Experts working to reduce the burden of Neglected Tropical Diseases(NTDs) in Nigeria have raised alarm over the high prevalence of Female Genital Schistosomiasis(FGS) prevalence in local riverine areas of Ondo and Kebbi States
They also disclosed that the burden of FGS cases prevalent among communities is traceable to the use of lakes, streams, ponds, and rivers for bathing, swimming, drinking, washing, fishing, and religious activities that are infested by the organisms.
Speaking at the sideline of the presentation of Female Genital Schistosomiasis(FGS) Research Findings Dissemination Meeting, organised by Sightsavers Nigeria, a consultant gynecologist with Sightsavers Nigeria, Dr Hameedat Abdussalam, explained that the disease has become prevalent but largely unknown and yet to get the desired attention.
Speaking further, she disclosed that schistosomiasis is a zoonotic disease and not a waterborne disease.
According to Hameedat, if an infected person urinates into a water body, those eggs are taken up by the snails, they develop in the snail, and the worms are released, and at those intermediate stages, they get into another person by piercing their skins and getting into their system.
“We came here for dissemination of findings of a survey that had been done in Ondo and Kebbi States.
“In Ondo State, we examined women and tried to find out what symptoms they had and did call colonoscope for all of them, and the symptoms and the findings have shown we actually have a high burden of FGS both in Ondo State and in Kebbi State, especially in the communities where Schistosomiasis has been endemic. Argongo Local Government Area is endemic for Schistosomiasis because we know that they are mostly involved in fishing.
“Then in Ondo State in Ilereje where we went to they find it difficult to have wells and they still go to surface water as their source of water so they have a very high burden.
“So if these findings bare communicated and disseminated to the appropriate quarters the more effort needs to be out in attacking Schistosomiasis more in those communities.
“We don’t know what the burden is currently in Nigeria. All these communities we went to with over 40 per cent prevalence are communities that have been declared as very high hotspots for Schistosomiasis on its own. Many don’t know that passing blood in urine is a disease rather celebrate it as being matured.
“There is a need for more studies and resources in this field because if we take care of the girls, at least we know that they are their fertility and their healthiest men are of so that they can now take care of their children with more healthy choices.
“And if the girls know that they can’t go to the rivers and not contract something, it’s a matter of time before the boys and every other person which is carried along.
“But while those are happening, a lot of women are being left out because they are either not in school or they are not educated enough to even be in school trained, or they are involved in other domestic, or they are out of the school-age group, and so we are seeing FGS in women who have not really been treated and even those who have been treated in the past, they keep going back to the rivers for their domestic activities. So after treatment, they go back there, they get reinfected until they develop an entity of FGS.
“It is usually contracted by bodily contact with water bodies, streams, lakes, rivers for any activity, whether it’s recreational activities like swimming or sports or domestic activities like fishing, washing, bathing, and others.
“So anybody who has ever had skin contact with those is at risk of contracting Schistosomiasis, and Schistosomiasis itself actually affects both males and females.
“And the classical symptoms really is where affected people have blood in their urine. So it is something that has been linked to
bladder carcinoma is cancer of the bladder and also in men and women.
“There are documented stories to that effect, but when it comes to Female Genital, Schistosomiasis is one of the complications of Schistosomiasis that is specific for women and girls of the reproductive age groups and outside the reproductive age groups.
“But it is more of concern in the reproductive age groups because even though this disease entity does not kill these patients it actually affects their quality of life and creates a very huge morbidity in them.” She added.
While disclosing the symptoms of Schistosomiasis, Abdussalam said the patients experience recurrent vaginal discharges, abnormal vaginal bleeding, painful sex, ectopic pregnancy.
She added that some infertility has been linked and associated with FGS, and noting that it has becomes a huge burden, especially in a healthy system where the entity of Schistosomiasis itself has been considered to be one of the Neglected Tropical Diseases*NTDs),
“This mean that we know the disease is there,we know about the lifecycle of the parasites that cause it but we haven’t really done much or we’ve not done enough to eradicate it unlike disease entities like HIV that has received so much attention, funding and so because of that entity that is neglected, FGS
has been considered as one of them most neglected female reproductive health diseases, and it affects any woman that has had a contact with water. So whether it is in the past, is current, it is every woman who has ever had that contact has that risk.” She added.
Also, a Research Associate, Sightsavers Nigeria, Omosefe Osinoiki, explained that the essence of the research was to raise the alarm and awareness of FGS, which is taking serious toll on the health of Nigerians, therefore needs to be tackled frontally and drastically reduced by government in collaboration with relevant development partners.
“The disease we are talking about is Female Genital Schistosomiasis, FGS, it is a gynecological condition that affects women of reproductive ages 15 and above.
“So, FGS is a disease that nobody talks about. It is something that affects women, especially those who are in endemic communities of schistosomiasis.
“Schisto will be endemic in communities where you have water bodies, where they engage most of their daily activities along with water bodies, so it could be washing, bathing, fetching, swimming, so it can be anybody so schisto can affect anybody who engages in the water body that is infected with water-snail that carries the haematobium that causes Schistosomiasis.”
According to her, before it is been treated in the blood of the patient, the eggs are produced 200 times, which adult ones produces 200 eggs daily, the eggs remain even if the patient is treated they move around the body and then they get stuck.
“So getting stuck in the cervical area is what causes FGS. Now, we have found that doing this study, because the world would say that Nigeria bears most of the burden in Sub Saharan Africa, however Nigeria does know how much it actually contributes.
