WOMEN’S HEALTH: Spotlight on Female Genital Schistosomiasis (FGS) – a neglected gynaecological condition
Despite the fact that Female Genital Schistosomiasis (FGS) affects 56 million women and girls in sub-Saharan Africa, the condition remains relatively unknown. As the world commemorates Women’s Month, this report highlights the issue and how in one remote part of Côte d’Ivoire, something is being done about it. (All photos by Nuits Balnéaires)
Female Genital Schistosomiasis is a complication of the disease Schistosomiasis, which is one of the Neglected Tropical Diseases (NTDs), a group of incapacitating, yet preventable diseases, often impacting the most impoverished and marginalized people. And despite FGS affecting 56 million women and girls in sub-Saharan Africa, it was almost unheard of in Côte d’Ivoire, until the Ministry of Health took action to make it known amongst the people in the area of Soubré.
FGS is caused by the parasite Schistosoma haematobium, which impacts the urinary and genital organs of those infected. Without treatment, women affected by FGS can experience life-changing effects, including infertility, ectopic pregnancy, and are at four times greater risk of human immunodeficiency virus (HIV) transmission.
However, symptoms of FGS are very similar to sexually transmitted infections (STIs) and therefore can often be mistaken as such, meaning the disease continues to be one of the most neglected sexual and reproductive health issues in the world.
Lack of awareness and misdiagnosis
In Côte d’Ivoire, many women are vulnerable to FGS, and at over 50%, the prevalence of the parasite remains high in certain districts, which represents a burden on healthcare systems in the country as women continue returning to the health centers due to misdiagnosis and incorrect treatment.
The great risks for women, the problems with misdiagnosis, and the lack of awareness led to the initiative developed by the Ministry of Health, to provide services for FGS in seven of the health centres in Soubré.
Located in the southwest of Côte d’Ivoire, Soubré is the country’s agricultural engine. It is home to vast stretches of farmland that contain water bodies, which the female farmers depend on for the irrigation of their crops. The prevalence of the parasite in this area is 41.9% and it is within these very water bodies, where the threat of the parasite causing FGS lies.
“There is a woman who said in view of the risks, that it is really God who has saved them so far”, says Poholé Lessenon Alida a midwife at the Urban Health Centre of Grand-Zattry.
The aim of the new initiative is to effectively and sustainably integrate awareness-raising and preventive treatment for FGS into the national health system. This is to ensure that women aged between 15 to 29 years old who attend routine services for HIV/Aids and female reproductive health are also routinely offered FGS preventive treatment.
“I make my patients understand that it is not a disease related to their sexual activity but more to their professional activity, because many are regularly in contact with water points in gardens and fields,” Alida adds.
Stigma and misconceptions
As symptoms of FGS are often mistaken for STIs, women suffering from FGS can be subjected to stigma due to their symptoms being associated with promiscuity. In the face of this, many women do not seek treatment and risk infertility as a result.
Marriage and being able to bear children are culturally very important in Côte d’Ivoire. The impact of FGS on these women’s lives can therefore be significant and so it was crucial for the Ministry of Health to focus on awareness-raising to dispel any misconceptions around the disease. What’s more, awareness of the risks of FGS amongst the farmers, who are often exposed to contaminated water given the conditions in which they work, was improved because of the initiative.
“We take advantage of the consultations to talk to women about FGS. This is something that we will continue to do. For pregnant women, sometimes they have sisters or nieces to whom they pass on the information”, remarks Head Nurse, Timite Baliadji, of Yabayo Urban Health Centre.
But the standard medical training in Côte d’Ivoire and throughout sub-Saharan Africa does not cover FGS, so with poor knowledge of the disease amongst health workers, it is of little surprise that the community in Soubré had not been informed about the risks and consequences of FGS prior to the initiative.
“We didn’t know that women could have this disease…Previously we only knew about male genital schistosomiasis”, Alida explains further.
In the early stages of the disease, there are difficulties surrounding diagnosis, so it is vital to focus on prevention and awareness before long-term complications can arise. That’s where praziquantel, the drug used to prevent FGS, comes into play.
“The advanced stage is usually manifested by bleeding from abortions and infertility. I think the prevention component is very important because it is easier to prevent FGS than to cure it, so we distribute praziquantel to prevent the disease and we manage to alleviate the symptoms thanks to the drug.” Baliadji explains.
The parasite also causes sickness in children and so in areas affected by the disease children aged 5 to 14 years old receive regular treatment with praziquantel, which is donated by the pharmaceutical Merck KGaA through the World Health Organization drug donation programme.
Limited Resources
However, there are limited resources across all countries with a high disease burden to also provide free mass treatment to at-risk adults. As a result, praziquantel is currently not widely available to women at-risk of FGS.
Integration of FGS services into the health system in Soubré meant that at-risk women were able to access free praziquantel, highlighting the importance of this approach.
“For example, the person who comes for a malaria consultation, when the health worker asks him/her questions and suspects other diseases, he/she is asked to do additional examinations. That is an integrated approach.”- Dr. Kouamin Alain Claver, Project Coordinator of the FGS pilot study in Côte d’Ivoire.
Were it not for projects like the initiative to provide FGS services, it is likely that FGS would still be unknown in Soubré. Appropriate services for women at-risk of FGS, like these female farmers, need to be made available, otherwise, these women will continue to be vulnerable to the effects of this devastating disease.
“It is necessary to focus on awareness, on the wearing of gloves, boots, and all the elements of protection to avoid contracting FGS. It is our duty to continue to raise awareness among our populations,” states Baliadji.
FIELD TESTIMONY
By Nuits Balnéaires
District.
It is at dusk after a long day of travel from Abidjan that we reach Soubré, leaving behind Grand-Zattry and Yabayo. The Capital of the Nawa region, Soubré is home to the largest hydroelectric dam in Côte d’Ivoire, erected on the Sassandra River.
The region is irrigated by the Nawa, the river with male and female mythical spirits revered by the local population. An area of incomparable beauty, traversing a region considered to be the economic development backbone of the area. Yet, on the first evening, the large mosquito population arouses my curiosity about the impact of the abundance of water on this region.
At dawn, we leave Soubré for Grand-Zattry. The route takes us through forests, rubber plantations, cocoa plantations, and rice fields. Between two plantations nestle ponds and rivers. This is a region generously irrigated and offering soil conducive to vegetable crops and rice cultivation.
Here, many fields are worked by women, who produce rice, lettuce and other food products prized by Ivorian consumers. As soon as we arrive in Grand-Zattry, midwife Alida leads us to a valley where an agglomeration of fields is developing. Navigating through these vast fields is proving difficult due to ponds and mud.
In the distance, with a wave of her hand, a woman shows us the right way to reach her field. A swamp borders this field not far from where children play. Our exchanges with the farmers of this rice field allow us to understand that even if some are aware of the dangers associated with this stagnant water, their means do not allow them to protect themselves adequately.
The same observation occurs further on in a lettuce field. For Safiatou, a brave mother of 5 who has been working here for 15 years, she emphasises that this field is all she has owned since the death of her husband.
Like most of the women here, it is this work that allows her to feed her family. She wonders what would happen to her and her family if she contracted a disease like FGS in these waters.
Although aware of the risk of infection they face, these women have no choice but to work in such conditions to make ends meet.
**This article is published courtsey of the SCI Foundation in collaboration with the NTD programme (called Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive) of the Ministry of Health of Public Hygiene and Universal health in Côte d’Ivoire.
Feature image: A farmer in the water body of her lettuce field in Grand-Zattry, District of Soubré.
