Systemic and Capacity barriers to Female Genital Schistosomiasis management among healthcare workers in Ghana: A Mixed-Method Approach

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Tetteh, Alfred K. Manyeh, Jabulani R. Ncayiyana, Themba G. Ginindza This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6981252/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Dec, 2025 Read the published version in Tropical Diseases, Travel Medicine and Vaccines → Version 1 posted 10 You are reading this latest preprint version Abstract Background Schistosomiasis causes significant morbidity in over 78 countries worldwide, including Ghana. In females, untreated urogenital schistosomiasis can lead to female genital schistosomiasis (FGS), which has a focal prevalence of 11% and 73% in Ghana and poses complex challenges for healthcare professionals. This study assessed the knowledge, attitudes, and practices of healthcare workers (HCWs) regarding FGS in two schistosomiasis-endemic districts. Methods A cross-sectional mixed-method study was conducted in 36 health facilities, involving 252 HCWs from the Lower Manya-Krobo (LMK) and Shai Osudoku districts (SOD). Quantitative data were analyzed using descriptive statistics, t-tests, and multivariable lineal regression (Stata 18). Additionally, 38 purposively selected HCWs were in interviewed, and qualitative data were analyzed thematically (NVivo 20). A joint display analysis was used to integrate findings. Results Significant gaps in FGS-related KAP were identified in both districts. HCWs in LMK had a lower mean knowledge score of 41.4 (95%CI 38.4–44.4) than those in SOD 55.9%, (95%CI 54.2–57.6). Practice scores were similarly low: 31.1% (95%CI 28.5–33.7) in LMK and 33.5% (95%CI 31.4–35.4) in SOD. HCWs reported hesitance to manage FGS due to limited knowledge, lack of training, absence of diagnostic tools, and unavailability of praziquantel. Only 4.8% of HCWs in LMK and 9.5% in SOD reported their facility could diagnose and manage FGS. KAP scores varied significantly by cadre, educational, years of experience, and work settings. Qualitative findings confirmed lack of FGS-specific interventions, including clinical guidelines and facility-level support. Participants recommended in-service training, integration of FGS into routine health education, and improved community sensitization. Conclusion The study reveals substantial gaps in HCWs KAP and preparedness to manage FGS in both districts exacerbated by a lack of systemic support, training, and resources. Addressing these gaps requires integrating FGS in health training curricula; regular in-service training for frontline HCWs; improved diagnostic and treatment capacity; community education; and strengthening district-level supervision. A multi-sectoral approach involving government, academia, civil society, and the private sectors is essential to improving FGS prevention and management in Ghana. Female genital schistosomiasis knowledge attitudes and practices (KAP) healthcare workers Neglected Tropical Diseases (NTDs) capacity building Ghana health system strengthening mixed-methods research Figures Figure 1 Background Female genital schistosomiasis (FGS) is a significant but under-recognized public health challenge, in sub-Saharan Africa (SSA), which account for over 90% of the global burden of urogenital schistosomiasis [ 1 – 3 ]. Affecting an estimated 56 million women and girls worldwide, FGS arises from untreated urogenital schistosomiasis, causing chronic inflammation and lesions in the genital tract [ 4 , 5 ]. Despite its identification over a century ago, awareness, diagnosis, and management of FGS remain limited, particularly in endemic regions [ 6 – 10 ]. Although schistosomiasis is better understood today, limited awareness among communities and healthcare professionals continues to hinder efforts to address FGS [ 11 – 14 ]. Global prevalence estimates suggest between 20 to 120 million FGS cases [ 5 ], with endemic regions in SSA reporting prevalence as high as 75% among urogenital schistosomiasis cases to [ 4 , 15 – 20 ]. Symptoms often mimic sexually transmitted infections (STIs), including vaginal itching, discharge, and lower abdominal pain, leading to frequent misdiagnosis and mistreatment [ 16 – 18 , 20 , 21 ]. The risk of infection is perpetuated by exposure to Schistosoma-infested water used for domestic, agricultural, and recreational purposes [ 22 – 27 ]. FGS lies at the intersection of neglected tropical diseases (NTDs) and women’s health, disproportionately affecting marginalized [ 5 , 6 , 28 , 29 ]. Limited diagnostic skills, poor health infrastructure, and the lack of targeted public health strategies worsen outcome for affected women [ 11 – 14 , 30 , 31 ]. Existing research in countries like Nigeria, Tanzania, Liberia, Ghana, Democratic Republic of Congo, and Cote d’Ivoire has documented significant gaps in healthcare worker (HCW) knowledge and capacity to diagnose and manage FGS [ 11 , 12 , 14 , 30 – 38 ]. Ghana, a country among the top five schistosomiasis-endemic nations in SSA, have reported a focal FGS prevalence estimate of 11% around the Volta basin and 75% around the Weija dam [ 1 , 16 , 39 , 40 ], addressing this gap is especially urgent. This study aims to assess the knowledge, attitudes, and practices (KAP) of healthcare workers regarding FGS in two endemic districts: Lower Manya-Krobo Municipal and Shai Osudoku District. The outcome of this research will help identify key gaps and guide the development of targeted interventions to improve the capacity of HCWs to address FGS effectively. Materials and Methods Study design This was a cross-sectional baseline study based on a sequential mixed-method approach in two schistosomiasis-endemic districts in Ghana [ 41 ]. Study sites This study was conducted in the Lower Manya-Krobo Municipal (LMK) and the Shai Osudoku District (SOD) from June and August 2023. LMK occupies a land area of 1,476 square km in the Eastern Region [ 27 ], while SOD covers a land size of 968.361 square km in the Greater Accra Region of Ghana [ 42 , 43 ]. The districts have communities spread along the Volta Lake, explaining their endemicity to schistosomiasis [ 27 , 43 ]. About 22 km stretch of the Volta Lake washes the Northeastern portion of SOD [ 43 ]. The inhabitants in both study sites are predominantly farmers, fisher folks and traders [ 27 , 43 ]. Between 2022 and 2024, LMK reported 148, 47 and 442 and in SOD, 18, 13, and 53 schistosomiasis cases for both sexes on the District Health Information and Management System 2 (DHIMS 2) respectively. Although LMK reported 91, 24 and 279 schistosomiases in females, SOD report only a case in 2023 but there were no records on FGS for both districts on DHIMS 2 [ 44 , 45 ], In each district, fourteen health facilities of different levels were included for a wide scope and understanding of FGS management across settings. They include 2 hospitals, 3 health centers, 3 private clinics and maternity homes, and 6 Community-based Health Planning and Services (CHPS) compounds. All these facilities provide basic to complex Sexual and Reproductive Health Services (SRHS) depending on the level of care (primary or secondary). Study population This comprise of doctors, physician assistants, general nurses, midwives, community health nurses, disease control officers and public health nurses who were involved in the diagnosis, management, educating or counseling patients in healthcare facilities were considered eligible for the survey. For the qualitative study, key players within the health system recruited for the Key Informant Interview (KII). Sample size Using Taro Yamane’s Formula [ 46 ] to estimate the sample size. $$\:n=N/(1+N(e\left)\right)2$$ N is the total population; n is the required sample; and e is the margin of error. As SOD has HCW population size three times than LMK, the later was used as the based population to estimate for the sample for equal representation. The population size being 179 HCWs in LMK, we assumed a 5% margin of error. Assuming a 50% baseline knowledge prevalence in both study districts, a total of 126 HCWs were required in each district for the study. Data collection A convenient sampling of all consenting HCWs in the clinical and preventive settings involved in the diagnosis, management, and education of patients in their line of their duty were included in the study. For the qualitative study, 38 key players within the health system including regional and district NTD focal persons, heads of facilities, doctors, disease control officers, midwives, community health nurses, general nurses, and public health nurses were purposively recruited only for the KII. A structured questionnaire was developed based on literature and went through a face and content validation, collected data via the Kobo Collect humanitarian platform [ 11 , 12 , 14 , 47 ]. Five HCWs in each district were randomly chosen to participate in a pre-test of the questionnaire before the survey was finally administered. This helped resolved problems with ambiguous phrases, and interpretation that enhanced the internal validity and reliability and the time length for the survey and KII. The questionnaire gathered data on background characteristics (age, sex, educational level, cadre, years of practice, and work settings), knowledge of FGS (causes, symptoms, mode of transmission, treatment, prevention and complications), attitudes and practices towards FGS diagnosis and management. Data management and analysis Questions on knowledge were scored as 1 = correct and 0 = wrong. Attitudes and practices were measured on the 5-point Likert scale, 1 = Strongly disagree to 5 = Strongly agreed and 1 = Never to 5-Always respectively. Outcome variables were knowledge, attitudes, and practices which were measured as a continuous variable i.e. percentage score. A sum score was generated by adding responses and multiplying the resultant value by 100 to get a percentage score for easy interpretation of the result. A mean percentage score was then generated for knowledge, attitudes, and practice for every district. The mean score was further used to categorize a score below the mean as “Poor” (0) and above the mean as “Good” (1) [ 48 ]. The voice recordings from the KII were transcribed verbatim by trained research assistants and imported into NVivo version 12 (Lumivero, Burlington, USA) for coding [ 49 ]. The field notes and codes were put together for thematic analysis. Reliability and consistency test was done on the constructs for knowledge, attitudes and practices. The overall Cronbach’ Alpha score of 0.80 was realized and accepted as the reliability cut-off criteria for this study [ 50 , 51 ]. An exploratory factor analysis (EFA) was done to assess the correlation and factor loading where an eigenvalue of 5.76 and a variance of 0.89 resulted from the EFA [ 52 , 53 ]. Using Stata 18 (Stata Corp, TX, USA) for quantitative analysis, descriptive statistics was computed, and the results were presented as frequencies, percentages and compare categorical variables (age, gender, educational level, cadre, years of practice, and work settings) by districts [ 54 ]. Chi-square and t-test test statistic was used to assess the mean differences in proportions between