The Struggle of Diagnosing Yaws in the Upper East Region
Cyril, an 11-year-old student from Zonno in the Bolgatanga East District of the Upper East Region, endured a painful ordeal as sores on his leg refused to heal despite multiple treatments. The condition, which initially appeared to be yaws, could not be confirmed due to the absence of test kits at the local health facility.
Mr Edmund Awuni Anazimi, a nurse at the Zonno Community Health-based Planning Services (CHPS), shared the challenges faced by health workers in diagnosing and treating suspected yaws cases. “Each year, we treat more than 10 suspected cases, but without test kits, we rely solely on clinical signs and symptoms,” he said.
For Cyril’s mother, Anaamah, the experience was both exhausting and heartbreaking. She traveled long distances between health facilities and traditional healers in search of relief for her son. “We thought it was an ordinary sore from a fall, but it kept spreading, and nothing seemed to work,” she recounted.
Diagnosing by Sight: A Global Challenge
The World Health Organisation (WHO) recommends early and accurate diagnosis using Rapid Diagnostic Tests (RDTs) for patients with suspected yaws or any disease before treatment. This helps healthcare providers distinguish between yaws and other diseases, leading to better patient management.
However, in the Upper East Region, health workers are often forced to diagnose based on visual signs alone, leading to uncertainty and potential misdiagnosis. Mr Anazimi explained, “Sometimes it’s difficult to tell whether a sore is caused by yaws or something else.”
Ms Maria Mahama, the Bolgatanga East District Director of the Ghana Health Service, highlighted the challenges faced in the district. “Yaws is curable, but without test kits to confirm and the medicine to treat it, it becomes difficult,” she said.
Still Endemic: The Reality of Yaws
Yaws, caused by the bacterium Treponema pallidum pertenue, affects the skin, bones, and joints and spreads through direct contact with fluid from lesions. It is most prevalent among children in poor, humid, rural communities. If left untreated, it can lead to disfigurement and disability.
According to the WHO, over 152,000 suspected yaws cases were reported globally from ten countries, but only 996 were confirmed due to the lack of routine laboratory testing. Ghana is one of nine African countries considered yaws-endemic, with 3,367 suspected cases reported in 2021.
Myths, Misconceptions, and Stigma
In rural communities like Zonno, myths and misconceptions about yaws persist. Many families attribute the disease to witchcraft, delaying proper treatment and pushing victims to seek traditional and spiritual help instead of visiting health facilities.
Mr Zak Abuba, a District Disease Control Officer, emphasized the need for education to dispel these misconceptions. “It was only in 2023 that the District Assembly supported us with some funds to purchase medicine and undertake community screening,” he said.
Fighting in the Dark: The Lack of Test Kits
According to Mr Eric Dakura, the Regional NTDs Coordinator, the lack of test kits for yaws and other Neglected Tropical Diseases (NTDs) is a nationwide issue. “Health workers are forced to depend only on what they see, and that makes reporting incomplete and unreliable,” he explained.
Without test kits, health workers now share photos of suspected cases on WhatsApp groups for second opinions, a stopgap method to improve accuracy.
Poor Sanitation Worsens Spread
Public health experts emphasize that addressing Water, Sanitation, and Hygiene (WASH) challenges is crucial in the fight against yaws. In many communities, residents rely on unsafe water sources, share bathing areas, and have limited access to toilets and waste disposal facilities.
“Improving access to clean water, promoting regular handwashing, and encouraging hygiene practices can significantly reduce transmission,” Mr Dakura said.
Funding Gap and Call for Investment
Yaws is among the 21 Neglected Tropical Diseases targeted by the WHO for elimination. However, inadequate funding and investment remain major barriers to the fight against NTDs.
Mr Thomas Adua, the Upper East Regional Vice Chairman of the Coalition of NGOs in Health, urged the government and development partners to prioritize investment in diagnostics, surveillance, and community sensitisation.
Way Forward
The fight against yaws in the Upper East Region and Ghana as a whole is not lost, but it is dangerously slowed by the absence of rapid diagnostic test kits, medicines, inadequate funding, and weak community sensitisation.
According to the WHO, NTDs have strong relevance to the Sustainable Development Goals (SDGs), particularly goal 3, which emphasizes achieving equitable access to quality healthcare by 2030.
Strategic investment in the provision of rapid diagnostic test kits and essential medicines for all health facilities is urgently needed. The government and civil society organizations must also invest in training and logistical support for health workers and community volunteers to strengthen community-level surveillance and education.
