Evaluation of Midwife-Led Colposcopy for Female Genital Schistosomiasis Screening at Primary Level of Care in Rural Madagascar - A Cross-Sectional Study

Sep 30, 2026

Female genital schistosomiasis requires complex diagnosis and can cause severe outcomes such as infertility. In endemic settings, colposcopy is recommended, yet it is rarely used in low-resource primary care because of limited expertise and insufficient infrastructure. This cross-sectional secondary analysis evaluates midwife-led colposcopy for screening in rural Madagascar, comparing diagnostic accuracy against gynaecologist reference diagnoses using image and decision data and reporting measures of accuracy with 95% confidence intervals.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

Materials and Methods

Results

Conclusion

Tropical Medicine & International Health RESEARCH ARTICLE OPEN ACCESS Evaluation of Midwife-Led Colposcopy for Female Genital Schistosomiasis Screening at Primary Level of Care in Rural Madagascar: A Cross-Sectional Study Pia Rausche1,2 | Jean-Marc Kutz1,2 | Zoly Rakotomalala3 | Bodo Sahondra Randrianasolo4 | Paule Donven1,2 | Rivo Solotiana Rakotomalala3 | Alexina Olivasoa Tsiky Zafinimampera5 | Olivette Totofotsy5 | Sonya Ratefiarisoa5 | Ravo Razafindrakoto6 | Nantenaina Matthieu Razafindralava6 | Zaraniaina Tahiry Rasolojaona6 | Jana Hey1,2 | Aaron Remkes1,2 | Tahinamandranto Rasamoelina6 | Eva Lorenz2,7 | Rapahel Rakotozandrindrainy8 | Jürgen May2,7,9 | Monika Hampl10,11 | Irina Kislaya2,7 | Valentina Marchese1,2 | Rivo Andry Rakotoarivelo5 | Daniela Fusco1,2 1RG Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany | 2German Center for Infection Research (DZIF) Hamburg-Lübeck-Borstel-Riems, Germany | 3Centre Hospitalier Universitaire Androva, Mahajanga, Madagascar | 4Association K'OLO VANONA, Antananarivo, Madagascar | 5University Fianarantsoa, Fianarantsoa, Madagascar | 6Centre D'infectiologie Charles Mérieux, Antananarivo, Madagascar | 7Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany | 8University Antananarivo, Antananarivo, Madagascar | 9Tropical Medicine I, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany | 10Department of Obstetrics and Gynaecology, St. Elisabeth Hospital, Cologne-Hohenlind, Germany | 11University Hospital of Düsseldorf, Düsseldorf, Germany Correspondence: Daniela Fusco (fusco@bnitm.de) Received: 19 June 2025 | Revised: 25 September 2025 | Accepted: 2 October 2025 Funding: This work was mainly supported by the Coalition for Operational Research on NTDs (CORNTD) through the project FIRM-UP (project number: NTDSC 210D) and partly funded by the German Centre for Infection Research (DZIF) through the project NAMASTE (project number: 8008803819) and the Else Kröner-Fresenius Stiftung (EKFS) through the project CHIMPS (2022 _EKA.101 _CHIMPS) . J.-M.K. received support through the Bayer Foundation (Carl Duisberg Fellowship for Medical Sciences). Open Access funding enabled and organised by Project DEAL. Keywords: colposcopy | diagnostic accuracy | female genital schistosomiasis | midwifery | neglected diseases | primary health care ABSTRACT Introduction: Female genital schistosomiasis is a condition with a complex diagnosis and severe consequences such as infertility. In the absence of a reliable biomarker, in endemic settings the World Health Organization recommends colposcopy as a diagnostic tool for the detection of female genital schistosomiasis lesions. Nevertheless, it is seldom performed in low-resource contexts due to a lack of expertise or insufficient infrastructure. This study aims to assess Female Genital Schistosomiasis colposcopy at the primary level of care, evaluating its diagnostic accuracy in reference to gynaecologist diagnosis in a highly endemic context. Materials and Methods: This is a secondary analysis of a cross-sectional study conducted in the Boeny region of Madagascar, which collected colposcopy images and Female Genital Schistosomiasis decision at the primary health care level with reevaluation by gynaecologists. Statistical analysis using R included descriptive statistics, measures of diagnostic accuracy with 95% confidence intervals and binary Poisson regression with robust standard errors, while reporting followed the STARD statement. | Abbreviations: APR, adjusted prevalence ratio; CPR, Crude prevalence ratio; FGS, female genital schistosomiasis; HPV, human papilloma virus; NPV, negative predictive value; PHCC, primary health care centre; PID, pseudonymised patient identifier; PPV, positive predictive value; STI, sexual transmitted infection; WHO, World Health Organization.
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FAQs

What diagnostic role does colposcopy play for female genital schistosomiasis in endemic settings?

Colposcopy is recommended as a diagnostic tool to detect female genital schistosomiasis lesions when a reliable biomarker is not available. It identifies lesions for clinical evaluation in these settings.

How does this study assess midwife-led colposcopy at the primary care level?

The study uses a secondary analysis of a cross-sectional dataset from rural Madagascar. It evaluates diagnostic accuracy of colposcopy images and primary-level decisions against gynaecologist diagnoses.

What were the main findings regarding sensitivity and specificity?

Midwife-led colposcopy showed high sensitivity but relatively low specificity compared with expert gynaecologists. Performance also varied across environments and was influenced by practice and workload.

Sep 30, 2026

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