the variables and a p-value of less than 0.05 was deemed statistically significant. A Linear multivariable regression model was fitted to assess the relationship between key independent variables: cadre, years of practice, heard of FGS and educational level and the dependent variables; Knowledge, Attitudes, and Practices (KAP). Only variables that were statistically significant (p < 0.05) in the bivariable analysis were included in the final model. A joint display analysis was used to integrate the quantitative and qualitative results together to reveal the convergence [ 55 – 57 ]. Results Description of participants background characteristics The study involved 252 healthcare workers, with demographic characteristics significantly different between districts. In LMK, the majority (56.4%) were aged 21–30 years, while SOD had more participants aged 31–40 years (46.8%). Most respondents were females (86.9%), and (77.4%) had heard of FGS before the study (Table 1 ). Table 1 Characteristics of study population (n = 252) Variables Lower Manya-Krobo Municipal Shai Osudoku District Total respondents P-value Freq % Freq % Freq % Mean age (Sd) 31.41 (± 6.50) 36.16 (± 6.0) 33.78 (± 6.68) Age group 0.00* 21–30 years 71 56.4 29 23.0 100 39.7 31–40 years 48 38.1 59 46.8 107 42.5 Above 40 years 7 5.6 38 30.2 45 17.9 Educational level Certificate 71 56.4 53 42.1 124 49.2 0.00* Diploma 50 39.7 46 36.5 96 38.1 Degree 5 3.9 27 21.4 32 12.7 Sex Male 14 11.1 19 15.1 33 13.1 0.35 Female 112 88.9 107 84.9 219 86.9 Mean Years of Practice 5.46 (± 5.95) 8.73 (± 4.51) 7.0 (± 5.51) 5 years & below 85 67.5 32 25.4 117 46.4 0.00* Above 5 years 41 32.5 94 74.6 135 53.6 Work settings Clinical 70 55.6 75 59.5 145 57.5 0.52 Preventive 56 44.4 51 40.5 107 42.5 Cadre of staff Med. Officer/Physician Assistant 2 1.6 2 1.6 4 1.6 0.00* General nurses 35 27.8 70 55.6 105 41.6 Community health nurses 44 34.9 22 17.5 66 26.2 Midwife 25 19.8 23 18.2 48 19.1 Other 20 15.9 9 7.1 29 11.5 Ever heard of FGS Yes 86 68.3 109 86.5 195 77.4 0.00* No 40 31.7 17 13.5 57 22.6 Participants sources of FGS information Regarding participants’ sources of FGS information, multiple sources indicated by participants in both study districts. Most participants in both districts cited their training institutions as the primary source. Specifically, (67.5%) in LMK and (90%) in SOD learned about FGS during formal training. In-service training or workshops were mentioned by (7.9%) in LMK and (48.5%) in SOD. Few participants reported exposure to FGS information through poster or flyer (12.7%) in LMK and SOD combined. There were differences in the sources of information between the districts as presented in Fig. 1 . Knowledge, attitudes, and practices Knowledge scores were significantly lower in LMK mean: 41.1 (95%CI: 38.4–44.4) compared to SOD mean: 55.9 (95%CI: 54.2–57.6). Attitudes and practices scores were similarly low across both districts. Qualitative data confirmed limited knowledge, reluctance to manage FGS, and inadequate diagnostic and treatment resources influencing attitude and practices (Tables 2 and 3 ). Only 4.8% of LMK and 9.5% of SOD participants knew their facility could diagnose FGS. Praziquantel availability was reported by 13.5% in LMK and 3.2% in SOD. No facility had WHO FGS Pocket Atlas to guide diagnosis, reporting forms, or educational materials [ 24 ]. The regression analysis provided additional insights into knowledge, attitudes and practices scores on participants’ background characteristics (Tables 4 and 5 ). In LMK, higher knowledge scores were significantly associated with being aged 41–50 years (AOR 18.1; 95%CI: 2.97–33.22; p = 0.01), having more than five years of practice (AOR 8.96; 95%CI: 0.46–17.46; p = 0.03), and being a medical officer/physician assistant (AOR 32.15; 95%CI: 12.76–61.52; p = 0.03). Positive attitudes were linked to being a medical officer/physician assistant, female, and having over five years of practice. For practices, being a medical officer/physician assistant and female were positive predictors, whereas holding diploma was negatively associated (Table 4 ). Table 4 Multivariable regress analysis on FGS KAP using respondents background characteristics in Lower Manya-Krobo Municipal Variable Coefficient P-value 95%CI Knowledge Age group (41–50 ears) 18.1 0.01* (2.97, 33.22) Years of practice (Above 5 years) 8.96 0.03* (0.46, 17.46) (Medical officer/physician assistant) 32.15 0.03* (12.78, 61.52) Attitudes Cadre (Medical officer/physician assistant) 13.17 0.02* (1.88, 24.45) Sex (Female) 5.74 0.01* (1.11, 10.37) Years of practice (Above 5 years) 4.27 0.00* (1.35, 7.15) Practices Cadre: (Medical officer/physician assistant) 30.85 0.03* (2.54, 59.16) Education level (Diploma) -7.14 0.04* (-13.94, -0.33) Sex (Female) 10.26 0.02* (1.26, 19.26) p-value < 0.05* In SOD, higher knowledge scores were associated with being a midwife (AOR 13.74; 95%CI: 7.83–19.62; p < 0.00), general nurse (AOR 10.56; 95%CI: 5.41–15.89; p < 0.00), or medical officer/physician assistant (AOR 29.55; 95%CI: 16.64–42.25; p < 0.00). Having heard of FGS previously was also a positive predictor of knowledge. Diploma holders consistently showed lower knowledge, attitudes, and practices scores. Work in clinical settings and being female were associated with lower practices scores (Table 5 ). Table 5 Multivariable regress analysis on FGS KAP using respondents background characteristics in Shai Osudoku District Variable Coefficient P-value 95%CI Knowledge Cadre (Midwife) 13.73 0.00* (7.83, 19.62) Cadre (General nurses) 10.65 0.00* (5.41, 15.89) Cadre (Medical officer/physician assistant) 29.55 0.00* (16.64, 42.25) Educational level (Diploma) -7.82 0.00* (-11.38, -4.27) Heard of FGS (Yes) 4.67 0.03* (0.34, 9.01) Attitudes Cadre (Medical officer/physician assistant) 9.97 0.03* (0.21, 19.42) Educational level (Diploma) -4.12 0.00* (-6.67, -1.75) Work setting (clinical) -2.72 0.01* (-4.82, -0.61) Sex (Female) -3.77 0.01* (-6.76, -0.78) Practices Sex (Female) -5.99 0.01* (-10, 75, -1.23) Work setting (Clinical) -5.45 0.00* (-8.81, -2.04) Cadre (General nurses) 6.08 0.04* (0.13, 12.04) Cadre (Midwife) 10.14 0.00* (3.42, 16.86) Educational level (Diploma) -12.11 0.00* (-16.05, -8.18) p-value < 0.05* Ways to improve FGS awareness and management. The qualitative findings highlighted key suggestions for improving FGS awareness and management. Participants proposed quarterly or regular in-service training to update knowledge and skills. They emphasized the need for diagnostic tools, registers, and medicines at health facilities to support FGS management. Participants also suggested greater community sensitization using local media, posters, and community information centers, with messages delivered in local languages. They recommended that public health authorities integrate FGS education into routine health promotion activities and ensure continuous monitoring and supervision by district teams (Table 6 ). Table 6 Suggestions to improve FGS case detection, diagnosis, and management in LMK and SOD Study area Suggestions targeting HCWs Suggestions targeting community members Lower Manya-Krobo “And then maybe….um, say quarterly training because sometimes we do get new staff, so quarterly training across the district. So, when they get the training, they can also educate and the people. (F37_Midwife_P14_CHPS_LMK) “We will go into the community, go to the information centers, and give education on FGS and I think that one too can help to improve upon it. community sensitization. (F28_G. Nurse_P4 _HC_LMK) “If we want to improve on the FGS intervention then I think resources, diagnostic tools and registers must be available, then more awareness creation. Training of personnel; I don’t think there has been direct training for personnel that I know of. That is if we want to improve on its intervention and management. Resources should be made available and training …. (F32_Midwife_P10_CHPS_LMK).). “Intensive education, and maybe the media will make announcements about FGS so that the people will know about it. Like how announcement was made for COVID-19 and what causes it. So, when they do education on television and radios with pictures to show how it is and its existence. That one too can help. (F41_Midwife_P15_CHPS_LMK) “I think more education, being it the local and the media, posters and if we can have audio presentations in the community centers that will be aired in the local languages so that they can understand what it is so that if anyone has the condition, they will know that what they have heard at the information center is what’s happening to the person and they will seek medical attention. (F22_Midwife_P1_CHPS_LMK). Shai Osudoku “So, if we are given the tools, training and everything, then, the DHMT level should also intensify monitoring of the program. (F34_Midwife_P6_HC_SOD) “Through creating more awareness, by giving health education, visiting schools, and educating health workers more about it. We all don’t have much education about the disease. (F39_Midwif_P11_ CHPS_SOD) Yes, if we get the resources, the medication, test kits, and training, we the nurses at the CHPS compound will be able to diagnose and manage FGS cases better and then, report on it. (F43_Nurs_P11_CHPS_SOD) “I would like public health to educate all women not necessarily pregnant women so that when they see any signs of schistosomiasis they will report early. Also, when they sensitize the community, I don’t see the reason why they will see it as spiritual and go for management at other places. (F35_GNurse_P7_District Hospital_SOD) “The DHMT should be able to train one person on the female schistosomiasis to go around to educate other nurses on the ground….and then tell us how err we will be able to. identify is a case….and then maybe without even a lab, you can identify a case, so these are the medicines you are supposed to give. And then the logistics should also come. (M34_Nurse_ P10_CHPS_SOD). “I think education should be continuous. We hardly hear of female schistosomiasis but males often. So, we need more education on it as health workers. Then, we can create more awareness, by giving health education, visiting schools, and the community more about it. We don’t have much education about the disease. (F48_Midwife_P13_CHPS_SOD). Key: Community-based Health Planning and Services - (CHPS), Female (F), Years of practice (P), General Nurse (GNurse), District Disease Control Officer (DDCO) Discussion This study highlighted substantial gaps in HCWs knowledge, attitudes and practices (KAP) regarding FGS in two endemic districts, providing valuable insights into addressing these gaps. Misconceptions about FGS causes and transmission, limited diagnostic capacity, and insufficient resources were key barriers to effective management. These issues were especially pronounced in Lower Manya-Krobo Municipality. Many HCWs attributed FGS to incorrect causes such as bacteria, poor hygiene, drinking contaminated water or sexual contact. These gaps mirror findings from studies in Tanzania, Democratic Republic of Congo, Nigeria and Ghana, where similar knowledge deficiencies led to misclassification as sexually transmitted infection (STIs) [ 12 , 36 , 37 ]. Healthcare workers in both districts were reluctant to manage