Tropical diseases, travel medicine and vaccines · 2025
Systemic and capacity barriers to female genital schistosomiasis management among healthcare workers in Ghana: a mixed-method approach.
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Tetteh Comfort D, Manyeh Alfred K, Ncayiyana Jabulani R, Ginindza Themba G
Аннотация
BACKGROUND: Schistosomiasis causes significant morbidity in over 78 countries, including Ghana. In females, untreated urogenital schistosomiasis can progress to female genital schistosomiasis (FGS), with focal prevalence ranging from 11% to 73% in sub-Saharan Africa (SSA). This condition 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 in Ghana.
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 (SOD) districts. Quantitative data were analyzed using descriptive statistics, independent t-tests, and Ordinary Least Squares (OLS) models with Huber-White robust standard errors in Stata 18. Additionally, 38 purposively selected HCWs were interviewed, and qualitative data were analyzed thematically (NVivo 20). A joint display analysis was used to integrate findings.
RESULTS: HCWs in SOD had significantly higher knowledge scores (M = 55.9, SD = 9.8) than those in LMK (M = 41.4, SD = 17.1; t (250) = - 8.25, p < 0.001), while attitudes or practices did not differ significantly between districts. Robust regression analysis showed knowledge was higher among HCWs with > 5 years of practice (β = 7.21, 95% CI: 3.34-11.08, p < 0.001), general nurses β = 10.59, 95% CI: 5.07-16.12, p < 0.001) and midwives (β = 13.92, 95% CI: 7.46-20.38, p < 0.001); attitudes were lower in clinical settings compared to public health settings (β = - 7.08, 95% CI: - 9.63 to - 4.53, p < 0.001); and practices were among general nurses (β = 9.58, 95% CI: 4.84-14.33, p < 0.001) and midwives (β = 12.48, 95% CI: 7.35-17.61, p < 0.001) but lower among diploma holders (β = - 9.90, 95% CI: - 14.71 to - 5.09, p < 0.001) in clinical settings (β = - 5.96, 95% CI: - 9.49 to - 2.43, p = 0.001). Only 4.8% of HCWs in LMK and 9.5% in SOD reported facility capacity to diagnose and manage FGS. Qualitative findings confirmed a lack of FGS-specific interventions, including clinical guidelines and facility-level support.
CONCLUSION: Substantial gaps exist in HCWs' KAP and readiness to manage FGS, exacerbated by systemic deficiencies in training, and resources. Addressing these gaps requires integration FGS in regular in-service training for frontline HCWs; improved diagnostic and treatment capacity; ensure the availability of resources and tools; and strengthened district-level supervision to facilities.
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 (SOD) districts. Quantitative data were analyzed using descriptive statistics, independent t-tests, and Ordinary Least Squares (OLS) models with Huber-White robust standard errors in Stata 18. Additionally, 38 purposively selected HCWs were interviewed, and qualitative data were analyzed thematically (NVivo 20). A joint display analysis was used to integrate findings.
RESULTS: HCWs in SOD had significantly higher knowledge scores (M = 55.9, SD = 9.8) than those in LMK (M = 41.4, SD = 17.1; t (250) = - 8.25, p < 0.001), while attitudes or practices did not differ significantly between districts. Robust regression analysis showed knowledge was higher among HCWs with > 5 years of practice (β = 7.21, 95% CI: 3.34-11.08, p < 0.001), general nurses β = 10.59, 95% CI: 5.07-16.12, p < 0.001) and midwives (β = 13.92, 95% CI: 7.46-20.38, p < 0.001); attitudes were lower in clinical settings compared to public health settings (β = - 7.08, 95% CI: - 9.63 to - 4.53, p < 0.001); and practices were among general nurses (β = 9.58, 95% CI: 4.84-14.33, p < 0.001) and midwives (β = 12.48, 95% CI: 7.35-17.61, p < 0.001) but lower among diploma holders (β = - 9.90, 95% CI: - 14.71 to - 5.09, p < 0.001) in clinical settings (β = - 5.96, 95% CI: - 9.49 to - 2.43, p = 0.001). Only 4.8% of HCWs in LMK and 9.5% in SOD reported facility capacity to diagnose and manage FGS. Qualitative findings confirmed a lack of FGS-specific interventions, including clinical guidelines and facility-level support.
CONCLUSION: Substantial gaps exist in HCWs' KAP and readiness to manage FGS, exacerbated by systemic deficiencies in training, and resources. Addressing these gaps requires integration FGS in regular in-service training for frontline HCWs; improved diagnostic and treatment capacity; ensure the availability of resources and tools; and strengthened district-level supervision to facilities.