Addressing Urogenital and Female Genital Schistosomiasis among Teenagers in Anambra State, Nigeria: A Cross-sectional Study
Authors: Aribodor *Ogechukwu B. , Azugo Nwadiuto O. , Jacob Eunice C. , Ngenegbo Uche C. , Onwusulu Nnaemeka D. , Obika Ifeanyi , Obikwelu Emmanuel M. , Nebe Obiageli J. 
Published: October 2023

Background
Urogenital schistosomiasis (UgS) remains a persistent health challenge among adolescents in Anambra State, Nigeria, despite ongoing control efforts. Since 2013, mass praziquantel treatment programs have primarily targeted school-aged children (5-14 years), leaving teenagers susceptible to Schistosoma haematobium infection. Additionally, the extent of female genital schistosomiasis (FGS), a neglected gynaecological manifestation of UgS remains unclear.
Methodology
To address these gaps, our study conducted a comprehensive investigation in Anaocha Local Government Area between February and May 2023. Using stratified random sampling, we enrolled 470 teenagers (aged 10-19 years old). The study involved urinalysis tests for haematuria and microscopic detection of S. haematobium eggs via polycarbonate membrane filters. For females with heavy infections (≥ 50 eggs/10 ml urine), we performed colposcopy examinations of the cervicovaginal canal, complemented by acetic acid and Lugol's iodine staining for comprehensive sexual and reproductive health assessments. Data collection employed Kobo ToolBox software, following guidelines from the COUNTDOWN Consortium on FGS, ensuring gender-sensitive data collection. Our data underwent rigorous analysis using SPSS version 25, incorporating descriptive statistics, multinomial logistic regression, odds ratios, and significance testing.
Results
Unveiling our findings, we noted UgS prevalence of 14.5% with an average infection intensity of 5.25 eggs/10 ml urine. While females exhibited a slightly higher prevalence (16.1%), with 7.5% of females enduring heavy infection burdens, the gender difference was not statistically significant. However, males showed higher odds of infection (OR: 1.332; 95% CI: 0.791-2.244; p-value: 0.280). Colposcopy examinations showed FGS lesions as well as co-infection with Trichomonas vaginalis. Teenagers aged 10-14 had the highest prevalence, with significantly higher odds of infection (OR: 1720; 95% CI: 1.012-2.923; p-value: 0.045). Haematuria, though prevalent (24.6%), was not the sole indicator, as those without it faced significantly higher odds of infection (OR: 2.924; 95% CI: 1.731-4.941; p-value: 0.000). Dysuria and genital itching/burning were other UgS-associated symptoms identified. Remarkably, a 17-year-old girl with an FGS-positive diagnosis who reported severe itching was found to have Pthirus pubis (pubic louse) in her urine. This uncommon occurrence is likely due to close contact with an infected person or animal. Direct water contact was associated with higher infection odds (OR: 2.601; 95% CI: 1.007-6.716; p-value: 0.048). Co-infections with cercarial dermatitis further emphasized the risks, especially among individuals with extended water contact histories.
Various risk factors were associated with UgS, including the purpose of waterbody visits, duration of freshwater exposure, awareness of UgS and FGS, deworming history, comfort in discussing genital health, and confidantes for such discussions.
Conclusion
The alarmingly high rates of UgS and FGS among teenagers in Anambra State call for integrated interventions, behaviour change campaigns, improved awareness, cost-effective diagnostics and treatments, and the training of healthcare workers in a people-centered approach. Our goal is to eliminate the neglect of marginalized populations and strive for disease elimination by 2030.