FGS cases, reflecting suboptimal attitudes influence by the limited knowledge, limited diagnosis capacity and lack of resources. HCWs in both districts exhibited lower prioritization of FGS diagnosis and management aligning with a study in Mozambique, Uganda and Nigeria, which highlight the impact of the lack of established policies, procedures, and standardized screening tools [ 30 , 58 – 60 ]. Regression analysis highlighted that professional cadre, years of practice and prior exposure to FGS information were key predictors of stronger KAP scores. Conversely, diploma-level education, fewer years of practice, and work in clinical settings were linked to poorer KAP outcomes. This underscores the need for continuous professional development (CPD) tailored capacity building programs targeting these groups, aligns with global strategies advocated by WHO, COUNTDOWN NTD and the FAST package [ 61 , 62 ]. Training institutions and in-service trainings were the major sources of FGS information cited by HCWs especially in SOD. The disparity in knowledge between districts may be due to difference in access to training opportunities, with HCWs in SOD possibly benefiting from in-service training or workshops that were not widely available in LMK [ 14 ]. Notably, the findings revealed the mass media (television and radio), social media (Facebook, WhatsApp, Twitter) and posters/flyers are underutilized for awareness creation and education when it comes to FGS. Qualitative insights expanded these findings by identifying actionable strategies to address the identified FGS KAP gaps. HCWs advocated for quarterly or regular training to update knowledge, practical skills, and confidence in managing FGS. They emphasized the importance of providing diagnostic tools, SOPs, medicines like praziquantel, and registers for proper documentation. Community awareness was seen as essential, with suggestions for mass media campaigns, local language materials, and community education through Community Information Centers (CIC) and schools. These approaches are less commonly discussed in literature but critical for rural and low-literacy populations. Additionally, integration of FGS education into broader sexual and reproductive health promotion and consistent monitoring by district health management teams were also stressed. Although Ghana has implemented mass drug administration (MDA) campaigns for over three decades, their impact is limited by lack of dedicated funding for the NTDs program [ 63 , 64 ]. Also, absence of FGS-specific interventions, and weak integration of NTD program with sexual and reproductive health services remain an area to be explored by Ghana Health Service [ 23 , 63 ]. Collaborative efforts, including corporate social responsibility initiatives like those by the Volta River Authority, offer models for scaling community-based prevention and treatment [ 65 ]. The experiences of countries such as Liberia, Nigeria, and Madagascar, where FGS management has been integrated into Sexual and Reproductive Health (SRH) services, demonstrate the feasibility and benefits of such approaches [ 32 , 58 , 62 , 66 , 67 ]. Ghana could adopt similar models to bridge service gaps [ 4 , 29 , 47 , 59 , 60 , 68 ]. The joint display analysis (JDA) underscored convergence between quantitative and qualitative findings [ 55 – 57 ], illustrating how systemic resource constraints and HCW knowledge gaps intersect to impede FGS case detection, management and reporting [ 31 , 68 , 69 ]. Addressing these issues through a comprehensive strategy encompassing capacity building, health system strengthening, and community engagement is vital for advancing FGS control and elimination efforts in Ghana and similar settings. This also aligns with global and national recommendation from WHO, USAID, the FAST package [ 4 , 59 , 62 ]. Strength and limitation A major strength of this study lies in its use of a mixed-method approach, combining quantitative surveys and qualitative interviews to provide a comprehensive understanding of HCWs KAP regarding FGS. The inclusion of diverse cadres across two endemic districts enhances the generalizability of the findings within the Ghanaian context. Additionally, the joint display analysis (JDA) facilitated a nuanced interpretation by triangulating qualitative and quantitative results. However, the study has limitation. It was limited to only two districts, which may not capture the full spectrum of regional variations in Ghana. Additionally, self-reported data may be influenced by social desirability bias. The cross-sectional nature of the study also limits the ability to infer causality between predictors and KAP scores. Finally, while qualitative interviews added depths, logistical constraints limited the number of participants who could be engaged in the study. Implications for policy and practice The findings underscore the urgent need for targeted interventions to address knowledge, attitudes, and practice gaps among HCWs. Policymakers should prioritize integration of FGS education into pre-services curricula and continuing professional development programs. Ensuring consistent supply of praziquantel, diagnostic tools, and FGS-specific job aids is essential for improving clinical practice. additionally, structured community education campaigns using local languages and culturally sensitive materials should be implemented to improve public awareness and reduce stigma. The Ghana Health Service and district health directorates should adopt a coordinated approach that includes regular supervision, training, and monitoring of FGS-related service delivery. Partnerships with non-governmental organization and private sector stakeholders could also support the development and dissemination of information, education, and communication (IE&C) materials and improve access to treatment services. Conclusion and recommendation This study reveals substantial gaps in healthcare workers’ KAP to manage FGS in two endemic districts in Ghana. The low knowledge, poor attitudes, and limited practices observed call for urgent attention from policymakers and health system actors. To address these challenges, the study recommends: (1) Integrating FGS modules into health training curricula.; (2) Conducting regular in-service training for frontline HCWs and integration into SRH services.; (3) Ensuring the availability of diagnostic tools, treatment protocols (WHO FGS pocket Atlas), and praziquantel in health facilities.; (4) Enhancing community education through culturally appropriate messaging,; and (5) Strengthening district-level support and supervision. Abbreviations CHPS Community-based Health Planning and Services CDP Continuous Development Program FGD Focused Group Discussion FGS Female Genital Schistosomiasis HCW Healthcare workers IE&C Information Education & Communication JDA Joint Display Analysis KAP Knowledge Attitudes Practices KII Key Informant Interview LMK Lower Manya-Krobo Municipality MDA Mass Drug Administration NTD Neglected Tropical Diseases OPD Outpatient department PHC Primary Healthcare Center SDG Sustainable Development Goal S. haematobium Schistosoma haematobium SOD Shai Osudoku Municipality SSA sub-Saharan Africa STI Sexually transmitted infections VRA Volta River Authority WHO World Health Organization TDR Tropical Diseases Research Program Declarations Ethical consideration Permission was granted by the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BREC/00005309/2023) and the Ethics Review Committee of the Ghana Health Service, Ghana (GHS-ERC:008/02/23). Additionally, permission was granted by the Eastern regional and Greater Accra regional Health Directorates, the Lower Manya-Krobo and the Shai Osudoku District Health Directorates and the head of health facilities involved. Study participants consent was also sought, and an information sheet was also shared with participants. Participants received no compensation for participating in the study. Consent for publication Not applicable Funding The authors declared no specific funding or grant for this study. However, this research was made possible through a HEARD PhD scholarship at the University of KwaZulu-Natal (UKZN), funded by the Swedish International Development Agency (SIDA). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of HEARD, UKZN, and SIDA. Availability of supporting data The data will be made available on request to the corresponding author. Authors contribution CDT, AKM, JRN, and TGG conceptualized the study. Methodology, data collection, data curation and analysis, original draft, writing (review and editing) was done by CDT and AKM. Supervision, review and editing was done by AKM, JRN, and TGG. The final draft was done by CDT, review and approval done and accepted by all authors. Acknowledgement This research was made possible through a HEARD PhD scholarship at the University of KwaZulu-Natal (UKZN), funded by the Swedish International Development Agency (SIDA). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of HEARD, UKZN, and SIDA. The authors are grateful to the Ghana Health Service, National NTD Control Program, Greater Accra and Eastern Regional Health Directorates, and Shai Osudoku and Lower Manya-Krobo Municipal Health Directorates for the support and commitment to the study. Competing interest The authors declared no competing interest that may have inappropriately influenced the results and the writing of this article. References Hotez, P.J. and A. Kamath, Neglected tropical diseases in sub-Saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Neglected Tropical Diseases, 2009. 3 (8): p. e412. WHO. Schistosomiasis Fact sheet . 2022 [cited 2022 18/05/2022]; Available from: https://www.who.int/news-room/fact-sheets/detail/schistosomiasis. Butrous, G., Schistosome infection and its effect on pulmonary circulation. Global cardiology science & practice, 2019. 2019 (1): p. 5-5. USAID, No more neglect, Female genital schistosomiasis and HIV: Integrating sexual and reproductive health interventions to improve women’s lives . 2019, USAID: Geneva, Switzerland. p. 1-44. Gyapong, M. and S. Theobald, The sexual and reproductive health issue you’ve probably never heard of… , in Open Democracy . 2015, OpenDemocracy: London, United Kingdom. p. 50. Christinet, V., et al., Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease. International Journal for Parasitology, 2016. 46 (7): p. 395-404. Poggensee, G., et al., Diagnosis of female genital schistosomiasis by indirect disease markers: determination of eosinophil cationic protein, neopterin and IgA in vaginal fluid and swab eluates. Acta Trop, 1996. 62 (4): p. 269-80. Gelfand, M., et al., Distribution and extent of schistosomiasis in female pelvic organs, with special reference to the genital tract, as determined at autopsy. American Journal of Tropical Medicine and Hygiene, 1971. 20 (6, Pt 1): p. 846-9. Charlewood, G., S. Shippel, and H. Renton, Schistosomiasis in gynaecology. Journal of Obstetrics and Gynaecology of the British Empire, 1949. 56 (3): p. 367-85. Madden, F., A case of bilharzia of the vagina. The Lancet, 1899. 153 (3956): p. 1716. Mazigo, H.D., 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): p. 1-19. Mazigo, H.D., 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 : p. 1604767. Mazigo, H.J., 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 Neglected Tropical Diseases, 2021. 