Knowledge, attitudes and practices towards yaws in endemic areas of Ghana, Cameroon and Côte d’Ivoire

by Camila González Beiras, Adingra Tano Kouadio, Becca Louise Handley, Daniel Arhinful, Serges Tchatchouang, Philippe Ndzomo, Laud Anthony Basing, Kouadio Aboh Hugues, Ivy Brago Amanor, Mohammed Bakheit, Emelie Landmann, Patrick Awondo, Claudia Müller, Tania Crucitti, Nadine Borst, Lisa Becherer, Simone Lüert, Sieghard Frischmann, Aboubacar Sylla, Mireille S. Kouamé-Sina, Emma Michèle Harding-Esch, Sascha Knauf, Oriol Mitjà, Sara Eyangoh, Kennedy Kwasi Addo, Solange Ngazoa Kakou, Michael Marks, Ahouansou Stanislas Sonagnon Houndji, Eric Tettey Nartey, Dolphine Osei Sarpong, Gely Menguena

Yaws, caused by Treponema pallidum ssp. pertenue, remains a significant public health concern in tropical regions of West Africa and the South Pacific, primarily affecting children in remote areas with limited access to hygiene and sanitation. In this study, conducted in three endemic countries of West Africa where yaws remains a significant public health concern (Ghana, Cameroon, and Côte d’Ivoire), we aimed to assess the knowledge, attitudes, and practices related to yaws among community members, community health workers (CHWs), and traditional healers. The study revealed variations in the perception of causes of yaws among community members: the majority or participants in Ghana attributed yaws to germs (60.2%); in Cameroon the most reported form of transmission was contact with or drinking infected water sources (44.6%); and in Côte d’Ivoire both of these answers were also the most prevalent (60.3% germs and 93.% water sources). A substantial proportion of participants in Côte d’Ivoire also associated yaws with witchcraft and divine punishment (44.8%). Only a small proportion of individuals in Ghana and Côte d’Ivoire correctly identified contact with an infected person as a form of transmission (11.9% and 20.7%, respectively) and less than half in Cameroon (42.6%), although more than 98% of all participants reported avoidance behaviours towards yaws infected people due to fear of getting infected. Most participants expressed a preference for seeking care at hospitals (49.2%, 60.6%, 86.2%) or health care professionals including doctors and nurses (58.5%, 41,5% and 17.2%) if they were diagnosed with yaws, although a quarter of participants in Côte d’Ivoire also sought support from traditional healers. The CHWs interviewed were generally well-trained on yaws causes and treatment options, although they often reported low availability of treatment and diagnostic tests for yaws. Our findings underscore the need for community education, awareness campaigns, ongoing CHW training, and improved access to yaws treatment and diagnostic resources. The data also suggest that collaboration with traditional healers, who usually hold a highly esteemed position in the society, such as giving training on yaws causes and transmission or exchanging knowledge on treatment options, could be beneficial in certain regions, particularly in Côte d’Ivoire.