“We don’t know schistosomiasis can affect the female reproductive system and increase the risk of HIV”: A mixed-methods analysis reveals gaps in risk factor determinants and health consequences of female genital schistosomiasis in Southern Chad

@article{asongha2026dont,
  title = {{“We don’t know schistosomiasis can affect the female reproductive system and increase the risk of HIV”: A mixed-methods analysis reveals gaps in risk factor determinants and health consequences of female genital schistosomiasis in Southern Chad}},
  author = {Melissa N Asongha and Toussaint N Ngakia and Pascaline Akawung and Chrisvalin Lokissidingao and Dum-Buo Nnamdi and Barou O Zephanias and Fotsa Blondeau and Abdoulaye Djelamde and David A Lewis and Efuetacha Betehndoh and Francis N Nkemngo},
  journal = {PLOS Neglected Tropical Diseases},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pntd.0014791},
  url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014791},
  note = {CC BY},
}

TY  - JOUR
TI  - “We don’t know schistosomiasis can affect the female reproductive system and increase the risk of HIV”: A mixed-methods analysis reveals gaps in risk factor determinants and health consequences of female genital schistosomiasis in Southern Chad
AU  - Melissa N Asongha
AU  - Toussaint N Ngakia
AU  - Pascaline Akawung
AU  - Chrisvalin Lokissidingao
AU  - Dum-Buo Nnamdi
AU  - Barou O Zephanias
AU  - Fotsa Blondeau
AU  - Abdoulaye Djelamde
AU  - David A Lewis
AU  - Efuetacha Betehndoh
AU  - Francis N Nkemngo
PY  - 2026
DA  - 2026/10/06
JO  - PLOS Neglected Tropical Diseases
DO  - 10.1371/journal.pntd.0014791
UR  - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014791
AB  - Background: Urogenital schistosomiasis caused by Schistosoma haematobium infection is a public health problem in Chad. Despite reports of urinary S. haematobium prevalence in endemic communities, research on the genital aspect of the disease, which disproportionately affects women, remains neglected especially given the contemporary geographical overlap with HIV/AIDS. This study was undertaken to establish baseline data on the awareness and perception of female genital schistosomiasis (FGS) among community inhabitants and healthcare professionals in southern Chad to inform effective policy decision-making. Methods: A mixed-methods cross-sectional design was employed for data collection in communities within the Guelo district from June to July 2025. Structured questionnaires were applied to capture quantitative data, while qualitative information was obtained through eleven focus group discussions (FGDs) and fifteen key informant interviews (KIIs). Quantitative and qualitative data were analyzed using statistical tools and NVIVO software, respectively, and outcomes were organized according to thematic categories. Results: A marked disparity characterized by sufficient knowledge about the urinary form of schistosomiasis [93.8% (CI: 91.5 – 96.2), 514/548] and minimal knowledge of FGS [3.1% (CI: 2.3 – 4.9), 17/548] was documented among the population. Moderate [63.2% (CI: 59.4 – 71.7), 325/514] and low [17.7% (CI: 11.3 – 21.8), 3/17] levels of awareness were respectively identified as predictors of urinary schistosomiasis and FGS, consistent with the perception that FGS is neither a risk factor for HIV nor cervical cancer. Additionally, verbal reports among informed community members and healthcare professionals revealed a shared belief that FGS is sexually transmitted and typically treated with antibiotics/antifungal medications. This belief was associated [χ2 = 13.7 (CI: 10.1 – 15. 6), p = 0.002] with negative consequences on hospital-treatment-seeking habits that arise from fear of identity-related stigma, particularly in cases involving recurrent genital symptoms. Conclusion: This study highlights the need for integrating FGS education and awareness initiatives within praziquantel delivery campaigns and sexual/reproductive preventive services at primary health care facilities in rural Chad. Furthermore, it underscores the urgency of providing comprehensive training for local healthcare professionals on the diagnosis and clinical management of FGS and the improvement of water, sanitation and hygiene (WaSH) services to minimize contact with freshwater bodies. Author summary: Female genital schistosomiasis is a chronic infection affecting adolescent girls and women, particularly in rural communities located near snail-infested river water bodies. Understanding the knowledge and perception of FGS among the local population is key to designing effective interventions. Using a combination of structured questionnaire, FGD and KII, we comprehensively captured a broad range of perspectives on urogenital schistosomiasis, with particular emphasis on FGS and its associated risk factors in southern Chad. Our data revealed limited knowledge and awareness levels characterized by misconception of FGS being a sexually transmitted infection (STI). The lack of awareness was compounded by the overlapping clinical presentations with common STIs, which are often associated with social stigma. Furthermore, verbal responses from local participants indicated that persistent symptoms associated with FGS led to negative hospital health-seeking behaviors. These behaviors were shaped by frequent antibiotic mis-prescriptions from healthcare professionals, which often did not alleviate symptoms, leading to diminished trust in the healthcare system. Overall, this study represents an initial effort in tackling the underrecognized impact of FGS in rural Chad and recommends training of local healthcare professionals on diagnosis and treatment of the condition, as well as implementing culturally appropriate messaging to address knowledge gap about FGS and improvement of WaSH infrastructures to limit water exposure.
SN  - 1935-2735
SN  - 1935-2727
ER  -