{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:45:57Z","timestamp":1793195157591,"version":"4.5.0"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T00:00:00Z","timestamp":1696809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Female genital schistosomiasis (FGS) is a neglected disease with long-term physical and psychosocial consequences, affecting approximately 50 million women worldwide and generally representing an unmet medical need on a global scale. FGS is the chronic manifestation of a persistent infection with <jats:italic>Schistosoma haematobium<\/jats:italic>. FGS services are not routinely offered in endemic settings with a small percentage of women at risk receiving adequate care. Madagascar has over 60% prevalence of FGS and no guidelines for the management of the disease. This study aimed to determine FGS knowledge among women and health care workers (HCWs) in a highly endemic area of Madagascar.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A convenience sampling strategy was used for this cross-sectional study. Descriptive statistics including proportions and 95% confidence intervals (CI) were calculated, reporting socio-demographic characteristics of the population. Knowledge sources were evaluated descriptively. Binary Poisson regression with robust standard errors was performed; crude (CPR) and adjusted prevalence ratio (APR) with 95% CIs were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 783 participants were included in the study. Among women, 11.3% (<jats:italic>n<\/jats:italic>\u2009=\u200978) were aware of FGS while among the HCWs 53.8% (<jats:italic>n<\/jats:italic>\u2009=\u200950) were aware of FGS. The highest level of knowledge was observed among women in an urban setting [24%, (<jats:italic>n<\/jats:italic>\u2009=\u200931)] and among those with a university education\/vocational training [23% (<jats:italic>n<\/jats:italic>\u2009=\u200913)]. A lower APR of FGS knowledge was observed in peri-urban [APR 0.25 (95% CI: 0.15; 0.45)] and rural [APR 0.37 (95% CI 0.22; 0.63)] settings in comparison to the urban setting. Most HCWs reported other HCWs [40% (<jats:italic>n<\/jats:italic>\u2009=\u200920)] while women mainly reported their family [32% (<jats:italic>n<\/jats:italic>\u2009=\u200925)] as being their main source of information in the 6\u2009months prior to the survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and conclusions<\/jats:title><jats:p>Our study shows limited awareness and knowledge of FGS among population groups in the highly endemic Boeny region of Madagascar. With this study we contribute to identifying an important health gap in Madagascar, which relates to a disease that can silently affect millions of women worldwide. In alignment with the targets of the NTD roadmap, addressing schistosomiasis requires a paradigm shift for its control and management including a greater focus on chronic forms of the disease.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2023.1278974","type":"journal-article","created":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T11:42:18Z","timestamp":1696851738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Awareness and knowledge of female genital schistosomiasis in a population with high endemicity: a cross-sectional study in Madagascar"],"prefix":"10.3389","volume":"14","author":[{"given":"Pia","family":"Rausche","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rivo Andry","family":"Rakotoarivelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Rakotozandrindrainy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rivo Solotiana","family":"Rakotomalala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya","family":"Ratefiarisoa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahinamandranto","family":"Rasamoelina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Kutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Jaeger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannick","family":"Hoeppner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Lorenz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"May","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dewi Ismajani","family":"Puradiredja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Fusco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0008149","DOI":"10.1371\/journal.pntd.0008149","article-title":"Understanding the role of disease knowledge and risk perception in shaping preventive behavior for selected vector-borne diseases in Guyana","volume":"14","author":"Aerts","year":"2020","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1080\/10810730902806760","article-title":"Peer-to-peer communication, cancer prevention, and the internet","volume":"14","author":"Ancker","year":"2009","journal-title":"J. Health Commun."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.ajog.2019.02.033","article-title":"Assessing research gaps and unmet needs in endometriosis","volume":"221","author":"As-Sanie","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0169388","DOI":"10.1371\/journal.pone.0169388","article-title":"Barriers and facilitators of screening for sexually transmitted infections in adolescent girls and young women in Mombasa, Kenya: a qualitative study","volume":"12","author":"Avuvika","year":"2017","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e0260555","DOI":"10.1371\/journal.pone.0260555","article-title":"Peer- and community-led responses to HIV: a scoping review","volume":"16","author":"Ayala","year":"2021","journal-title":"PLoS One"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2288-3-21","article-title":"Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio","volume":"3","author":"Barros","year":"2003","journal-title":"BMC Med. Res. Methodol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1016\/S1473-3099(16)00175-4","article-title":"Outbreak of urogenital schistosomiasis in Corsica (France): an epidemiological case study","volume":"16","author":"Boissier","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e330","DOI":"10.1016\/S1473-3099(19)30160-4","article-title":"More medicines alone cannot ensure the treatment of neglected tropical diseases","volume":"19","author":"Chami","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1093\/jac\/dkac251","article-title":"Unmet needs and practical solutions in the management of invasive mould infections in Asia","volume":"77","author":"Chen","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.ijpara.2016.02.006","article-title":"Female genital schistosomiasis (FGS): from case reports to a call for concerted action against this neglected gynaecological disease","volume":"46","author":"Christinet","year":"2016","journal-title":"Int. J. Parasitol."