article · PLoS neglected tropical diseases
Female genital schistosomiasis remains under-recognised in endemic areas due to limited access to appropriate diagnostics. A cross-sectional investigation of 695 women in KwaZulu-Natal, South Africa, examined the prevalence and predictors of self-reported symptoms indicative of the disease. Overall, 45.9 percent of participants reported experiencing at least one suggestive symptom, with the highest prevalence of 53.2 percent found among women aged 30 to 39 years. Lower abdominal pain and vaginal itching were the most frequently identified complaints, reported by 40.8 percent and 34.5 percent of symptomatic women, respectively. Statistical analysis demonstrated that religious affiliation, income source, and prior awareness of female genital schistosomiasis were significantly associated with symptom reporting. These findings indicate a high symptom burden in the region, underscoring the potential utility of integrating standardised symptom screening into primary reproductive care.
Female genital schistosomiasis is a neglected tropical disease that frequently goes undetected due to a lack of diagnostic tools. Highlighting that almost half of women in an endemic area experience suggestive symptoms shows the scale of the burden. It provides public health programmes with straightforward evidence to improve frontline screening, raise disease awareness, and establish earlier clinical referral pathways in affected communities.
The findings support the design of symptom-based screening algorithms and digital health triage tools for community health workers and reproductive clinics. This is early-stage applied research: while no commercial diagnostic device was tested, the identified symptom profiles and risk predictors could inform public health software developers and primary care service providers looking to build validated clinical decision-support tools for low-resource endemic settings.
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BACKGROUND: Female genital schistosomiasis (FGS) is a neglected tropical disease affecting women and girls in schistosomiasis-endemic areas. However, it remains under-recognised because of limited access to FGS-appropriate diagnostic approaches. Symptom-based reporting is often used to estimate the burden of FGS. This study aimed to determine the prevalence and identify the associated risk factors of self-reported FGS-suggestive symptoms among women in KwaZulu-Natal, South Africa. METHODS: A cross-sectional study was conducted from June to August 2025 using a structured, interviewer-administered questionnaire. 713 women were enrolled, of whom 695 provided complete data and were included in the analysis. Data were processed and analysed using Stata 19.5 SE. Descriptive statistics were used to summarise the data. The Pearson chi-square test was used to assess the association between sociodemographic characteristics and symptoms suggestive of FGS, and a multivariable logistic regression model was used to identify the independent predictors of these symptoms. Wald tests were used to assess the overall significance of the predictors, and model fit was evaluated using the Hosmer-Lemeshow test. RESULTS: Overall, 45.9% (95%CI: 42.2-49.6) reported experiencing ≥1 suggestive FGS symptom, and this differed across age groups, with the highest proportion observed in the 30-39 years age group (53.2%; 95% CI: 46.6-59.8). Lower abdominal pain (n = 130; 40.8%) and vaginal itching (n = 110; 34.5%) were the most common symptoms. In the overall model, religious affiliation (p = 0.001), income source (p < 0.001), and awareness of FGS (p < 0.001) were statistically significantly associated with reporting symptoms suggestive of FGS. CONCLUSION: Nearly half of the women in this schistosomiasis-endemic setting reported FGS-suggestive symptoms, providing important evidence for incorporating symptom screening into existing reproductive and community health worker guidelines to strengthen the early detection and referral of women at risk of FGS.
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DOI: 10.1371/journal.pntd.0014633
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