15 (9): p. 1-25. Kukula, V.A., et al., A major hurdle in the elimination of urogenital schistosomiasis revealed: Identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers. PLoS Negl Trop Dis, 2019. 13 (3): p. e0007207. Kjetland, E.F., et al., Female genital schistosomiasis due to Schistosoma haematobium Clinical and parasitological findings in women in rural Malawi. Acta Tropica, 1996. 62 (4): p. 239-255. Yirenya-Tawiah, D., et al., A survey of female genital schistosomiasis of the lower reproductive tract in the volta basin of Ghana. Ghana Medical Journal, 2011. 45 (1): p. 16-21. Leutscher, P., et al., Clinical findings in female genital schistosomiasis in Madagascar. Trop Med Int Health, 1998. 3 (4): p. 327-32. Poggensee, G., et al., Female genital schistosomiasis of the lower genital tract: prevalence and disease-associated morbidity in northern Tanzania. The Journal of Infectious Diseases, 2000. 181 (3): p. 1210-1213. Hegertun, I.E., et al., S. haematobium as a common cause of genital morbidity in girls: a cross-sectional study of children in South Africa. PLoS Negl Trop Dis, 2013. 7 (3): p. e2104. Ekpo, U., et al., Female genital schistosomiasis (FGS) in Ogun State, Nigeria: a pilot survey on genital symptoms and clinical findings. Parasitology Open, 2017. 3 : p. e10. Kjetland, E.F., et al., Female genital schistosomiasis--a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital Schistosoma haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe. Trop Med Int Health, 2008. 13 (12): p. 1509-17. Kjetland, E.F., P.D. Leutscher, and P.D. Ndhlovu, A review of female genital schistosomiasis. Trends Parasitol, 2012. 28 (2): p. 58-65. Boateng, E.M., et al., A literature review of schistosomiasis in Ghana: a reference for bridging the research and control gap. Transactions of The Royal Society of Tropical Medicine and Hygiene, 2023. 117 (6): p. 407-417. WHO, FEMALE GENITAL SCHISTOSOMIASIS: A pocket atlas for clinical health-care professional . 2015, Geneva, Switzerland: World Health Organization. 49. Norseth, H.M., et al., The colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa. PLoS Negl Trop Dis, 2014. 8 (11): p. e3229. Volta River Authority, Public Health Division Volta River Authority: Summary of prevalence of Bilhazia for all districts (VRA Data) . 2020, Volta River Authority: Accra, Ghana. p. 2pg. Ghana Statistical Service, 2010 Population and housing census: District Report Lower Manya Krobo Municipality . 2014, Ghana Statistical Service: Accra, Ghana. p. 1-97 pg. Vos, T., et al., Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet, 2015. 386 (9995): p. 743-800. Engels, D., et al., Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer. Bull World Health Organ, 2020. 98 (9): p. 615-624. Mbwanji, G., et al., Female genital schistosomiasis is a neglected public health problem in Tanzania: Evidence from a scoping review. PLoS Negl Trop Dis, 2024. 18 (3): p. e0011954. Ursini, T., et al., Assessing the prevalence of Female Genital Schistosomiasis and comparing the acceptability and performance of health worker-collected and self-collected cervical-vaginal swabs using PCR testing among women in North-Western Tanzania: The ShWAB study. PLoS Negl Trop Dis, 2023. 17 (7): p. e0011465. Nganda, M., et al., Incorporating the diagnosis and management of female genital schistosomiasis in primary healthcare in Liberia: a mixed methods pilot study. Int Health, 2023. 15 (Suppl 1): p. i43-i51. Oluwole, A.S., et al., A quality improvement approach in co-developing a primary healthcare package for raising awareness and managing female genital schistosomiasis in Nigeria and Liberia. International Health, 2023. 15 (Supplement_1): p. i30-i42. Aribodor, O.B., et al., Profiling the knowledge of female medical/para-medical students, and expertise of health care professionals on female genital schistosomiasis in Anambra, South Eastern Nigeria. PLOS Neglected Tropical Diseases, 2023. 17 (2): p. e0011132. Piotrowski, H., et al., Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria. Int Health, 2023. 15 (Suppl 1): p. i18-i29. Azanu, W.K., et al., Knowledge of female genital schistosomiasis and urinary schistosomiasis among final-year midwifery students in the Volta Region of Ghana. PLoS One, 2024. 19 (5): p. e0302554. Wambui, C.W., et al., Knowledge, attitudes and practices toward female genital schistosomiasis among community women and healthcare professionals in Kimpese region, Democratic Republic of Congo. PLOS Neglected Tropical Diseases, 2024. 18 (7): p. e0011530. Emeto, D.C., et al., Recognition and reporting of neglected tropical diseases by primary health care workers in Ibadan, Nigeria. Pan Afr Med J, 2021. 38 : p. 224. Hotez, P.J., et al., Female genital schistosomiasis. N Engl J Med, 2019. 381 (26): p. 2493-5. Kaur, N., et al., Female Genital Schistosomiasis (FGS) Prevalence and Burden Across Endemic Countries, Timelines, and Age Groups: A Retrospective Study. Parasitologia, 2024. 4 (4): p. 382-389. Creswell, J.W. and J.D. Creswell, Research design: Qualitative, quantitative, and mixed methods approaches . 2017: Sage Publications. Ghana Statistical Service, 2010 Population and housing census: district analytical report Ada East District . 2014, Ghana Statistical Services: Accra, Ghana. p. 1-88pg. Shai-Osudoku District Assembly. The Shai-Osudoku District Assembly Profile . 2022 [cited 2022 06/06/2022]; Available from: https://www.soda.gov.gh/about. GHS, Schistosomiasis Reported Cases . 2024, MoH/Ghana Health Service: Ghana. MoH/GHS. DHIMS 2 platform . 2022 [cited 2022 08/06/2022]; Database for storing aggregated health data]. Available from: https://chimgh.org/dhims/dhis-web-commons/security/login.action. Yamane, T., Statistics: An Introductory Analysis . 2nd Edition ed. J. Mathemetics. Vol. 1. 1967, New York: Harper and Row. 1-29. Jacobson, J., 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. 19 (20): p. 1-15. Tolossa, D., G. Medhin, and M. Legesse, Community knowledge, attitude, and practices towards tuberculosis in Shinile town, Somali regional state, eastern Ethiopia: a cross-sectional study. BMC public health, 2014. 14 : p. 1-13. Lumivero. NVivo (version 12) . 2017 [cited 2022 18/05/2022]; 12:[Available from: https://lumivero.com/resources/whats-new-in-nvivo-12/. Cho, E. and S. Kim, Cronbach’s coefficient alpha: Well known but poorly understood. Organizational research methods, 2015. 18 (2): p. 207-230. Cronbach, L.J., Coefficient alpha and the internal structure of tests. psychometrika, 1951. 16 (3): p. 297-334. Cudeck, R., Exploratory factor analysis , in Handbook of applied multivariate statistics and mathematical modeling . 2000, Elsevier. p. 265-296. Fabrigar, L.R. and D.T. Wegener, Exploratory factor analysis . 2012: Oxford University Press. StataCorp. Stata Statistical Software: Release 17 . 2021; Available from: https://www.stata.com/support/faqs/resources/citing-software-documentation-faqs/. Guetterman, T.C., M.D. Fetters, and J.W. Creswell, Integrating Quantitative and Qualitative Results in Health Science Mixed Methods Research Through Joint Displays. Ann Fam Med, 2015. 13 (6): p. 554-61. Haynes-Brown, T.K. and M.D. Fetters, Using Joint Display as an Analytic Process: An Illustration Using Bar Graphs Joint Displays From a Mixed Methods Study of How Beliefs Shape Secondary School Teachers’ Use of Technology. International Journal of Qualitative Methods, 2021. 20 : p. 1609406921993286. McCrudden, M.T., G. Marchand, and P.A. Schutz, Joint displays for mixed methods research in psychology. Methods in Psychology, 2021. 5 : p. 100067. Piotrowski, H., et al., Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria. Int Health, 2023. 15 (Suppl 1): p. i18-i29. Umbelino-Walker, I., et al., Integration of female genital schistosomiasis into HIV/sexual and reproductive health and rights and neglected tropical diseases programmes and services: a scoping review. SRHM, 2023. 31 (1): p. 1-17. Oluwole, A.S., et al., A quality improvement approach in co-developing a primary healthcare package for raising awareness and managing female genital schistosomiasis in Nigeria and Liberia. Int Health, 2023. 15 (Suppl 1): p. i30-i42. Dalaba, M., et al., PA-206 Breaking the silence of female genital schistosomiasis in Ghana’s health system: a case of health workers within the FAST project . 2023, BMJ Specialist Journals. SCI Foundation. FGS Accelerated Scale together (FAST) package project . 2022 [cited 2022 04/07/2022]; Available from: https://schistosomiasiscontrolinitiative.org/projects/fast-research-project. Ghana Health Service, Neglected Tropical Disease Program, and Public Health Division GHS, Master Plan for Neglected Tropical Diseases Programme, Ghana (2021 - 2025) . 2021, Ghana Health Service: Accra, Ghana. p. 1-103. Grimes, J.E., et al., The roles of water, sanitation and hygiene in reducing schistosomiasis: a review. Parasit Vectors, 2015. 8 : p. 156. Volta River Authority. Corporate Social Responsibility . 2024 2024 [cited 2024 22-02-2024]; Available from: https://www.vra.com/csr/index.php. Pillay, L.N., et al., Minimum Service Package for the integration of female genital schistosomiasis into sexual and reproductive health and rights interventions. Frontiers in Tropical Diseases, 2024. 5 . Bustinduy, A.L., et al., An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. Adv Parasitol, 2022. 115 : p. 1-44. Lamberti, O., et al., Time to bring female genital schistosomiasis out of neglect. Br Med Bull, 2024. 149 (1): p. 45-59. Gyapong, M., et al., Breaking the silence of female genital schistosomiasis in Ghana’s health system: A case of health workers within the FAST project. PLOS Neglected Tropical Diseases, 2024. 