The control and elimination of schistosomiasis have over the last two decades involved several strategies, with the current strategy by the World Health Organization (WHO) focusing mainly on treatment with praziquantel during mass drug administration (MDA). However, the disease context is complex with an interplay of social, economic, political, and cultural factors that may affect achieving the goals of the Neglected Tropical Disease (NTD) 2021-2030 Roadmap. There is a need to revisit the current top-down and reactive approach to schistosomiasis control among sub-Saharan African countries and advocate for a dynamic and diversified approach. This paper highlights the challenges of praziquantel-focused policy for schistosomiasis control and new ways to move from schistosomiasis control to elimination in sub-Saharan Africa. We will also discuss an alternative and diversified approach that consists of a Systems Thinking Framework that embraces intersectoral collaboration fully and includes co-creating locally relevant strategies with affected communities. We propose that achieving the goals for control and elimination of schistosomiasis requires a bottom-up and pro-active approach involving multiple stakeholders. Such a pro-active integrated approach will pave the way for achieving the goals of the NTD 2021-2030 roadmap for schistosomiasis, and ultimately improve the wellbeing of those living in endemic areas.

Schistosomiasis is one of the Neglected Tropical Diseases that affects over 200 million people worldwide, of which 29 million people in Nigeria. The principal strategy for schistosomiasis in Nigeria is a control and elimination program which comprises a school-based Mass Drug Administration (MDA) with limitations of high re-infection rates and the exclusion of high-risk populations. The World Health Organization (WHO) recommends guided case management of schistosomiasis (diagnostic tests or symptom-based detection plus treatment) at the Primary Health Care (PHC) level to ensure more comprehensive morbidity control. However, these require experienced personnel with sufficient knowledge of symptoms and functioning laboratory equipment. Little is known about where, by whom and how diagnosis is performed at health facilities within the case management of schistosomiasis in Nigeria. Furthermore, there is a paucity of information on patients’ health-seeking behaviour from the onset of disease symptoms until a cure is obtained. In this study, we describe both perspectives in Oyo state, Nigeria and address the barriers using adapted health-seeking stages and access framework. The opportunities for improving case management were identified, such as a prevalence study of high-risk groups, community education and screening, enhancing diagnostic capacity at the PHC through point-of-care diagnostics and strengthening the capability of health workers.

Background: Schistosomiasis, one of the neglected tropical diseases, is a water-based parasitic disease of public health importance. Currently, tests for Schistosoma haematobium infection either demonstrate poor specificity, are expensive or too laborious for use in endemic countries, creating a need for more sensitive, cheaper, and easy to use devices for the diagnosis of schistosomiasis. To ensure engagement during the process of device development; and effective acceptance and use after the introduction of diagnostics devices for S. haematobium, there is a need to involve stakeholders with varying power, interest, and stakes in device co-creation, as well as those relevant for later use situation in the diagnostic landscape. The main goal of this study is to identify and analyze relevant stakeholders for co-creation using a power-interest matrix. Materials and Methods: The study was based on an action research methodology using a case study approach. A contextual inquiry approach consisting of 2 stages: stakeholder identification and interview; and stakeholder analysis was used. The field part of the study was carried out in Oyo State, Nigeria using a multistage cluster purposive sampling technique based on the category of stakeholders to be interviewed predicated on the organizational structure within the state and communities. A mix of qualitative research techniques was used. Identified themes related to power and interest were mapped and analyzed. Results: We identified 17 characteristics of stakeholders across 7 categories of stakeholders important for schistosomiasis diagnostics. Most of the stakeholders were important for both the co-creation and adoption phase of the device development for diagnostics. However, not all stakeholders were relevant to co-creation. Key Stakeholders relevant for diagnostics co-creation demonstrated significant social power, organization power, and legitimate power bases. Most of the stakeholders showed significant interest in the device to be created. Discussion: The power and interest of these stakeholders reveal some insight into how each stakeholder may be engaged for both co-creation and device usage. The involvement of relevant actors who will also be important for co-creation and implementation, will simplify the engagement process for the critical stakeholders, increase the ability to manage the process, and increase diagnostic device acceptability.

