Breaking the chain of yaws infection in Ghana

By Access and Delivery Partnership

Students at a school in West Akim, Ghana line up to be screened for skin lesions and tested for yaws. Photo: Nii Armah Solomon

“I had a small boil last month, and it became big this month. It is sometimes painful and distracts me in school, so I got some medicines from the drugstore. But it is not going away,” said Godfrey Tamate, a 14-year-old student at Topease Methodist School in West Akim municipality, Ghana.

“I have had the sore for more than two years now. I use hot water and an ointment from the drugstore, but it’s still there. I wasn’t taken to the hospital,” said 16-year-old Samuel Achia.

What Godfrey and Samuel had was a chronic infection of the endemic treponematosis bacterium, commonly known as ‘yaws’. It is a disfiguring and debilitating disease that targets the skin, cartilage and bones. The disease mainly affects children under the age of 15 years and those in remote communities. If left untreated, it can cause lifelong disability.

Yaws—classified by the World Health Organization (WHO) as a neglected tropical disease (NTD)—is primarily found in warm, humid climates. It is currently known to be endemic in 15 countries, including Ghana.

Breaking the chain of yaws infection in Ghana

The WHO yaws eradication strategy calls for rounds of total community treatment (or mass drug administration, which involves treating entire populations) and total targeted treatment (treating cases and their contacts), to identify cases, then treat and cure them, putting a stop to ongoing transmission.

Since 2019, the Access and Delivery Partnership (ADP) has supported the National Buruli Ulcer Control and Yaws Eradication Programme of the Ghana Health Service in its efforts to eradicate yaws. This has been through support for implementation research and strengthening of national capacities for community-based mass drug administration using the antibiotic azithromycin, which cures yaws after a single dose.

Implementation research—a systematic approach to understanding and addressing localized barriers to effective and quality implementation of health interventions, strategies and policies—is a key pillar of the ADP approach to support countries to introduce and scale up new health technologies.

At the start of 2020, as part of preparatory-phase activities, a 30-day endemicity mapping survey was conducted in the West Akim district of Eastern Ghana to collect relevant information from affected communities. The survey involved interviews with local leaders and community members about where and when yaws was occurring.

“The first step is to map out the endemic communities. If everybody is treated at least once, there is little chance that the disease will continue to spread,” said Dr. Samuel Agyeman Boateng, West Akim Municipal Director of Health Services.

Dr. Samuel Agyeman Boateng, West Akim Municipal Director of Health Services. Photo: Nii Armah Solomon

Important operational challenges, including those related to the effective use of rapid diagnostic tests and sample collection, and the need for community mobilization to prevent gender- and stigma-related barriers, were identified.

The survey also established a baseline by identifying and mapping endemic and non-endemic communities in the municipality and helping to target interventions down to the subdistrict level.

Since eradication efforts require extensive planning and multiple phases of activities, ADP supported the training of front-line and community-based health workers to build relevant capacities. Health workers from the National Buruli Ulcer Control and Yaws Eradication Programme and regional NTD focal persons received training on case identification and reporting, as well as on monitoring adverse effects of the treatment.

According to Dr. Nana Konama Kotey, Programme Manager at the National Buruli Ulcer Control and Yaws Eradication Programme, Ghana Health Service, the eradication of yaws in Ghana holds great promise:

“Eradication of yaws will have a significant impact on the lives of the people of Ghana—it has the potential to be transformational and will definitely improve public health.”

Dr. Nana Konama Kotey, Programme Manager at the National Buruli Ulcer Control and Yaws Eradication Programme, Ghana Health Service. Photo: Nii Armah Solomon

During 2022, the National Buruli Ulcer Control and the Yaws Eradication Programme is intensifying efforts to continue total targeted treatment in selected districts, as this approach enhances surveillance and represents a key tool in the eradication of yaws.

Further information:

Ministère de la Santé et de l’Action Sociale and PATH, ‘Manual of Standard Operating Procedures for NTDs Drug Management during Mass Drug Administration in Senegal’, 1 April 2021

UNDP, TDR, COUNTDOWN and LSTM, ‘Discussion paper: The gender dimensions of neglected tropical diseases’, 21 November 2019

Tanzania Ministry of Health, ‘Guidelines for frontline health workers in Tanzania: Supply Chain Management of Medicines for Mass Drug Administration Campaigns for Neglected Tropical Diseases in Tanzania Mainland’, 12 May 2016

Tanzania Ministry of Health, ‘Guidelines for community drug distributors in Tanzania: Supply Chain Management of Medicines for Mass Drug Administration Campaigns for Neglected Tropical Diseases in Tanzania Mainland’, 12 May 2016

Tanzania Ministry of Health, ‘Guidelines for district pharmacists in Tanzania: Supply Chain Management of Medicines for Mass Drug Administration Campaigns for Neglected Tropical Diseases in Tanzania Mainland’, 12 May 2016

ADP, ‘Strengthening the prevention of neglected tropical diseases in Tanzania’, 5 September 2016

This is part of a collection of impact stories highlighting the work of the Access and Delivery Partnership in ensuring access to health technologies for those in need. For more information and to read additional impact stories, please visit the ADP website.