18 (9): p. e0012443. Table 2 and 3 Table 2 and 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table2and3.docx Cite Share Download PDF Status: Published Journal Publication published 24 Dec, 2025 Read the published version in Tropical Diseases, Travel Medicine and Vaccines → Version 1 posted Editorial decision: Revision requested 21 Aug, 2025 Reviews received at journal 30 Jul, 2025 Reviews received at journal 23 Jul, 2025 Reviewers agreed at journal 19 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviewers agreed at journal 08 Jul, 2025 Reviewers invited by journal 08 Jul, 2025 Editor assigned by journal 04 Jul, 2025 Submission checks completed at journal 04 Jul, 2025 First submitted to journal 26 Jun, 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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Affecting an estimated 56\u0026nbsp;million women and girls worldwide, FGS arises from untreated urogenital schistosomiasis, causing chronic inflammation and lesions in the genital tract [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Despite its identification over a century ago, awareness, diagnosis, and management of FGS remain limited, particularly in endemic regions [\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although schistosomiasis is better understood today, limited awareness among communities and healthcare professionals continues to hinder efforts to address FGS [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobal prevalence estimates suggest between 20 to 120\u0026nbsp;million FGS cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], with endemic regions in SSA reporting prevalence as high as 75% among urogenital schistosomiasis cases to [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Symptoms often mimic sexually transmitted infections (STIs), including vaginal itching, discharge, and lower abdominal pain, leading to frequent misdiagnosis and mistreatment [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The risk of infection is perpetuated by exposure to Schistosoma-infested water used for domestic, agricultural, and recreational purposes [\u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFGS lies at the intersection of neglected tropical diseases (NTDs) and women\u0026rsquo;s health, disproportionately affecting marginalized [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Limited diagnostic skills, poor health infrastructure, and the lack of targeted public health strategies worsen outcome for affected women [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Existing research in countries like Nigeria, Tanzania, Liberia, Ghana, Democratic Republic of Congo, and Cote d\u0026rsquo;Ivoire has documented significant gaps in healthcare worker (HCW) knowledge and capacity to diagnose and manage FGS [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34 CR35 CR36 CR37\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGhana, a country among the top five schistosomiasis-endemic nations in SSA, have reported a focal FGS prevalence estimate of 11% around the Volta basin and 75% around the Weija dam [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], addressing this gap is especially urgent. This study aims to assess the knowledge, attitudes, and practices (KAP) of healthcare workers regarding FGS in two endemic districts: Lower Manya-Krobo Municipal and Shai Osudoku District. The outcome of this research will help identify key gaps and guide the development of targeted interventions to improve the capacity of HCWs to address FGS effectively.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was a cross-sectional baseline study based on a sequential mixed-method approach in two schistosomiasis-endemic districts in Ghana [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy sites\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted in the Lower Manya-Krobo Municipal (LMK) and the Shai Osudoku District (SOD) from June and August 2023. LMK occupies a land area of 1,476 square km in the Eastern Region [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], while SOD covers a land size of 968.361 square km in the Greater Accra Region of Ghana [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The districts have communities spread along the Volta Lake, explaining their endemicity to schistosomiasis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. About 22 km stretch of the Volta Lake washes the Northeastern portion of SOD [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The inhabitants in both study sites are predominantly farmers, fisher folks and traders [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Between 2022 and 2024, LMK reported 148, 47 and 442 and in SOD, 18, 13, and 53 schistosomiasis cases for both sexes on the District Health Information and Management System 2 (DHIMS 2) respectively. Although LMK reported 91, 24 and 279 schistosomiases in females, SOD report only a case in 2023 but there were no records on FGS for both districts on DHIMS 2 [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e],\u003c/p\u003e\u003cp\u003eIn each district, fourteen health facilities of different levels were included for a wide scope and understanding of FGS management across settings. They include 2 hospitals, 3 health centers, 3 private clinics and maternity homes, and 6 Community-based Health Planning and Services (CHPS) compounds. All these facilities provide basic to complex Sexual and Reproductive Health Services (SRHS) depending on the level of care (primary or secondary).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis comprise of doctors, physician assistants, general nurses, midwives, community health nurses, disease control officers and public health nurses who were involved in the diagnosis, management, educating or counseling patients in healthcare facilities were considered eligible for the survey.\u003c/p\u003e\u003cp\u003eFor the qualitative study, key players within the health system recruited for the Key Informant Interview (KII).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUsing Taro Yamane\u0026rsquo;s Formula [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] to estimate the sample size.\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=N/(1+N(e\\left)\\right)2$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eN is the total population; n is the required sample; and e is the margin of error.\u003c/p\u003e\u003cp\u003eAs SOD has HCW population size three times than LMK, the later was used as the based population to estimate for the sample for equal representation. The population size being 179 HCWs in LMK, we assumed a 5% margin of error. Assuming a 50% baseline knowledge prevalence in both study districts, a total of 126 HCWs were required in each district for the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA convenient sampling of all consenting HCWs in the clinical and preventive settings involved in the diagnosis, management, and education of patients in their line of their duty were included in the study. For the qualitative study, 38 key players within the health system including regional and district NTD focal persons, heads of facilities, doctors, disease control officers, midwives, community health nurses, general nurses, and public health nurses were purposively recruited only for the KII.\u003c/p\u003e\u003cp\u003eA structured questionnaire was developed based on literature and went through a face and content validation, collected data via the Kobo Collect humanitarian platform [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Five HCWs in each district were randomly chosen to participate in a pre-test of the questionnaire before the survey was finally administered. This helped resolved problems with ambiguous phrases, and interpretation that enhanced the internal validity and reliability and the time length for the survey and KII. The questionnaire gathered data on background characteristics (age, sex, educational level, cadre, years of practice, and work settings), knowledge of FGS (causes, symptoms, mode of transmission, treatment, prevention and complications), attitudes and practices towards FGS diagnosis and management.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData management and analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eQuestions on knowledge were scored as 1\u0026thinsp;=\u0026thinsp;correct and 0\u0026thinsp;=\u0026thinsp;wrong. Attitudes and practices were measured on the 5-point Likert scale, 1\u0026thinsp;=\u0026thinsp;Strongly disagree to 5\u0026thinsp;=\u0026thinsp;Strongly agreed and 1\u0026thinsp;=\u0026thinsp;Never to 5-Always respectively. Outcome variables were knowledge, attitudes, and practices which were measured as a continuous variable i.e. percentage score. A sum score was generated by adding responses and multiplying the resultant value by 100 to get a percentage score for easy interpretation of the result. A mean percentage score was then generated for knowledge, attitudes, and practice for every district. The mean score was further used to categorize a score below the mean as \u0026ldquo;Poor\u0026rdquo; (0) and above the mean as \u0026ldquo;Good\u0026rdquo; (1) [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe voice recordings from the KII were transcribed verbatim by trained research assistants and imported into NVivo version 12 (Lumivero, Burlington, USA) for coding [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The field notes and codes were put together for thematic analysis.\u003c/p\u003e\u003cp\u003eReliability and consistency test was done on the constructs for knowledge, attitudes and practices. The overall Cronbach\u0026rsquo; Alpha score of 0.80 was realized and accepted as the reliability cut-off criteria for this study [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. An exploratory factor analysis (EFA) was done to assess the correlation and factor loading where an eigenvalue of 5.76 and a variance of 0.89 resulted from the EFA [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUsing Stata 18 (Stata Corp, TX, USA) for quantitative analysis, descriptive statistics was computed, and the results were presented as frequencies, percentages and compare categorical variables (age, gender, educational level, cadre, years of practice, and work settings) by districts [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Chi-square and t-test test statistic was used to assess the mean differences in proportions between the variables and a p-value of less than 0.05 was deemed statistically significant. A Linear multivariable regression model was fitted to assess the relationship between key independent variables: cadre, years of practice, heard of FGS and educational level and the dependent variables; Knowledge, Attitudes, and Practices (KAP). Only variables that were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the bivariable analysis were included in the final model.\u003c/p\u003e\u003cp\u003eA joint display analysis was used to integrate the quantitative and qualitative results together to reveal the convergence [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDescription of participants background characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study involved 252 healthcare workers, with demographic characteristics significantly different between districts. In LMK, the majority (56.4%) were aged 21\u0026ndash;30 years, while SOD had more participants aged 31\u0026ndash;40 years (46.8%). Most respondents were females (86.9%), and (77.4%) had heard of FGS before the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of study population (n\u0026thinsp;=\u0026thinsp;252)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eLower Manya-Krobo Municipal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eShai Osudoku District\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eTotal respondents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFreq\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFreq\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFreq\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean age (Sd)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e31.41 (\u0026plusmn;\u0026thinsp;6.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e36.16 (\u0026plusmn;\u0026thinsp;6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e33.78 (\u0026plusmn;\u0026thinsp;6.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.00*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove 40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCertificate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e49.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.00*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDegree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e86.