Diagnostic competence and health worker knowledge of female genital schistosomiasis management in a rural Ghanaian district.

BACKGROUND

Schistosomiasis is a neglected tropical disease with a greater burden in Africa, including Ghana. Female Genital Schistosomiasis (FGS), a gynaecological manifestation of urogenital schistosomiasis, is often missed or misdiagnosed due to similarities with sexually transmitted infections and other gynaecological infections, with limited ease of health worker identification and diagnostic capability. This study assessed healthcare workers' knowledge and diagnostic capacity for FGS in the Central Gonja District of Ghana.

METHODS

A quantitative cross-sectional study sampled 237 healthcare workers from 19 facilities near the Black and the White Volta rivers using a three-phase multistage sampling process. Data was collected via a self-administered Kobo Toolbox questionnaire, focusing on sociodemographic factors, whether facilities had functional screening tools for FGS and health workers' capacity to diagnose and treat these conditions. Analysis was conducted in Statistical Package for Social Sciences (SPSS), employing descriptive statistics and Pearson's chi-square tests to assess inferential associations between variables and health workers' knowledge of FGS/schistosomiasis, which served as the main outcome variable.

RESULTS

The study involved health workers with a mean age of 31.6 ± 4.18 years, of whom 52.3% were male. Knowledge gaps were significant: only 30% (71/237) demonstrated good understanding of schistosomiasis and merely 16.9% (40/237) showed adequate knowledge of FGS. Despite 91.6% recognition of schistosomiasis ('Bilharzia'), knowledge of genital manifestations lagged severely (FGS: 26.8%, MGS (Male genital schistosomiasis): 18.1%). While demographic factors showed no association, experienced staff demonstrated better FGS knowledge (p = 0.003). Critical health system deficiencies emerged; 74% of facilities lacked laboratories, 90% lacked praziquantel and 100% lacked FGS diagnostic capacity. Even among clinicians, < 43% knew standard FGS treatment and only 1/3 considered FGS in relevant diagnoses.

CONCLUSION

In the Central Gonja District of the savannah region located in the northern part of Ghana, where schistosomiasis prevalence is classified as moderate (10-49%), healthcare workers demonstrated limited knowledge and diagnostic capacity regarding FGS. These findings highlight the need to integrate FGS into reproductive health guidelines, strengthen healthcare worker training and improve diagnostic resources for early detection and management in endemic settings.