# Institutionalising urogenital schistosomiasis surveillance: Best practices to improve female genital and urinary schistosomiasis control in South Africa

## TL;DR

This paper discusses how South Africa can improve surveillance and control of urogenital and female genital schistosomiasis by integrating it into existing health systems.

## Contribution

The paper identifies opportunities to institutionalize surveillance best practices for schistosomiasis, particularly female genital schistosomiasis, in South Africa.

## Key findings

- Existing surveillance systems in South Africa report urogenital schistosomiasis but not female genital schistosomiasis.
- Most cases are reported from public health facilities, indicating a need for improved reporting and integration.
- Integrating surveillance into reproductive health services could enhance detection and management of the disease.

## Abstract

In the absence of an active schistosomiasis control programme, the affected community is vulnerable to complications such as female genital schistosomiasis. Research has shown that female genital schistosomiasis is a challenge faced by many African women including those from South Africa. Since 2008, the South African National Department of Health has been trying to resuscitate the schistosomiasis control programme; the programme has not been fully established or implemented. However, there are some surveillance best practices that the country can institutionalise to improve control.

A descriptive analysis of urogenital schistosomiasis data from the National Health Laboratory Services, Notifiable Medical Conditions Surveillance System, and District Health Information System was conducted in 2023. A document review was also carried out in 2023 to determine surveillance best practices to guide the establishment of sentinel sites for improving schistosomiasis and female genital schistosomiasis control.

The Health Laboratory Services, Notifiable Medical Conditions Surveillance System, and District Health Information System are the existing surveillance and reporting systems. According to the Notifiable Medical Conditions Surveillance System (the overall and central notification system for the notifiable medical conditions), a total of 56529 urogenital schistosomiasis cases were reported nationwide between 2017 and 2021 (ranging from annual cases of 4140–15032). Most cases (>90%) were reported from public health facilities. The country’s Regulations on the surveillance and control of notifiable medical conditions stipulate that schistosomiasis is one of the priority conditions that should be notified (within 7 days of clinical or laboratory diagnosis) by all public and private health care providers, as well as public and private health laboratories. The Regulations did not specify female genital schistosomiasis as one of the notifiable medical conditions. As a result, there was no reported data on female genital schistosomiasis and true burden was not known.

The data collected through the National Health Laboratory Services, Notifiable Medical Conditions Surveillance System, and District Health Information System demonstrate that there are formalised schistosomiasis reporting systems, but no female genital schistosomiasis reporting. The existence and use of these surveillance systems demonstrate the country’s potential to integrate the systems to enhance the prevention, surveillance, reporting, and management of schistosomiasis and introduction of surveillance for female genital schistosomiasis surveillance. Prioritisation of urogenital schistosomiasis and female genital schistosomiasis surveillance is paramount and will generate valuable information that will guide the review and implementation of the current and old policies that were developed by the National Department of Health and stakeholders.

Urogenital schistosomiasis and female genital schistosomiasis continue to be among the neglected tropical diseases, posing challenges in accurately determining the true burden of these diseases. Female genital schistosomiasis, a gynaecological manifestation of Schistosoma haematobium, affects a significant number of women and young girls in regions where schistosomiasis is endemic. Some women suffering from female genital schistosomiasis are frequently misdiagnosed with conditions such as human papilloma virus (HPV) or other sexually transmitted infections (STIs). Integrating the surveillance of these neglected diseases into existing healthcare programmes, such as cervical cancer screening and HIV/STI and existing reproductive health services, offers opportunities for a comprehensive approach to patient screening and disease control. This study outlines the current neglected tropical diseases programme in South Africa and identifies opportunities for enhancing surveillance. Despite the neglect and challenges related to sustainability and under-reporting, the presence and utilization of surveillance systems in South Africa highlight the country’s potential for prioritization and integration to improve the prevention, surveillance, reporting, and management of schistosomiasis, as well as the introduction of surveillance for female genital schistosomiasis. Furthermore, establishing sentinel sites would provide opportunities to establish baseline prevalence and enhance monitoring of progress towards elimination.