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean Years of Practice\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e5.46 (\u0026plusmn;\u0026thinsp;5.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8.73 (\u0026plusmn;\u0026thinsp;4.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e7.0 (\u0026plusmn;\u0026thinsp;5.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 years \u0026amp; below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e46.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.00*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbove 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e53.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWork settings\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e57.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreventive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCadre of staff\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMed. Officer/Physician Assistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e0.00*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGeneral nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity health nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMidwife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEver heard of FGS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e86.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e77.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.00*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants sources of FGS information\u003c/b\u003e\u003c/p\u003e\u003cp\u003eRegarding participants\u0026rsquo; sources of FGS information, multiple sources indicated by participants in both study districts. Most participants in both districts cited their training institutions as the primary source. Specifically, (67.5%) in LMK and (90%) in SOD learned about FGS during formal training. In-service training or workshops were mentioned by (7.9%) in LMK and (48.5%) in SOD. Few participants reported exposure to FGS information through poster or flyer (12.7%) in LMK and SOD combined. There were differences in the sources of information between the districts as presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eKnowledge, attitudes, and practices\u003c/b\u003e\u003c/p\u003e\u003cp\u003eKnowledge scores were significantly lower in LMK mean: 41.1 (95%CI: 38.4\u0026ndash;44.4) compared to SOD mean: 55.9 (95%CI: 54.2\u0026ndash;57.6). Attitudes and practices scores were similarly low across both districts. Qualitative data confirmed limited knowledge, reluctance to manage FGS, and inadequate diagnostic and treatment resources influencing attitude and practices (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOnly 4.8% of LMK and 9.5% of SOD participants knew their facility could diagnose FGS. Praziquantel availability was reported by 13.5% in LMK and 3.2% in SOD. No facility had WHO FGS Pocket Atlas to guide diagnosis, reporting forms, or educational materials [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe regression analysis provided additional insights into knowledge, attitudes and practices scores on participants\u0026rsquo; background characteristics (Tables \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e). In LMK, higher knowledge scores were significantly associated with being aged 41\u0026ndash;50 years (AOR 18.1; 95%CI: 2.97\u0026ndash;33.22; p\u0026thinsp;=\u0026thinsp;0.01), having more than five years of practice (AOR 8.96; 95%CI: 0.46\u0026ndash;17.46; p\u0026thinsp;=\u0026thinsp;0.03), and being a medical officer/physician assistant (AOR 32.15; 95%CI: 12.76\u0026ndash;61.52; p\u0026thinsp;=\u0026thinsp;0.03). Positive attitudes were linked to being a medical officer/physician assistant, female, and having over five years of practice. For practices, being a medical officer/physician assistant and female were positive predictors, whereas holding diploma was negatively associated (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariable regress analysis on FGS KAP using respondents background characteristics in Lower Manya-Krobo Municipal\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge group (41\u0026ndash;50 ears)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(2.97, 33.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of practice (Above 5 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(0.46, 17.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Medical officer/physician assistant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(12.78, 61.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (Medical officer/physician assistant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(1.88, 24.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(1.11, 10.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYears of practice (Above 5 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(1.35, 7.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre: (Medical officer/physician assistant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(2.54, 59.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level (Diploma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-13.94, -0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(1.26, 19.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003ep-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05*\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eIn SOD, higher knowledge scores were associated with being a midwife (AOR 13.74; 95%CI: 7.83\u0026ndash;19.62; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00), general nurse (AOR 10.56; 95%CI: 5.41\u0026ndash;15.89; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00), or medical officer/physician assistant (AOR 29.55; 95%CI: 16.64\u0026ndash;42.25; p\u0026thinsp;\u0026lt;\u0026thinsp;0.00). Having heard of FGS previously was also a positive predictor of knowledge. Diploma holders consistently showed lower knowledge, attitudes, and practices scores. Work in clinical settings and being female were associated with lower practices scores (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariable regress analysis on FGS KAP using respondents background characteristics in Shai Osudoku District\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCoefficient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (Midwife)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(7.83, 19.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (General nurses)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(5.41, 15.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (Medical officer/physician assistant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(16.64, 42.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level (Diploma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-7.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-11.38, -4.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeard of FGS (Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(0.34, 9.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttitudes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (Medical officer/physician assistant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(0.21, 19.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level (Diploma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-6.67, -1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWork setting (clinical)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-4.82, -0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-6.76, -0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePractices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.01*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-10, 75, -1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWork setting (Clinical)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-8.81, -2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (General nurses)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(0.13, 12.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCadre (Midwife)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(3.42, 16.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level (Diploma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-12.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.00*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(-16.05, -8.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003ep-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05*\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWays to improve FGS awareness and management.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative findings highlighted key suggestions for improving FGS awareness and management. Participants proposed quarterly or regular in-service training to update knowledge and skills. They emphasized the need for diagnostic tools, registers, and medicines at health facilities to support FGS management. Participants also suggested greater community sensitization using local media, posters, and community information centers, with messages delivered in local languages. They recommended that public health authorities integrate FGS education into routine health promotion activities and ensure continuous monitoring and supervision by district teams (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSuggestions to improve FGS case detection, diagnosis, and management in LMK and SOD\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy area\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSuggestions targeting HCWs\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSuggestions targeting community members\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eLower Manya-Krobo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;And then maybe\u0026hellip;.um, say quarterly training because sometimes we do get new staff, so quarterly training across the district. So, when they get the training, they can also educate and the people. (F37_Midwife_P14_CHPS_LMK)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;We will go into the community, go to the information centers, and give education on FGS and I think that one too can help to improve upon it. community sensitization. (F28_G. Nurse_P4 _HC_LMK)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;If we want to improve on the FGS intervention then I think resources, diagnostic tools and registers must be available, then more awareness creation. Training of personnel; I don\u0026rsquo;t think there has been direct training for personnel that I know of. That is if we want to improve on its intervention and management. Resources should be made available and training \u0026hellip;. (F32_Midwife_P10_CHPS_LMK).).\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Intensive education, and maybe the media will make announcements about FGS so that the people will know about it. Like how announcement was made for COVID-19 and what causes it. So, when they do education on television and radios with pictures to show how it is and its existence. That one too can help. (F41_Midwife_P15_CHPS_LMK)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I think more education, being it the local and the media, posters and if we can have audio presentations in the community centers that will be aired in the local languages so that they can understand what it is so that if anyone has the condition, they will know that what they have heard at the information center is what\u0026rsquo;s happening to the person and they will seek medical attention. (F22_Midwife_P1_CHPS_LMK).