Prevalence and associated risk factors of self-reported symptoms suggestive of female genital schistosomiasis (FGS) among women in KwaZulu-Natal, South Africa

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.