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Abstract：
BACKGROUND: Schistosomiasis is a debilitating neglected tropical disease endemic in sub-Saharan Africa. The role of health facilities in the prevention, diagnosis, control, and elimination of schistosomiasis is poorly documented. In a setting targeted for schistosomiasis elimination in Zanzibar, we assessed the prevalence of Schistosoma haematobium among patients seeking care in a health facility and investigated schistosomiasis-related knowledge of staff, and health facilities\' capacities and needs for schistosomiasis diagnosis and management.
METHODS: We conducted a health facility-based mixed-method study on Pemba Island from June to August 2023. Patients aged ≥ 4 years seeking care in four health facilities were screened for S. haematobium infection using urine filtration and reagent strips. Those patients aged ≥ 10 years were additionally interviewed about signs and symptoms. Staff from 23 health facilities responded to a questionnaire assessing knowledge and practices. Ten staff participated in a focus group discussion (FGD) about capacities and needs for schistosomiasis diagnosis and management.
RESULTS: The prevalence of S. haematobium infection in patients attending the health facilities, as determined by the presence of eggs in urine, was 1.1% (8/712). Microhaematuria was detected in 13.3% (95/712) of the patients using reagent strips. Among patients responding to the questionnaire, pelvic pain, pain during sex, and painful urination were reported by 38.0% (237/623), 6.3% (39/623), and 3.2% (20/623), respectively. Among the health facility staff, 90.0% (44/49) and 87.8% (43/49) identified blood in urine and pelvic pain, respectively, as symptoms of urogenital schistosomiasis, 81.6% (40/49) and 93.9% (46/49) reported collecting a urine sample and pursuing a reagent strip test, respectively, for diagnosis, and 87.8% (43/49) administered praziquantel for treatment. The most reoccurring themes in the FGD were the need for more staff training about schistosomiasis, requests for diagnostic equipment, and the need to improve community response to schistosomiasis services in health facilities.
CONCLUSIONS: The prevalence of S. haematobium infection in patients seeking care in health facilities in Pemba is very low and similar to what has been reported from recent community-based cross-sectional surveys. The health facility staff had good schistosomiasis-related knowledge and practices. However, to integrate schistosomiasis patient management more durably into routine health facility activities, scalable screening pathways need to be identified and capacities need to be improved by regular staff training, and an unbroken supply of accurate point-of-care diagnostics and praziquantel for the treatment of cases.
METHODS: We conducted a health facility-based mixed-method study on Pemba Island from June to August 2023. Patients aged ≥ 4 years seeking care in four health facilities were screened for S. haematobium infection using urine filtration and reagent strips. Those patients aged ≥ 10 years were additionally interviewed about signs and symptoms. Staff from 23 health facilities responded to a questionnaire assessing knowledge and practices. Ten staff participated in a focus group discussion (FGD) about capacities and needs for schistosomiasis diagnosis and management.
RESULTS: The prevalence of S. haematobium infection in patients attending the health facilities, as determined by the presence of eggs in urine, was 1.1% (8/712). Microhaematuria was detected in 13.3% (95/712) of the patients using reagent strips. Among patients responding to the questionnaire, pelvic pain, pain during sex, and painful urination were reported by 38.0% (237/623), 6.3% (39/623), and 3.2% (20/623), respectively. Among the health facility staff, 90.0% (44/49) and 87.8% (43/49) identified blood in urine and pelvic pain, respectively, as symptoms of urogenital schistosomiasis, 81.6% (40/49) and 93.9% (46/49) reported collecting a urine sample and pursuing a reagent strip test, respectively, for diagnosis, and 87.8% (43/49) administered praziquantel for treatment. The most reoccurring themes in the FGD were the need for more staff training about schistosomiasis, requests for diagnostic equipment, and the need to improve community response to schistosomiasis services in health facilities.
CONCLUSIONS: The prevalence of S. haematobium infection in patients seeking care in health facilities in Pemba is very low and similar to what has been reported from recent community-based cross-sectional surveys. The health facility staff had good schistosomiasis-related knowledge and practices. However, to integrate schistosomiasis patient management more durably into routine health facility activities, scalable screening pathways need to be identified and capacities need to be improved by regular staff training, and an unbroken supply of accurate point-of-care diagnostics and praziquantel for the treatment of cases.
