Towards elimination of genital schistosomiasis in Africa: Outlining strategic public health objectives and measures to protect future generations.

Urogenital schistosomiasis has 2 gender-specific manifestations, male genital schistosomiasis (MGS) and female genital schistosomiasis (FGS). The burdens of MGS and FGS are multifaceted, encompassing financial hardship, emotional and mental health problems and sometimes social stigmatization. Given the pernicious nature of sequelae in the genitalia, managing these chronic health conditions is expensive, difficult and problematic in resource poor settings. Key challenges include lack of epidemiological data on the burden of MGS and FGS, inadequate knowledge among primary and auxiliary health care workers, leading to misdiagnosis, incorrect treatment administration, e.g. overuse of antibiotics, and a lack of appropriate point-of-care diagnostic equipment. Prevention of MGS and FGS is therefore more preferable, however, current preventive programmes and chemotherapy campaigns offering praziquantel are becoming more resource constrained and in most endemic areas are not reaching at-risk adults (and adolescents), sufficiently. Furthermore, there are limited prospects for adequate access to treatment in pre-school children where infections can be first acquired. Therefore, we propose 3 key recommendations guiding movement towards elimination of schistosomiasis as a public health problem: scaling-up praziquantel treatment for other at-risk groups; developing a targeted One Health approach to reduce environmental transmission in both humans and animals; Multi-stakeholder collaboration and community engagement for effective implementation of Water Sanitation and Hygiene components of disease control. Whilst maintaining a school-based approach is still foundational, targeted and sustainable expansion of preventive chemotherapy to other at-risk groups within communities is needed to secure real prospects in elimination of genital schistosomiasis as a public health problem in Africa.