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

Abstract

Background: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.