Acceptability and feasibility of integrating female genital schistosomiasis and sexual and reproductive health interventions in Kenya A demonstration study

Female genital schistosomiasis (FGS) is a neglected gynaecological condition that is a manifestation of chronic urogenital schistosomiasis. This disease has significant implications for the reproductive health and overall well-being of women and girls, especially in areas with limited access to water, sanitation, and hygiene (WASH). In Kenya, where urogenital schistosomiasis is endemic, the burden of FGS and how to best address it within existing sexual and reproductive health (SRH) services has not been fully explored. This mixed-methods study applied an implementation research approach to assess the feasibility and acceptability of integrating FGS services into routine SRH interventions across public health facilities in three high schistosomiasis endemic counties in Kenya. The intervention included implementing a minimum service package, between December 2023 and December 2024, encompassing health literacy, screening, diagnosis, and treatment. A total of 8,856 women were screened for FGS, with an overall estimated positivity rate of 27.7% (95% CI [26.7, 28.7]). A quantitative survey with a subset of 1,041 clients revealed high acceptability of integration 98.8% (95% CI [98, 99.3]). Integration enabled diagnosis and highlighted a hidden burden of FGS. Qualitative findings revealed significant gaps in knowledge and awareness, stigma-related barriers, and the absence of standardised indicators in the Kenya Health Information System (KHIS), which hampers effective data collection, reporting, and resource planning, including procurement of praziquantel. These findings show the urgent need for health system improvements, including the integration of standardised FGS indicators into the KHIS, to support surveillance, preparedness, and equitable resource distribution, the need for inclusion of FGS within medical training curricula, and for normative clinical guidance on FGS. The evidence supports scaling up FGS-SRH integration and positions MCH clinics and outreach programs as critical entry points.