"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.

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.