Case Report: Three cases of suspected female genital schistosomiasis and precancerous lesions for cervical cancer in a highly endemic country—from clinical management to public health implications

Female genital schistosomiasis (FGS) is a chronic manifestation of schistosomiasis, usually caused by Schistosoma haematobium infection, which can be responsible for infertility, ectopic pregnancy, and abortion, and is associated with an increased prevalence of HIV infection. No screening programs are currently recommended for FGS. Colposcopy, the conventionally suggested diagnostic tool for FGS, is also considered a crucial screening tool for cervical cancer (CC). We performed an experimental screening via colposcopy for FGS at primary healthcare centers (PHCCs) in the Boeny region of Madagascar, allowing for the detection of patients with both FGS signs and HPV-related dysplasia (HPV-dy). All suspected FGS cases were treated with praziquantel on the day of colposcopy, and all images of suspected CC or HPV-dy were re-assessed by a gynecologist and, if needed, patients were then provided with additional colposcopy for histologic diagnosis and treatment. We describe three cases of FGS and HPV-related precancerous lesions detected during the project, discussing the state of art of the relationship between CC, FGS and HPV and the real-life challenges encountered in terms of both patient compliance and the diagnostic and treatment cascade. Despite the current diagnostic limitations, a screening for FGS via colposcopy may contribute to the early identification of CC or precancerous lesions. The addition of visual inspection with acetic acid (VIA) during colposcopy for FGS screening could improve its impact on CC screening. In addition, although there is limited evidence of the effectiveness of praziquantel in FGS, treatment should in any case be proposed for suspicious lesions, given its safety and ease of administration. The benefit of combined screening could be maximised by increasing the availability of good quality services and improve awareness of both diseases among wome

Erhebungsmethodik des Student Surveillance Systems der HAW Hamburg: Eine vergleichende Mixed-Method Analyse der Paper-Pen- und der Online Erhebungsmethodik im SuSy Projekt

Die SARS-CoV-2 Pandemie hat die Art zu Forschen stark beeinflusst. Zahlreiche Projekte mussten ihre Forschung und die damit verbundenen Erhebungsmethoden an die neue Situation anpassen und persönliche Erhebungen durch Online-Erhebungen ersetzen. Auch das Student Surveillance System der Hochschule für angewandte Wissenschaften Hamburg musste kurzfristig die Erhebungsmethode von einer Paper-Pencil-Erhebung auf eine Online-Erhebung umstellen. Das Ziel dieser Arbeit ist es eine Handlungsempfehlung zu der Frage, welche Erhebungsmethode sich am besten für die Datenerhebung des Student Surveillance System der HAW Hamburg eignet, zu entwickeln. Diese Handlungsempfehlung wird auf Basis der Ergebnisse eines Mixed-Method Ansatzes gebildet. Im Rahmen des Mixed-Method Ansatzes werden zunächst Experteninterviews mit je drei ausgewählten Forschenden der beiden Erhebungsmethoden durchgeführt. Auf Basis dieser Interviews werden fünf Arbeitshypothesen aufgestellt, welche anhand der quantitativen Daten des SuSy Projektes geprüft werden. Es zeigt sich, dass die Erhebungsform jeweils eine Assoziation auf die Barrierefreiheit der Befragung, die Response Rate, die Kosten-Gestaltung des Projektes, die Vollständigkeit der Daten, sowie die Stabilität der Daten in der Zeitreihendarstellung hat. Auf Basis der Ergebnisse wird in dieser Arbeit die resultierende Handlungsempfehlung gegeben, eine zukünftige Erhebung des SuSy Projektes in Form einer gemischten Erhebungsmethode durchzuführen, welche die Vorteile beider Erhebungsdurchgänge miteinander verbindet. In der kommenden Zeit wird es interessant sein, zu beobachten, welche Veränderungen in den weiteren Befragungsdurchgängen auftreten, sowie welche Einflüsse eine potentielle Umstellung auf einen gemischten Erhebungs-Ansatz auf die Daten und ihre Qualität haben könnten

