Yaws resurgence in Bankim, Cameroon: The relative effectiveness of different means of detection in rural communities

Abstract

BackgroundYaws is an infectious, debilitating and disfiguring disease of poverty that mainly affects children in rural communities in tropical areas. In Cameroon, mass-treatment campaigns carried out in the 1950s reduced yaws to such low levels that it was presumed the disease was eradicated. In 2010, an epidemiological study in Bankim Health District detected 29 cases of yaws. Five different means of detecting yaws in clinical and community settings were initiated in Bankim over the following five years.MethodologyThis observational study reviews data on the number of cases of yaws identified by each of the five yaws detection approaches: 1) passive yaws detection at local clinics after staff attended Neglected Tropical Disease awareness workshops, 2) community-based case detection carried out in remote communities by hospital staff who relied on community health workers to identify cases, 3) yaws screening following mass Buruli Ulcer outreach programs being piloted in the district, 4) school-based screening programs conducted as stand-alone and follow-up activities to mass outreach events, and 5) house to house active surveillance activities conducted in thirty-eight communities. Implementation of each of the four community-based approaches was observed by a team of health social scientists tasked with assessing the strengths and limitations of each detection method.FindingsEight hundred and fifteen cases of yaws were detected between 2012 and 2015. Only 7% were detected at local clinics. Small outreach programs and household surveys detected yaws in a broad spectrum of communities. The most successful means of yaws detection, accounting for over 70% of cases identified, were mass outreach programs and school based screenings in communities where yaws was detected.ConclusionThe five interventions for detecting yaws had a synergistic effect and proved to be valuable components of a yaws eradication program. Well planned, culturally sensitive mass outreach educational programs accompanied by school-based programs proved to be particularly effective in Bankim. Including yaws detection in a Buruli Ulcer outreach program constituted a win-win situation, as the demonstration effect of yaws treatment (rapid cure) increased confidence in early Buruli ulcer treatment. Mass outreach programs functioned as magnets for both diseases as well as other kinds of chronic wounds that future outreach programs need to address.

Skin disease prevalence study in schoolchildren in rural Côte d'Ivoire: Implications for integration of neglected skin diseases (skin NTDs)

“…To overcome this limitation, a combined approach should be considered in detection of skin NTDs, especially for areas with high endemicity. Researchers in Cameroon have done so by successfully combining community-surveys and school-surveys for BU and yaws detection [ 50 ].…”

Social Science Contributions to BU Focused Health Service Research in West-Africa

“…When yaws cases were recognized by health staff during wound screening, schools in the community were also screened. Over 850 cases of yaws were identified and treated [58]. This illustrates the effectiveness of mass outreach programs as well as the potential of integrated NTD programs.…”

Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa

“…Cases of yaws identified during BU outreach programs alerted health staff of the presence of the disease and they then conducted follow up school based screenings in these communities. Eight hundred and fifteen cases of confirmed cases of yaws were successfully treated [ 23 ].…”