Objective: To evaluate inhaler sustainability in asthma and Chronic Obstructive Pulmomary Disease (COPD) by analysing how inhaler design typology, prescribing and usage patterns, disposal and recycling practices influence human health and environmental outcomes, using a People-Process-Product (PPP) framework to identify actionable opportunities for improvement. Design: A systematic review was conducted in May 2024, with reporting structured around the PPP framework using narrative synthesis. Data sources: MEDLINE, Scopus, Cochrane Library and relevant grey literature were searched for publications over the period from April 2014 to April 2024. Eligibility criteria: Studies were included if published between 2014 and 2024, involved patients with asthma or COPD and healthcare professionals and specifically examined aspects of inhaler sustainability, including patient behaviours, healthcare provider prescribing practices and environmental impacts. Data extraction and synthesis: Two independent reviewers screened and extracted data from 63 studies. Due to diverse methodologies, quality assessment focused on research design robustness, completeness of outcome reporting and potential biases. Findings were synthesised narratively to address each research question using the PPP framework. Results: 33% of included studies focused on two or more domains of the PPP framework as both primary and/or secondary outcomes. Studies mapped to the ‘People’ domain (n=34) showed limited awareness among patients and clinicians regarding the environmental impact of inhaler prescription patterns, use patterns and disposal methods, with over 75% of patients discarding inhalers in household waste. In the ‘Process’ domain (n=11), switching from pressurised metered-dose inhalers (pMDIs) to dry powder inhalers (DPIs) or soft mist inhalers (SMIs) was associated with improved inhaler adherence and asthma control, though uptake of new inhalers was influenced by patients’ prior experience, competence, proficiency and perceived usability. The ‘Product’ domain (n=41) showed that DPIs and SMIs consistently had lower carbon footprints than pMDIs, with short-acting beta-agonists (SABAs) pMDIs having the highest emissions due to prescription, use patterns and disposal. Conclusions: Improving patient education on sustainable inhaler use and disposal and providing healthcare professionals with focused training on low-carbon prescribing are critical steps towards achieving significant clinical benefits and supporting environmental sustainability in asthma and COPD management. PROSPERO registration number: CRD42024541927.

Designing new and inclusive diagnostic tools to detect Neglected Tropical Diseases (NTDs) to achieve rational disease control requires a co-design process where end-users’ input is important. Failure to involve all potential end-users in new diagnostics for NTDs can result in low use and adoption failure, leading to persistent infection hot spots and ineffective disease control. There are different categories of potential end-users of new diagnostic tools for NTD control, and it is unclear if there are differences between the user efficiency, effectiveness, perception, and acceptability across these end-user categories. This study evaluated the usability, user perception, contextual factors affecting the user’s experience, and acceptability of a new digital optical diagnostic device for NTDs across three types of potential end users. A total of 21 participants were tested. Laboratory scientists, technicians, and Community Health Extension Workers (CHEWs) in training achieved similar scores on the usability and user perception questionnaires with no statistically significant difference between end-user categories. All participants also have high scores for the user perception domains which strongly correlate with the acceptability of the AiDx NTDx Assist device. This study indicates that, by providing digital diagnostic tools in combination with minimal training and support, CHEWs undergoing training and, by extension, CHEWs post-training, can be involved in the diagnoses of NTDs, potentially enhancing a community’s capabilities to diagnose, treat, and control NTDs.

Schistosomiasis is a treatable and preventable neglected tropical disease of Public Health importance affecting over 200 million people worldwide while Nigeria is one of the high burden countries. Currently, available diagnostic tests are cumbersome, low in sensitivity and not field-adaptable given the high skills required that are not available in the rural settings where the diseases are majorly prevalent. There is an urgent need for an easy to use automated diagnostic device to replace the current gold standard, the human-operated microscope. Many promising automated diagnostic technologies are under development. However, a good understanding of the real needs within the local healthcare context is crucial in order to develop and implement a new health diagnostic device. Too often, there is a mismatch between what is needed and what is developed. A target product profile can guide the R&D process in matching with the needs in the local healthcare context. The goal of this project is to combine gaps in the healthcare system and needs from stakeholders with technological possibilities in order to develop a target product profile for a diagnostic device for S. haematobium for specific healthcare scenarios in Nigeria.