\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eShai Osudoku\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;So, if we are given the tools, training and everything, then, the DHMT level should also intensify monitoring of the program. (F34_Midwife_P6_HC_SOD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Through creating more awareness, by giving health education, visiting schools, and educating health workers more about it. We all don\u0026rsquo;t have much education about the disease. (F39_Midwif_P11_ CHPS_SOD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eYes, if we get the resources, the medication, test kits, and training, we the nurses at the CHPS compound will be able to diagnose and manage FGS cases better and then, report on it. (F43_Nurs_P11_CHPS_SOD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I would like public health to educate all women not necessarily pregnant women so that when they see any signs of schistosomiasis they will report early. Also, when they sensitize the community, I don\u0026rsquo;t see the reason why they will see it as spiritual and go for management at other places. (F35_GNurse_P7_District Hospital_SOD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;The DHMT should be able to train one person on the female schistosomiasis to go around to educate other nurses on the ground\u0026hellip;.and then tell us how err we will be able to. identify is a case\u0026hellip;.and then maybe without even a lab, you can identify a case, so these are the medicines you are supposed to give. And then the logistics should also come. (M34_Nurse_ P10_CHPS_SOD).\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I think education should be continuous. We hardly hear of female schistosomiasis but males often. So, we need more education on it as health workers. Then, we can create more awareness, by giving health education, visiting schools, and the community more about it. We don\u0026rsquo;t have much education about the disease. (F48_Midwife_P13_CHPS_SOD).\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eKey: Community-based Health Planning and Services - (CHPS), Female (F), Years of practice (P), General Nurse (GNurse), District Disease Control Officer (DDCO)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis study highlighted substantial gaps in HCWs knowledge, attitudes and practices (KAP) regarding FGS in two endemic districts, providing valuable insights into addressing these gaps. Misconceptions about FGS causes and transmission, limited diagnostic capacity, and insufficient resources were key barriers to effective management. These issues were especially pronounced in Lower Manya-Krobo Municipality. Many HCWs attributed FGS to incorrect causes such as bacteria, poor hygiene, drinking contaminated water or sexual contact. These gaps mirror findings from studies in Tanzania, Democratic Republic of Congo, Nigeria and Ghana, where similar knowledge deficiencies led to misclassification as sexually transmitted infection (STIs) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Healthcare workers in both districts were reluctant to manage FGS cases, reflecting suboptimal attitudes influence by the limited knowledge, limited diagnosis capacity and lack of resources. HCWs in both districts exhibited lower prioritization of FGS diagnosis and management aligning with a study in Mozambique, Uganda and Nigeria, which highlight the impact of the lack of established policies, procedures, and standardized screening tools [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e–\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegression analysis highlighted that professional cadre, years of practice and prior exposure to FGS information were key predictors of stronger KAP scores. Conversely, diploma-level education, fewer years of practice, and work in clinical settings were linked to poorer KAP outcomes. This underscores the need for continuous professional development (CPD) tailored capacity building programs targeting these groups, aligns with global strategies advocated by WHO, COUNTDOWN NTD and the FAST package [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTraining institutions and in-service trainings were the major sources of FGS information cited by HCWs especially in SOD. The disparity in knowledge between districts may be due to difference in access to training opportunities, with HCWs in SOD possibly benefiting from in-service training or workshops that were not widely available in LMK [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Notably, the findings revealed the mass media (television and radio), social media (Facebook, WhatsApp, Twitter) and posters/flyers are underutilized for awareness creation and education when it comes to FGS.\u003c/p\u003e\u003cp\u003eQualitative insights expanded these findings by identifying actionable strategies to address the identified FGS KAP gaps. HCWs advocated for quarterly or regular training to update knowledge, practical skills, and confidence in managing FGS. They emphasized the importance of providing diagnostic tools, SOPs, medicines like praziquantel, and registers for proper documentation. Community awareness was seen as essential, with suggestions for mass media campaigns, local language materials, and community education through Community Information Centers (CIC) and schools. These approaches are less commonly discussed in literature but critical for rural and low-literacy populations. Additionally, integration of FGS education into broader sexual and reproductive health promotion and consistent monitoring by district health management teams were also stressed.\u003c/p\u003e\u003cp\u003eAlthough Ghana has implemented mass drug administration (MDA) campaigns for over three decades, their impact is limited by lack of dedicated funding for the NTDs program [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Also, absence of FGS-specific interventions, and weak integration of NTD program with sexual and reproductive health services remain an area to be explored by Ghana Health Service [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Collaborative efforts, including corporate social responsibility initiatives like those by the Volta River Authority, offer models for scaling community-based prevention and treatment [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. The experiences of countries such as Liberia, Nigeria, and Madagascar, where FGS management has been integrated into Sexual and Reproductive Health (SRH) services, demonstrate the feasibility and benefits of such approaches [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. Ghana could adopt similar models to bridge service gaps [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe joint display analysis (JDA) underscored convergence between quantitative and qualitative findings [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e–\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], illustrating how systemic resource constraints and HCW knowledge gaps intersect to impede FGS case detection, management and reporting [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Addressing these issues through a comprehensive strategy encompassing capacity building, health system strengthening, and community engagement is vital for advancing FGS control and elimination efforts in Ghana and similar settings. This also aligns with global and national recommendation from WHO, USAID, the FAST package [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrength and limitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA major strength of this study lies in its use of a mixed-method approach, combining quantitative surveys and qualitative interviews to provide a comprehensive understanding of HCWs KAP regarding FGS. The inclusion of diverse cadres across two endemic districts enhances the generalizability of the findings within the Ghanaian context. Additionally, the joint display analysis (JDA) facilitated a nuanced interpretation by triangulating qualitative and quantitative results.\u003c/p\u003e\u003cp\u003eHowever, the study has limitation. It was limited to only two districts, which may not capture the full spectrum of regional variations in Ghana. Additionally, self-reported data may be influenced by social desirability bias. The cross-sectional nature of the study also limits the ability to infer causality between predictors and KAP scores. Finally, while qualitative interviews added depths, logistical constraints limited the number of participants who could be engaged in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications for policy and practice\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings underscore the urgent need for targeted interventions to address knowledge, attitudes, and practice gaps among HCWs. Policymakers should prioritize integration of FGS education into pre-services curricula and continuing professional development programs. Ensuring consistent supply of praziquantel, diagnostic tools, and FGS-specific job aids is essential for improving clinical practice.\u003c/p\u003e\u003cp\u003eadditionally, structured community education campaigns using local languages and culturally sensitive materials should be implemented to improve public awareness and reduce stigma. The Ghana Health Service and district health directorates should adopt a coordinated approach that includes regular supervision, training, and monitoring of FGS-related service delivery.\u003c/p\u003e\u003cp\u003ePartnerships with non-governmental organization and private sector stakeholders could also support the development and dissemination of information, education, and communication (IE\u0026amp;C) materials and improve access to treatment services.\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eThis study reveals substantial gaps in healthcare workers’ KAP to manage FGS in two endemic districts in Ghana. The low knowledge, poor attitudes, and limited practices observed call for urgent attention from policymakers and health system actors.\u003c/p\u003e\u003cp\u003eTo address these challenges, the study recommends: (1) Integrating FGS modules into health training curricula.; (2) Conducting regular in-service training for frontline HCWs and integration into SRH services.; (3) Ensuring the availability of diagnostic tools, treatment protocols (WHO FGS pocket Atlas), and praziquantel in health facilities.; (4) Enhancing community education through culturally appropriate messaging,; and (5) Strengthening district-level support and supervision.