Systemic and capacity barriers to female genital schistosomiasis management among healthcare workers in Ghana: a mixed-method approach.

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.