Dimensions of awareness of Female Genital Schistosomiasis among women and health care workers in rural Madagascar : a mixed methods approach

Background: Water-borne infections with S. haematobium are endemic in tropical re-gions. Chronic infection can cause Female Genital Schistosomiasis (FGS), possibly leading to severe gynecological conditions, including infertility. However, awareness of FGS prevention, diagnosis and treatment is limited. This study aims to identify and investigate dimensions of FGS awareness among women and healthcare workers (HCW) in the Boeny region of Madagascar. Methods: Mixed methods data collection involved cross-sectional survey of adult women (n=694), HCWs (n=93), and focus group discussions (Women; n=24, HCW; n=29). Quantitative results were described including proportions and 95% confidence intervals (CI) and measures of central tendency. Additionally, a FGS knowledge score was calculated. Qualitative analysis was conducted using a framework analysis ap-proach. Triangulation of quantitative and qualitative data is performed to determine the dimensions of awareness in the region. Results: Results show that 11.2% (CI [9.0–13.8%]) of women and 53.2% (CI [42.6–63.6%]) of HCW had heard of FGS. Among these, 34.6% (CI [24.1–46.2%]) women and 42.0% (CI [28.1–56.8%]) HCW were unaware of its characteristic gynecological symptoms. No significant differences were seen in the overall low knowledge score among HCW and women. In addition to confirming limited knowledge of the disease and treatment, qualitative analysis highlights influence on FGS awareness in the re-spondents’ daily life. While some women are aware that contact with infested water carries a risk of infection, their livelihoods depend on rice-farming, making preventive behaviors challenging and possibly leading to resignation. Although HCWs demon-strated proportionally more FGS awareness, uncertainties about treatment were ob-served. The triangulation determined four key dimensions of awareness in the region: Infrastructure, delivery of information, health behavior, and socio-structural factors. Conclusion: Overall, results show low levels of FGS awareness in a representative sample of Madagascar. Findings align with existing literature describing underreport-ing and undertreatment of FGS. Identifying gaps, barriers and facilitators in FGS awareness can inform the design of targeted FGS awareness campaigns to improve the health of women affected in Madagascar

Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study

Abstract Background Women’s health in resource-limited settings can benefit from the integrated management of high-burden diseases, such as female genital schistosomiasis (FGS) and human papilloma virus (HPV)-related cervical cancer. In schistosomiasis-endemic countries such as Madagascar, data on FGS and HPV prevalence are lacking as well as preventive measures for both conditions. This study aims to estimate the prevalence of FGS and HPV in rural Madagascar, and to examine associated risk factors to identify opportunities for improving women’s health. Methods After initial community outreach activities, interested women aged 18–49 years were recruited consecutively in 2021 at three primary health care centers in the district of Marovoay. FGS was detected by colposcopy. Colposcopy images were double-blind reviewed by two independent specialists. A Luminex bead-based assay was performed on cervical vaginal lavage specimens for HPV typing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated using univariable and multivariable binary Poisson regression with 95% confidence intervals (CIs). Results Among 500 women enrolled, 302 had complete information on FGS and HPV diagnosis, and were thus eligible for analysis. Within the sample, 189 (62.6%, 95% CI: 56.9–68.1) cases of FGS were detected. A total of 129 women (42.7%, 95% CI: 37.1–48.5) tested positive for HPV. In total, 80 women (26.5%, 95% CI: 21.6–31.8]) tested positive for both conditions. No association was observed between FGS and HPV positivity, while previous pregnancy (APR = 0.65, 95% CI: 0.43–0.78) and older age (APR = 0.59, 95% CI: 0.42–0.81) are showing a negative association with HPV infection compared to no previous pregnancy and younger age groups. Conclusions The results of the study show that FGS and HPV are highly prevalent in rural Madagascar. The concurrent prevalence of these two conditions requires urgent adaptations of public health strategies to improve women’s health, such as integrated services at primary level of care. Graphical Abstrac

Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study

Abstract Background The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. Methods In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios. Results The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection. Conclusions Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches

Additional file 1 of Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study

Additional file 1: Table S1. Mobility history of co-infected participants