摘要：
背景：血吸虫病是撒哈拉以南非洲特有的一种使人衰弱的被忽视的热带病。卫生设施在预防中的作用，诊断,control,消除血吸虫病的文献很少。在旨在消除桑给巴尔血吸虫病的环境中，我们评估了在医疗机构寻求治疗的患者中的血吸虫病患病率，并调查了工作人员的血吸虫病相关知识，以及医疗设施对血吸虫病诊断和管理的能力和需求。
方法：我们于2023年6月至8月在奔巴岛进行了基于医疗机构的混合方法研究。使用尿液过滤和试剂条筛查了在四个医疗机构寻求护理的≥4岁的患者是否感染了血杆菌。那些年龄≥10岁的患者还接受了关于体征和症状的访谈。来自23个医疗机构的工作人员回答了评估知识和实践的问卷。十名工作人员参加了关于血吸虫病诊断和管理的能力和需求的焦点小组讨论（FGD）。
结果：在医疗机构就诊的患者中，根据尿液中的卵子的存在，为1.1%（8/712）。使用试剂条在13.3％（95/712）的患者中检测到微血尿。在回答问卷的患者中，盆腔疼痛,性爱时的疼痛,尿痛报告为38.0%(237/623)，6.3%（39/623），和3.2%(20/623)，分别。在医疗机构的工作人员中，90.0％（44/49）和87.8％（43/49）确定尿液中的血液和骨盆疼痛，分别,作为泌尿生殖道血吸虫病的症状，81.6％（40/49）和93.9％（46/49）报告收集尿液样本并进行试剂条测试，分别,为了诊断，87.8%(43/49)给予吡喹酮治疗。FGD中最反复出现的主题是需要更多有关血吸虫病的员工培训，诊断设备的请求，以及需要改善卫生机构对血吸虫病服务的社区反应。
结论：在奔巴的医疗机构寻求治疗的患者中，嗜血杆菌感染率非常低，与最近基于社区的横断面调查所报告的情况相似。医疗机构工作人员具有良好的血吸虫病相关知识和实践。然而,将血吸虫病患者管理更持久地纳入常规医疗机构活动，需要确定可扩展的筛查途径，需要通过定期员工培训来提高能力，以及不间断地提供准确的即时诊断和吡喹酮，用于治疗病例。
方法：我们于2023年6月至8月在奔巴岛进行了基于医疗机构的混合方法研究。使用尿液过滤和试剂条筛查了在四个医疗机构寻求护理的≥4岁的患者是否感染了血杆菌。那些年龄≥10岁的患者还接受了关于体征和症状的访谈。来自23个医疗机构的工作人员回答了评估知识和实践的问卷。十名工作人员参加了关于血吸虫病诊断和管理的能力和需求的焦点小组讨论（FGD）。
结果：在医疗机构就诊的患者中，根据尿液中的卵子的存在，为1.1%（8/712）。使用试剂条在13.3％（95/712）的患者中检测到微血尿。在回答问卷的患者中，盆腔疼痛,性爱时的疼痛,尿痛报告为38.0%(237/623)，6.3%（39/623），和3.2%(20/623)，分别。在医疗机构的工作人员中，90.0％（44/49）和87.8％（43/49）确定尿液中的血液和骨盆疼痛，分别,作为泌尿生殖道血吸虫病的症状，81.6％（40/49）和93.9％（46/49）报告收集尿液样本并进行试剂条测试，分别,为了诊断，87.8%(43/49)给予吡喹酮治疗。FGD中最反复出现的主题是需要更多有关血吸虫病的员工培训，诊断设备的请求，以及需要改善卫生机构对血吸虫病服务的社区反应。
结论：在奔巴的医疗机构寻求治疗的患者中，嗜血杆菌感染率非常低，与最近基于社区的横断面调查所报告的情况相似。医疗机构工作人员具有良好的血吸虫病相关知识和实践。然而,将血吸虫病患者管理更持久地纳入常规医疗机构活动，需要确定可扩展的筛查途径，需要通过定期员工培训来提高能力，以及不间断地提供准确的即时诊断和吡喹酮，用于治疗病例。
