Schistosomiasis control in Ghana: case management and means for diagnosis and treatment within the health system

An essential component of integrated schistosomiasis control as promoted by WHO is adequate clinical care for patients presenting at health care facilities. We evaluated the functioning of the Ghanaian health system for diagnosis and treatment of schistosomiasis by interviewing health workers from 70 health care facilities in 4 geographical areas in April and May 2000. Results from presentation of 4 hypothetical cases and a subsequent interview demonstrated that patients presenting with symptoms related to schistosomiasis have a small chance of receiving adequate treatment: often health workers do not recognize the symptoms, especially those of Schistosoma mansoni; patients are frequently referred for a diagnostic test or treatment with a large risk of non-compliance; and praziquantel was not available in 78% of the health care facilities with reported schistosomiasis in their coverage area. The overall cost of treatment is considerable: €2.13 for S. haematobium and €1.81 for S. mansoni patients, with drug costs contributing approximately 40% of the total cost. To better meet WHO recommendations for passive case detection as part of integrated schistosomiasis control, the Ghanaian health system needs to emphasize training of health workers in schistosomiasis case recognition and case management and increase the availability of praziquantel. Experience from other West African countries indicate that this is feasible.