsticks (66.7%). Some did not have head lamps and speculums, the key tools for gynaecological examinations. On the other hand, reagents such as Lugol Iodine and equipment like urine samples collection containers were available at \u0026gt;\u0026thinsp;67% of the health facilities covered. The dedicated spaces or rooms for gynaecological examination were available at all the assessed facilities, however some had challenges of privacy. The assessment of diagnosis and examination capacity for FGS was important in identifying operational gaps which need to be addressed before the integration is activated. There is a strong link between the availability of diagnosis and examination tools with the experience of healthcare workers who have used or are aware of any of the diagnosis methods for FGS. Over 70% of the healthcare workers have no experience of diagnosing FGS or schistosomiasis because these diseases have not been managed at their health facilities.\u003c/p\u003e\u003cp\u003eThe level of awareness about FGS among healthcare workers in the study sites is low, while in the community it was found to be completely non-existent. These findings corroborate previous reports which revealed lack of knowledge of FGS among healthcare workers and communities [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It was intriguing to find out that all FGD participants heard of FGS for the first time during the discussion. This calls for implementing health promotion activities focusing on FGS across all regions with moderate to high prevalence of \u003cem\u003eSchistosoma haematobium\u003c/em\u003e. This will raise awareness about FGS and the interventions for it within the communities and the healthcare workers as well. Additionally, only two out of 27 healthcare workers have heard about the WHO pocket atlas for diagnosing FGS. This demonstrated clearly that FGS is not a priority disease, despite all conditions and community\u0026rsquo;s affirmation that the problem is big among women in the study sites. It is likely that the absence of FGS in the standard treatment guideline (STG) and lack of surveillance data contributes to the incompetence of healthcare workers in addressing this chronic NTD.\u003c/p\u003e\u003cp\u003eThe healthcare workers and communities in the study sites supported the integration of clinical services for FGS with the delivery of paediatric praziquantel as a feasible strategy. However, the gaps and bottlenecks identified during the discussions need to be addressed if this strategy is to be realized and effective. One of the critical gaps is the limited number of staff with knowledge of FGS and schistosomiasis in general which may affect access and delivery of the integrated service. Schistosomiasis and FGS share a common etiology, with the latter being a secondary and chronic form of the former (urogenital schistosomiasis). Thus, integrating clinical services for paediatric schistosomiasis and FGS will not be complex from the diagnosis and treatment points of view. Complex proposals for integration have been made before. For instance, there have been proposals to integrate FGS and sexual and reproductive health (SRH) services [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. SRH services are diverse and complex, however it seemed feasible to integrate FGS with it. Furthermore, there have been proposals to integrate clinical services for FGS, cervical cancer and HIV as FGS increases risks for HIV infection, and there have been misdiagnosis of FGS as cervical cancer [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, it was encouraging to note that healthcare workers welcomed the idea and over 80% of them were ready and comfortable to deliver an integrated service. This study has confirmed that integrating FGS into the delivery of clinical services for paediatric schistosomiasis is a feasible undertaking. This is irrespective of several improvements required to be made at the health facility level and provision of health education at the community level, including linkages between the intermediate freshwater snails host and schistosomiasis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere have been several recommendations to integrate FGS with the existing health programmes. Unfortunately, FGS remains a neglected disease despite the increasing voices on the negative impacts and risks this NTD poses. The proposed integration discussed in this work brings to light a completely new focus. The introduction of arPZQ for the treatment of paediatric schistosomiasis is a viable platform for integration of clinical services for FGS. It offers a promising opportunity to get FGS introduced in the routine clinical care coupled with the development of necessary tools required to support the integration. The proposed integration is feasible due to various reasons, however two are worth mentioning: the two diseases share a common etiology, they share some diagnosis techniques, and all are new in healthcare service delivery hence share similar gaps thus while addressing the needs for paediatric schistosomiasis, one can easily integrate the needs of FGS. The critical and common gaps for both include: training needs for healthcare workers, developing STG for FGS and paediatric schistosomiasis, health promotion to raise community\u0026rsquo;s awareness about FGS and paediatric schistosomiasis infection, and strengthening supportive environment for the provision of integrated services. Additionally, praziquantel (PZQ) a drug needed for the treatment of FGS should be a prescription drug available at the health facilities, and not only for mass drug distribution (MDA) campaigns targeting programmatic interventions for schistosomiasis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications and recommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo address the burden of FGS in endemic district councils covered in the current study, these findings recommend increased public knowledge of early symptoms of FGS in order to seek timely health care interventions. Furthermore, there is a need for the integration of FGS interventions with the roll out of arPZQ to enhance early recognition of the disease and promote the understanding of the general population on its severity and mode of transmission.\u003c/p\u003e\u003cp\u003eFor a comprehensive and integrated approach in addressing FGS problem and other secondary schistosomiasis health problems, the health authorities should undertake snails survey at the community freshwater contact points to establish the presence or absence of the intermediate host snails and undertake appropriate control and community awareness measures.