},{"key":"ref11","volume-title":"The RCSI sample size handbook","author":"Conroy","year":"2018"},{"key":"ref12","volume-title":"Troisi\u00e8me recensement g\u00e9n\u00e9ral de la population et de l\u2019habitation (RGPH-3)","year":"2021"},{"key":"ref13","doi-asserted-by":"crossref","DOI":"10.31235\/osf.io\/m7kpu","article-title":"Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases","author":"de Rijk","year":"2021"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"615","DOI":"10.2471\/BLT.20.252270","article-title":"Integration of prevention and control measures for female genital schistosomiasis, HIV and cervical cancer","volume":"98","author":"Engels","year":"2020","journal-title":"Bull. World Health Organ."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e1001991","DOI":"10.1371\/journal.pmed.1001991","article-title":"Building learning health systems to accelerate research and improve outcomes of clinical Care in low- and middle-income countries","volume":"13","author":"English","year":"2016","journal-title":"PLoS Med."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e0006484","DOI":"10.1371\/journal.pntd.0006484","article-title":"Schistosomiasis in Africa: improving strategies for long-term and sustainable morbidity control","volume":"12","author":"French","year":"2018","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s40249-023-01094-z","article-title":"Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study","volume":"12","author":"Gruninger","year":"2023","journal-title":"Infect. Dis. Poverty"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1016\/S0140-6736(06)69440-3","article-title":"Human schistosomiasis","volume":"368","author":"Gryseels","year":"2006","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s13012-017-0555-2","article-title":"The physician\u2019s experience of changing clinical practice: a struggle to unlearn","volume":"12","author":"Gupta","year":"2017","journal-title":"Implement. Sci."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J. Biomed. Inform."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.1056\/NEJMp1914709","article-title":"Female genital schistosomiasis","volume":"381","author":"Hotez","year":"","journal-title":"N. Engl. J. Med."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e0007025","DOI":"10.1371\/journal.pntd.0007025","article-title":"Female genital schistosomiasis and HIV\/AIDS: reversing the neglect of girls and women","volume":"13","author":"Hotez","year":"","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/AOG.0000000000000025","article-title":"Helminth infections: a new global Women\u2019s health agenda","volume":"123","author":"Hotez","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref25","year":"2022"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"105","DOI":"10.4082\/kjfm.18.0107","article-title":"Religion and health behaviors in primary care patients","volume":"41","author":"Kang","year":"2020","journal-title":"Korean J. Fam. Med."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.pt.2011.10.008","article-title":"A review of female genital schistosomiasis","volume":"28","author":"Kjetland","year":"2012","journal-title":"Trends Parasitol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.ijgo.2014.07.014","article-title":"Classification of the lesions observed in female genital schistosomiasis","volume":"127","author":"Kjetland","year":"2014","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/S1473-3099(21)00090-6","article-title":"Effect of preventive chemotherapy with praziquantel on schistosomiasis among school-aged children in sub-Saharan Africa: a spatiotemporal modelling study","volume":"22","author":"Kokaliaris","year":"2022","journal-title":"Lancet Infect. Dis."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e0007207","DOI":"10.1371\/journal.pntd.0007207","article-title":"A major hurdle in the elimination of urogenital schistosomiasis revealed: identifying key gaps in knowledge and understanding of female genital schistosomiasis within communities and local health workers","volume":"13","author":"Kukula","year":"2019","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1186\/s13071-020-04409-3","article-title":"The impact of mass drug administration on schistosoma haematobium infection: what is required to achieve morbidity control and elimination?","volume":"13","author":"Kura","year":"2020","journal-title":"Parasit. Vectors"},{"key":"ref340","doi-asserted-by":"publisher","DOI":"10.1186\/s40249-023-01139-3","article-title":"Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study","volume":"12","author":"Kutz","year":"2023","journal-title":"Infect. Dis. Poverty."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.cnur.2020.05.002","article-title":"The stigma of sexually transmitted infections","volume":"55","author":"Lee","year":"2020","journal-title":"Nurs. Clin. North Am."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e1414","DOI":"10.1016\/S2214-109X(19)30346-8","article-title":"Improving public health control of schistosomiasis with a modified WHO strategy: a model-based comparison study","volume":"7","author":"Li","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1007\/s10461-021-03518-z","article-title":"A systematic review of HIV testing implementation strategies in sub-Saharan African countries","volume":"26","author":"Mannoh","year":"2022","journal-title":"AIDS Behav."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1111\/jocn.15661","article-title":"Peer learning and collaborative placement models in health care: a systematic review and qualitative synthesis of the literature","volume":"30","author":"Markowski","year":"2021","journal-title":"J. Clin. Nurs."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e0000007","DOI":"10.1371\/journal.pgph.0000007","article-title":"Female genital schistosomiasis (FGS) in Cameroon: a formative epidemiological and socioeconomic investigation in eleven rural fishing communities","volume":"1","author":"Masong","year":"2021","journal-title":"PLOS Glob. Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1604767","DOI":"10.3389\/ijph.2022.1604767","article-title":"Healthcare workers\u2019 low knowledge of female genital schistosomiasis and proposed interventions to prevent, control, and manage the disease in Zanzibar","volume":"67","author":"Mazigo","year":"","journal-title":"Int. J. Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e0009789","DOI":"10.1371\/journal.pntd.0009789","article-title":"\u201cWe know about schistosomiasis but we know nothing about FGS\u201d: a qualitative assessment of knowledge gaps about female genital schistosomiasis among communities living in Schistosoma haematobium endemic districts of Zanzibar and northwestern Tanzania","volume":"15","author":"Mazigo","year":"2021","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e0000059","DOI":"10.1371\/journal.pgph.0000059","article-title":"\u201cFemale genital schistosomiasis is a sexually transmitted disease\u201d: gaps in healthcare workers\u2019 knowledge about female genital schistosomiasis in Tanzania","volume":"2","author":"Mazigo","year":"","journal-title":"PLOS Glob. Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1038\/s41572-018-0013-8","article-title":"Schistosomiasis","volume":"4","author":"McManus","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1080\/13625187.2018.1465546","article-title":"Are there unmet needs in contraceptive counselling and choice? Findings of the European TANCO study","volume":"23","author":"Merki-Feld","year":"2018","journal-title":"Eur J Contracept Reprod Health Care"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1186\/s12909-023-04427-6","article-title":"Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review","volume":"23","author":"Merry","year":"2023","journal-title":"BMC Med. Educ."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"382","DOI":"10.3390\/tropicalmed7110382","article-title":"Establishing and integrating a female genital schistosomiasis control programme into the existing health care system","volume":"7","author":"Nemungadi","year":"2022","journal-title":"Trop. Med. Infect. Dis."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e3229","DOI":"10.1371\/journal.pntd.0003229","article-title":"The Colposcopic atlas of schistosomiasis in the lower female genital tract based on studies in Malawi, Zimbabwe, Madagascar and South Africa","volume":"8","author":"Norseth","year":"2014","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s40249-017-0361-8","article-title":"Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond","volume":"6","author":"Ortu","year":"2017","journal-title":"Infect. Dis. Poverty"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.ijid.2020.10.088","article-title":"Association of schistosomiasis and HIV infections: a systematic review and meta-analysis","volume":"102","author":"Patel","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref47","first-page":"342","article-title":"Use of contraceptives and unmet need for family planning among tribal women in India and selected hilly states","volume":"32","author":"Prusty","year":"2014","journal-title":"J. Health Popul. Nutr."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e012598","DOI":"10.1136\/bmjgh-2023-012598","article-title":"Schistosomiasis elimination in Madagascar: challenges and opportunities for implementing the new WHO guidelines","volume":"8","author":"Rasoamanamihaja","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1097\/OLQ.0b013e3181685855","article-title":"Association of sexually transmitted disease-related stigma with sexual health care among women attending a community clinic program","volume":"35","author":"Rusch","year":"2008","journal-title":"Sex. Transm. Dis."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e0010901","DOI":"10.1371\/journal.pntd.0010901","article-title":"Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: a qualitative study on disease perception, health impairment and social impact","volume":"16","author":"Schuster","year":"2022","journal-title":"PLoS Negl. Trop. Dis."},{"key":"ref51","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12875-023-01979-w","article-title":"The effect of peer-to-peer education on health literacy, knowledge, and adherence to COVID-19 protocols in vulnerable adolescents","volume":"24","author":"Shoghli","year":"2023","journal-title":"BMC Prim. Care"},{"key":"ref52","article-title":"Global health: Madagascar","year":"2022"},{"key":"ref53","volume-title":"No more neglect female genital schistosomiasis and HIV","year":"2019"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1016\/j.jval.2019.07.007","article-title":"Unmet medical need: an introduction to definitions and stakeholder perceptions","volume":"22","author":"Vreman","year":"2019","journal-title":"Value Health"},{"key":"ref55","article-title":"Female genital schistosomiasis: a pocket atlas for clinical health-care professionals","year":"2015"},{"key":"ref56","volume-title":"Ending the neglect to attain the sustainable development goals: a sustainability framework for action against neglected tropical diseases 2021\u20132030","year":"2021"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1186\/s12916-020-01613-x","article-title":"The challenges of colposcopy for cervical cancer screening in LMICs and solutions by artificial intelligence","volume":"18","author":"Xue","year":"2020","journal-title":"BMC Med."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s40258-021-00655-3","article-title":"Towards a new understanding of unmet medical need","volume":"19","author":"Zhang","year":"2021","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/S1473-3099(21)00448-5","article-title":"Global burden and trends of sexually transmitted infections from 1990 to 2019: an observational trend study","volume":"22","author":"Zheng","year":"2022","journal-title":"Lancet Infect. Dis."}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2023.1278974\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,9]],"date-time":"2023-10-09T11:42:30Z","timestamp":1696851750000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2023.1278974\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,9]]},"references-count":60,"alternative-id":["10.3389\/fmicb.2023.1278974"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2023.1278974","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,9]]},"article-number":"1278974"}}