“So this study was a way to give like a snapshot of what Nigeria contributes. So we did our study in four Local Government Areas. However, because we want to be able to say yes for what we did the right thing we follow due process, our methodology is clear is why we can we are given results for three LGAs.
“And the prevalence overall, we have two LGAs in Ondo State and two LGAs in Kebbi State and the prevalence from thode LGAs tells us that the prevalence is about 41 per cent. So 41 per cent from just three LGAs of FGS. So, what does that tell us about the other LGAs across Nigeria.
“Now, what’s the way forward? Yes, we may just be a small study, which Sightsavers internally funded. We would appreciate first of all that the national program of Schistosomiasis takes this forward because if they have their focus on it, at least they can project to other organizations for support in one way or the other.
“Now, it’s not just about money it’s about the ability to do the research, its ability, the ability to find out what actually is happening, and how to then provide care because the truth is there is no treatment plan for FGS. You can provide Praziquantel but Nigeria as a country cannot give you a guideline for what it is that you need to take care of FGS.
“Why it is not taught in medical school. That is number one. So we need to face that so at least every doctor is aware that is something called FGS.
“Two, we should also ensure that our frontline health workers, those at the grassroots, not every health facility has a doctor. So you have to choose the health workers, those people who work with the grassroot because most times the people would have schisto and then go on to have FGS are those in the grassroots.
“So those health workers do need to be aware and needed to be educated about it. And our previous study the countdown study in Sightsavers, we have a tool and guideline for frontline health workers that we can use to train them.
“However, Nigeria Programme for schisto has not push that forward because at the moment, at least frontline health workers should be able to say that they know about FGS and that’s not the case.
“Thirdly, it would be great for us to have a guideline something every health facility and healthcare worker can refer to.
“We have the WHO Atlas. There are some resources that are available, but they have not been projected, they have not been given enough awareness, either from the state level, the LGA level and up to the federal level.
“Moving forward, we need to find ways to increase awareness as the states and LG and as a country. So, it’s not being on national now, it is national states and local communities need to be aware, and everybody will be able to come up together because is not just the NTD world now it also have effects on the reproductive health of the women. So it is not just NTD now. So it’s NTD, WASH, and reproductive health.
“We need to come together to have a collaborative effort or system or processes that would help us take care of FGS from the community up to the national level.
“So from our findings too, some communities have wells and boreholes, however, the water that comes up for example a community Irele Local Government Area of Ondo State.
“They have wells dug up, however, bitumen comes out in the water. So after some time, the cake up. So there’s no water from that.
“So they would have to go back to the river, whether or not they knew that the water has schistoma eggs.
“Now, we also have the issue of behavioral change that’s a major challenge for us as human beings, even, whether it’s schisto or another disease, because if you say, an individual whose religious activity or whose economic activities is surrounded or focused on the water, so for a woman those the palm oil processing, she needs the water.
“For somebody who has religious activities that she engaged in, they will go back to the water. So those kind of people you can’t tell them that this water is the cause of your problem.
On the treatment of Schistosomiasis, Osinoikisaid, “First thing first, as treatment is being done, which is something we advocated for and WHO has actually brought out a guideline for about that.
“The treatment should not just be for school-age children alone, it should be for everybody in the community that is endemic with Schistosomiasis.
“Now, even everybody gets treated so everybody also should not engage in those WASH activities. So nobody is to urinate in the water, because if out of 100 people 99 persons get treated and one person has Schistosomiasis and once he urinates by the river that person deposits the egg in the river and everybody else gets it when they come to the river.
“Adherence to schisto treatment is important. First of all, before we start saying, Okay, let’s work on behavior change, and government providing water no providing water we know that resources for government is limited.”
According to her the research on FGS in Ondo and Kebbi States lasted for a year It took us about a year, but had some challenges including low human resources, logistics, and others.
Meanwhile, the Director, Federal Ministry of Health and Co-Principal Investigator, Female Genital Schistosomiasis, FGS, Survey, Dr Obiageli Nebe, described the research findings as reliable.
Nebe said: “I can authoritatively say that this research findings is quite reliable because we developed the tools that were used in the field for data collection.
“The disease has been living with us for a very long time and the better approach to this now is that we have started investigating on Female Genital Schistosomiasis and has a complication of snail fever.
“We need to engage more with relevant programmes, departments and agencies. It is not just something that Ministry of Health can handle alone, we have the PHCs, reproductive departments and units.
“We need to engage with them because this particular disease condition is a reproductive health issue as well as psychological issue, so we need stakeholders and partners, and those in other health systems to tackle this disease.
“We have been working closely with Federal Ministry of Water Resources and Sanitation in Water Sanitation and Hygiene Management System, WASH platform. The NTDs Programme has linked up with them.
“We are collaborating to see how we can use the platform to collect data on Water Sanitation and Hygiene. We need to work with them when working around issues like management of the water sources because the sole mandate of Federal Water Resources and Sanitation is to provide water across the towns and communities.”
However, speaking on funding, she (said, a lot of funds is required to mitigate the challenges posed by FGS.
“No matter what the partner is bringing is not going to be enough, we need government support. Although government has been providing some fundings, it is still not enough compared to the amount of work that needs to be done.
“We need government to step-up the funding. We need a lot of domestic support, Public Private Partnership because government alone cannot do it, we need to involve the private sector into this.
“The investment for NTDs will require support from private sector and even local communities and every stakeholder should come on board to ensure the necessary support is provided to eliminate.
“There is hope for more scale-up because the findings we got from this will help look into future investment in this regard to scale-up to other places so that we can actually put the outcome together and develop implementation guidelines. We need data because there is huge data gap.”
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