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size used for the study allows for the findings from the study to be generalized to the study areas. Moreover, the sampling techniques and analysis used in the study minimized the possibility of participant selection bias with positive implications for the study findings. In terms of limitations, due to the cross-sectional nature of the study, causality cannot be established. While our findings are generalizable to the district councils, they may not necessarily reflect the situation in other regions of Tanzania. Furthermore, the study did not assess the participants\u0026rsquo; knowledge on the relationship between schistosomiasis and the intermediate host snails, an additional risk factor that would influence their health seeking behavior.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical consideration (Human Ethics)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was reviewed and approved by the Lake Zone Institutional Review Board of the National Institute for Medical Research with the approval No. MR/53/100/788. Furthermore, the study was conducted according to the ethical principles established by the World Medical Association in the Helsinki declaration of Ethical Principles for Medical Research Involving Human Subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed Consent was sought from all participants (healthcare workers and the community members) before the administration of questionnaires and conducting FGDs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission to publish this paper was obtained from the Director General of the National Institute for Medical Research (NIMR), Tanzania. All the authors have scrutinized the script and given their consent for publication\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and study resources\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors meet the criteria for authorship as stated in the International Committee of Medical Journal Editors (ICMJE) authorship guidelines. PEK, EMK and MN conceived and designed the study. EMK secured the grant funding. PEK and JO analysed the data. JM and PEK designed the data collection tools. CI and OG provided methodological insights. PEK, JO and MN oversaw data curation. OG, JM and CI collected the data. PEK, JM, JO, CI and EMK drafted the initial manuscript. PEK, MN, sand JO supervised the research. All authors reviewed and commented on the manuscript and approved the final draft for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Access and Delivery Partnership (ADP). ADP is funded by the Government of Japan and led by the United Nations Development Programme, in collaboration with the World Health Organization, the Special Programme for Research and Training in Tropical Diseases (TDR) and PATH through NIMR [TDR\u0026nbsp;APW-PO 203308093].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the participants for the time spent answering our questionnaires and their participation in the FGDs and IDI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declares no conflict of interests associated with the implementation of the study in the study sites.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrish VN, Komla E, Morhe S, Azanu W, Alhassan RK, Gyapong M. The parasitology of female genital schistosomiasis. 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Control of \u003cem\u003eSchistosoma haematobium\u003c/em\u003e morbidity on Pemba Island: Validity and efficiency of indirect screening tests. Bull World Health Organ. 1997;75:247\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJacobson J, Pantelias A, Williamson M, Kjetland EF, Krentel A, Gyapong M et al. Addressing a silent and neglected scourge in sexual and reproductive health in Sub-Saharan Africa by development of training competencies to improve prevention, diagnosis, and treatment of female genital schistosomiasis (FGS) for health workers. Reproductive Health. 2022;1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaizilege GK, Kiritta R, Chuma C, Ndaboine E, Ottoman O, Elias E, Zinga MM, et al. Female Genital Schistosomiasis, a Neglected Differential of Cervical Precancerous and Cancerous Lesion: a Wake-up Call for on-Job Training for Healthcare Workers in Endemic Areas. Austin J Clin Case Rep. 2022;9(1):1241.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJin E, Noble JA, Gomes M. A Review of Computer-Aided Diagnostic Algorithms for Cervical Neoplasia and an Assessment of Their Applicability to Female Genital Schistosomiasis. Mayo Clin Proc Digit Health. 2023;1(3):247\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRossi B, Previtali L, Salvi M, Gerami R, Tomasoni LR, Quiros-Roldan E. Female genital schistosomiasis: A neglected among the Neglected Tropical Diseases. Microorganisms. 2024;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e458.https://doi.org/10.3390/microorganisms12030458\u003c/span\u003e\u003cspan address=\"458.10.3390/microorganisms12030458\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSteben M, Kjetland EF, Ndao M. Global Library of Women's medicine: Female genital schistosomiasis, August 2023.ISSN:1756\u0026ndash;2228;Doi10.3843/GLOWM.419983.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePreston A, Vitolas CT, Kouamin AC, Nadri J, Lavry SL, Dhanani N, et al. Improved prevention of female genital schistosomiasis: piloting integration of services into the national health system in Cote d\u0026rsquo;Ivoire. Front Trop Dis. 2023;4:1308660.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel P, Rose CE, Kjetland EF, Downs JA, Mbabazi PS, Sabing K, et al. Association of schistosomiasis and HIV infections: A systematic review and meta-analysis. Int J Infect Dis. 2021;102:544\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, et al. We know about schistosomiasis, but we know nothing about FGS: A qualitative assessment of knowledge gaps about female genital schistosomiasis among communities living in Schistosoma haematobium endemic districts of Zanzibar and Northwestern Tanzania. PLoS Negl Trop Dis. 2021;15(9):e0009789.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO guideline on control and elimination of human schistosomiasis. Geneva: World Health Organization. 2022;Licence:CC BY-NC-SA 3.0 IGO.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, et al. Healthcare Workers\u0026rsquo; Low Knowledge of Female Genital Schistosomiasis and Proposed Interventions to Prevent, Control, and Manage the Disease in Zanzibar. Int J Public Health. 2022;67:1604767.