Systemic and Capacity barriers to Female Genital Schistosomiasis management among healthcare workers in Ghana: A Mixed-Method Approach

Background Schistosomiasis causes significant morbidity in over 78 countries worldwide, including Ghana. In females, untreated urogenital schistosomiasis can lead to female genital schistosomiasis (FGS), which has a focal prevalence of 11% and 73% in Ghana and poses complex challenges for healthcare professionals. This study assessed the knowledge, attitudes, and practices of healthcare workers (HCWs) regarding FGS in two schistosomiasis-endemic districts. Methods A cross-sectional mixed-method study was conducted in 36 health facilities, involving 252 HCWs from the Lower Manya-Krobo (LMK) and Shai Osudoku districts (SOD). Quantitative data were analyzed using descriptive statistics, t-tests, and multivariable lineal regression (Stata 18). Additionally, 38 purposively selected HCWs were in interviewed, and qualitative data were analyzed thematically (NVivo 20). A joint display analysis was used to integrate findings. Results Significant gaps in FGS-related KAP were identified in both districts. HCWs in LMK had a lower mean knowledge score of 41.4 (95%CI 38.4–44.4) than those in SOD 55.9%, (95%CI 54.2–57.6). Practice scores were similarly low: 31.1% (95%CI 28.5–33.7) in LMK and 33.5% (95%CI 31.4–35.4) in SOD. HCWs reported hesitance to manage FGS due to limited knowledge, lack of training, absence of diagnostic tools, and unavailability of praziquantel. Only 4.8% of HCWs in LMK and 9.5% in SOD reported their facility could diagnose and manage FGS. KAP scores varied significantly by cadre, educational, years of experience, and work settings. Qualitative findings confirmed lack of FGS-specific interventions, including clinical guidelines and facility-level support. Participants recommended in-service training, integration of FGS into routine health education, and improved community sensitization. Conclusion The study reveals substantial gaps in HCWs KAP and preparedness to manage FGS in both districts exacerbated by a lack of systemic support, training, and resources. Addressing these gaps requires integrating FGS in health training curricula; regular in-service training for frontline HCWs; improved diagnostic and treatment capacity; community education; and strengthening district-level supervision. A multi-sectoral approach involving government, academia, civil society, and the private sectors is essential to improving FGS prevention and management in Ghana.