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCHPS Community-based Health Planning and Services\u003c/p\u003e\n\u003cp\u003eCDP Continuous Development Program\u003c/p\u003e\n\u003cp\u003eFGD Focused Group Discussion\u003c/p\u003e\n\u003cp\u003eFGS Female Genital Schistosomiasis\u003c/p\u003e\n\u003cp\u003eHCW Healthcare workers\u003c/p\u003e\n\u003cp\u003eIE\u0026amp;C Information Education \u0026amp; Communication\u003c/p\u003e\n\u003cp\u003eJDA Joint Display Analysis\u003c/p\u003e\n\u003cp\u003eKAP Knowledge Attitudes Practices\u003c/p\u003e\n\u003cp\u003eKII Key Informant Interview\u003c/p\u003e\n\u003cp\u003eLMK Lower Manya-Krobo Municipality\u003c/p\u003e\n\u003cp\u003eMDA Mass Drug Administration\u003c/p\u003e\n\u003cp\u003eNTD Neglected Tropical Diseases\u003c/p\u003e\n\u003cp\u003eOPD Outpatient department\u003c/p\u003e\n\u003cp\u003ePHC Primary Healthcare Center\u003c/p\u003e\n\u003cp\u003eSDG Sustainable Development Goal\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eS.\u003c/em\u003e \u003cem\u003ehaematobium Schistosoma\u003c/em\u003e \u003cem\u003ehaematobium\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSOD Shai Osudoku Municipality\u003c/p\u003e\n\u003cp\u003eSSA sub-Saharan Africa\u003c/p\u003e\n\u003cp\u003eSTI Sexually transmitted infections\u003c/p\u003e\n\u003cp\u003eVRA Volta River Authority\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e\n\u003cp\u003eTDR Tropical Diseases Research Program\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eEthical consideration\u003c/p\u003e\n\u003cp\u003ePermission was granted by the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BREC/00005309/2023) and the Ethics Review Committee of the Ghana Health Service, Ghana (GHS-ERC:008/02/23). Additionally, permission was granted by the Eastern regional and Greater Accra regional Health Directorates, the Lower Manya-Krobo and the Shai Osudoku District Health Directorates and the head of health facilities involved. Study participants consent was also sought, and an information sheet was also shared with participants. Participants received no compensation for participating in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors declared no specific funding or grant for this study. However, this research was made possible through a HEARD PhD scholarship at the University of KwaZulu-Natal (UKZN), funded by the Swedish International Development Agency (SIDA). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of HEARD, UKZN, and SIDA.\u003c/p\u003e\n\u003cp\u003eAvailability of supporting data\u003c/p\u003e\n\u003cp\u003eThe data will be made available on request to the corresponding author.\u003c/p\u003e\n\u003cp\u003eAuthors contribution\u003c/p\u003e\n\u003cp\u003eCDT, AKM, JRN, and TGG conceptualized the study. Methodology, data collection, data curation and analysis, original draft, writing (review and editing) was done by CDT and AKM. Supervision, review and editing was done by AKM, JRN, and TGG. The final draft was done by CDT, review and approval done and accepted by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was made possible through a HEARD PhD scholarship at the University of KwaZulu-Natal (UKZN), funded by the Swedish International Development Agency (SIDA). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of HEARD, UKZN, and SIDA.\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the Ghana Health Service, National NTD Control Program, Greater Accra and Eastern Regional Health Directorates, and Shai Osudoku and Lower Manya-Krobo Municipal Health Directorates for the support and commitment to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no competing interest that may have inappropriately influenced the results and the writing of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHotez, P.J. and A. 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Available from: https://schistosomiasiscontrolinitiative.org/projects/fast-research-project.\u003c/li\u003e\n\u003cli\u003eGhana Health Service, Neglected Tropical Disease Program, and Public Health Division GHS, \u003cem\u003eMaster Plan for Neglected Tropical Diseases Programme, Ghana (2021 - 2025)\u003c/em\u003e. 2021, Ghana Health Service: Accra, Ghana. p. 1-103.\u003c/li\u003e\n\u003cli\u003eGrimes, J.E., et al., \u003cem\u003eThe roles of water, sanitation and hygiene in reducing schistosomiasis: a review.\u003c/em\u003e Parasit Vectors, 2015. \u003cstrong\u003e8\u003c/strong\u003e: p. 156.\u003c/li\u003e\n\u003cli\u003eVolta River Authority. \u003cem\u003eCorporate Social Responsibility\u003c/em\u003e. 2024 2024 [cited 2024 22-02-2024]; Available from: https://www.vra.com/csr/index.php.\u003c/li\u003e\n\u003cli\u003ePillay, L.N., et al., \u003cem\u003eMinimum Service Package for the integration of female genital schistosomiasis into sexual and reproductive health and rights interventions.\u003c/em\u003e Frontiers in Tropical Diseases, 2024. \u003cstrong\u003e5\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eBustinduy, A.L., et al., \u003cem\u003eAn update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now.\u003c/em\u003e Adv Parasitol, 2022. \u003cstrong\u003e115\u003c/strong\u003e: p. 1-44.\u003c/li\u003e\n\u003cli\u003eLamberti, O., et al., \u003cem\u003eTime to bring female genital schistosomiasis out of neglect.\u003c/em\u003e Br Med Bull, 2024. \u003cstrong\u003e149\u003c/strong\u003e(1): p. 45-59.\u003c/li\u003e\n\u003cli\u003eGyapong, M., et al., \u003cem\u003eBreaking the silence of female genital schistosomiasis in Ghana\u0026rsquo;s health system: A case of health workers within the FAST project.\u003c/em\u003e PLOS Neglected Tropical Diseases, 2024. \u003cstrong\u003e18\u003c/strong\u003e(9): p. e0012443.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 2 and 3","content":"\u003cp\u003eTable 2 and 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"tropical-diseases-travel-medicine-and-vaccines","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tdtm","sideBox":"Learn more about [Tropical Diseases, Travel Medicine and Vaccines](http://tdtmvjournal.biomedcentral.com)","snPcode":"40794","submissionUrl":"https://submission.nature.com/new-submission/40794/3","title":"Tropical Diseases, Travel Medicine and Vaccines","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Female genital schistosomiasis, knowledge, attitudes and practices (KAP), healthcare workers, Neglected Tropical Diseases (NTDs), capacity building, Ghana, health system strengthening, mixed-methods research","lastPublishedDoi":"10.21203/rs.3.rs-6981252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6981252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSchistosomiasis causes significant morbidity in over 78 countries worldwide, including Ghana. In females, untreated urogenital schistosomiasis can lead to female genital schistosomiasis (FGS), which has a focal prevalence of 11% and 73% in Ghana and poses complex challenges for healthcare professionals. This study assessed the knowledge, attitudes, and practices of healthcare workers (HCWs) regarding FGS in two schistosomiasis-endemic districts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional mixed-method study was conducted in 36 health facilities, involving 252 HCWs from the Lower Manya-Krobo (LMK) and Shai Osudoku districts (SOD). Quantitative data were analyzed using descriptive statistics, t-tests, and multivariable lineal regression (Stata 18). Additionally, 38 purposively selected HCWs were in interviewed, and qualitative data were analyzed thematically (NVivo 20). A joint display analysis was used to integrate findings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSignificant gaps in FGS-related KAP were identified in both districts. HCWs in LMK had a lower mean knowledge score of 41.4 (95%CI 38.4\u0026ndash;44.4) than those in SOD 55.9%, (95%CI 54.2\u0026ndash;57.6). Practice scores were similarly low: 31.1% (95%CI 28.5\u0026ndash;33.7) in LMK and 33.5% (95%CI 31.4\u0026ndash;35.4) in SOD. HCWs reported hesitance to manage FGS due to limited knowledge, lack of training, absence of diagnostic tools, and unavailability of praziquantel. Only 4.8% of HCWs in LMK and 9.5% in SOD reported their facility could diagnose and manage FGS. KAP scores varied significantly by cadre, educational, years of experience, and work settings. Qualitative findings confirmed lack of FGS-specific interventions, including clinical guidelines and facility-level support. Participants recommended in-service training, integration of FGS into routine health education, and improved community sensitization.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study reveals substantial gaps in HCWs KAP and preparedness to manage FGS in both districts exacerbated by a lack of systemic support, training, and resources. Addressing these gaps requires integrating FGS in health training curricula; regular in-service training for frontline HCWs; improved diagnostic and treatment capacity; community education; and strengthening district-level supervision. A multi-sectoral approach involving government, academia, civil society, and the private sectors is essential to improving FGS prevention and management in Ghana.\u003c/p\u003e","manuscriptTitle":"Systemic and Capacity barriers to Female Genital Schistosomiasis management among healthcare workers in Ghana: A Mixed-Method Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 11:18:16","doi":"10.21203/rs.3.rs-6981252/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-21T17:08:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T14:10:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-23T19:00:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255593024592095815440176238839059951170","date":"2025-07-19T16:06:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296681921147279318459742123750120914119","date":"2025-07-17T18:13:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299309774726098613056739254847891833684","date":"2025-07-08T16:59:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-08T14:37:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-04T08:10:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-04T08:07:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Tropical Diseases, Travel Medicine and Vaccines","date":"2025-06-26T08:22:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"tropical-diseases-travel-medicine-and-vaccines","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tdtm","sideBox":"Learn more about [Tropical Diseases, Travel Medicine and Vaccines](http://tdtmvjournal.biomedcentral.com)","snPcode":"40794","submissionUrl":"https://submission.nature.com/new-submission/40794/3","title":"Tropical Diseases, Travel Medicine and Vaccines","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83c1e34c-70bc-41f3-add9-c5cb203963a9","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:06:42+00:00","versionOfRecord":{"articleIdentity":"rs-6981252","link":"https://doi.org/10.1186/s40794-025-00276-x","journal":{"identity":"tropical-diseases-travel-medicine-and-vaccines","isVorOnly":false,"title":"Tropical Diseases, Travel Medicine and Vaccines"},"publishedOn":"2025-12-24 15:58:35","publishedOnDateReadable":"December 24th, 2025"},"versionCreatedAt":"2025-07-14 11:18:16","video":"","vorDoi":"10.1186/s40794-025-00276-x","vorDoiUrl":"https://doi.org/10.1186/s40794-025-00276-x","workflowStages":[]},"version":"v1","identity":"rs-6981252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6981252","identity":"rs-6981252","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}