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKayuni SA, Cunningham LJ, Kumwenda D, Mainga B, Lally D, Chammudzi P, et al. Challenges in the diagnosis and control of female genital schistosomiasis in sub-Saharan Africa: an exemplar case report associated with mixed and putative hybrid schistosome infection in Nsanje District, Southern Malawi. Front Trop Dis. 2024;5:1354119. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fitd.2024.1354119\u003c/span\u003e\u003cspan address=\"10.3389/fitd.2024.1354119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLamberti O, Bozzani F, Kiyoshi K, Bustinduy AL. Time to bring female genital schistosomiasis out of neglect. Br Med Bull. 2024;149:45\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/bmb/ldad034\u003c/span\u003e\u003cspan address=\"10.1093/bmb/ldad034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazigo HD, Uisso C, Kazyoba P, Mwingira UJ. Primary health care facilities capacity gaps regarding diagnosis, treatment and knowledge of schistosomiasis among healthcare workers in North-western Tanzania: a call to strengthen the horizontal system. BMC Health Serv Res. 2021;21:529.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMazigo HD, Samson A, Lambert VJ, Kosia AL, Ngoma DD, Murphy R, et al. Female genital schistosomiasis is a sexually transmitted disease: Gaps in healthcare workers\u0026rsquo; knowledge about female genital schistosomiasis in Tanzania. PLOS Global Public Health. 2022;2(3):e0000059. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pgph.0000059\u003c/span\u003e\u003cspan address=\"10.1371/journal.pgph.0000059\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePillay LN, Umbelino-Walker I, Schlosser D, Kalume C, Karuga R. Minimum service package for the integration of female genital schistosomiasis into sexual and reproductive health and rights interventions. Front Trop Dis. 2024;5:1321069.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEngels D, Hotez PJ, Ducker C, Gyapong M, Bustinduy AL, Secor WE et al. Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer. Bull World Health Organ (Policy \u0026amp; Practice). 2020;98:615\u0026ndash;624. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.2471/BLT.20.252270\u003c/span\u003e\u003cspan address=\"10.2471/BLT.20.252270\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"FGS, paediatric praziquantel, schistosomiasis, integrated services","lastPublishedDoi":"10.21203/rs.3.rs-7123493/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7123493/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eFemale genital schistosomiasis (FGS) is a gynaecological manifestation of a chronic \u003cem\u003eSchistosoma haematobium\u003c/em\u003e infection affecting over 40 million women and girls, mostly in sub-Saharan Africa. In low- and middle-income countries like Tanzania diagnosis and treatment of FGS is a challenge due to limited healthcare capacity for neglected tropical diseases (NTDs). This leaves many women suffering from untreated FGS and its complications. The upcoming distribution of paediatric praziquantel (arPZQ) through routine healthcare in Tanzania presents a unique opportunity to integrate FGS care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study assessed the feasibility of integrating FGS diagnosis and treatment services with arPZQ delivery using a mother and child integrated model for schistosomiasis intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study employed both qualitative and quantitative data collection and analysis methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIntegrating FGS services with the delivery of arPZQ was supported by healthcare workers (HCW) and the communities as a feasible strategy. This is only if diagnostic and treatment capacities for FGS at the primary healthcare facilities are strengthened. The study has revealed that over 70% of HCW lacked FGS awareness and experience in its diagnosis and treatment. Consequently, there have been frequent misdiagnosis of FGS as UTI, STIs or fungal infections, resulting in ineffective treatment. Similarly, communities were unaware of FGS and its symptoms. The repeated treatment failure which has been manifested by the recurrence of heinous symptoms affected their health seeking behavior. Majority of the FGS affected women have resorted to traditional medicines, unfortunately with no success. After learning about FGS and its symptoms, women expressed their readiness to seek treatment at the nearest health facility. The healthcare workers as providers of services expressed their willingness to provide integrated services for FGS and paediatric schistosomiasis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The integration of healthcare services for FGS and paediatric schistosomiasis is a feasible strategy. The two diseases share a common etiology, share some diagnosis techniques, and all are new in the healthcare service delivery system therefore have similar implementation or operational gaps. Consequently, when addressing the gaps for diagnosing and treating paediatric schistosomiasis, one can easily integrate the needs of FGS.\u003c/p\u003e","manuscriptTitle":"Integrating female genital schistosomiasis services with paediatric praziquantel delivery in Tanzania: A feasibility study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:03:05","doi":"10.21203/rs.3.rs-7123493/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-10T06:54:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"262645493662316926414401321290787779813","date":"2025-09-02T07:22:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-02T05:19:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127325175777019480281193951890725487130","date":"2025-08-31T16:13:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-28T16:53:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208456244986006475130948950761438317880","date":"2025-08-25T09:32:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42992503812671448406272831734153826598","date":"2025-08-21T14:45:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-18T18:57:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T06:47:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-23T09:35:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-22T08:11:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-07-22T08:08:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0dd24861-62e9-4f31-a3aa-e4fc5018fe41","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-27T07:03:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:03:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7123493","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7123493","identity":"rs-7123493","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}