An integrated active case search for skin-NTDs in yaws endemic health districts in Cameroon, Côte d’Ivoire and Ghana
Authors: Tchatchouang Serges , Basing Laud A. , Kouadio-Aboh Hugues , Handley Becca L. , G-Beiras Camila , Amanor Ivy , Ndzomo Philippe , Bakheit Mohammed , Becherer Lisa , Knauf Sascha , Müller Claudia , Njih-Tabah Earnest , Njmanshi Theophilus , Crucitti Tania , Borst Nadine , Lüert Simone , Frischmann Sieghard , Gmoser Helena , Landmann Emelie , Sylla Aboubacar , Kouamé-Sina Mireille S. , Arhinful Daniel , Awondo Patrick , Menguena Gely , Harding-Esch Emma-Michèle , Tano Adingra , Kaloga Mamadou , Koffi-Aboa Paul , Konama-Kotey Nana , Mitjà Oriol , Eyangoh Sara , Kwasi-Addo Kennedy , Ngazoa-Kakou Solange , Marks Michael 
Published: November 2023

Background

Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin-NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin-NTDs.

Methods

From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d’Ivoire, and Ghana. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin-NTDs were then referred to a health facility for appropriate management.

Results

Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d’Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections (scabies versus fungal infections) in Cameroon with 5.1% (214/4204) versus 88.7% (3730/4204), Côte d’Ivoire with 25.2% (1285/5095) versus 50.4% (2567/5095) and Ghana 20% (419/2090) versus 1.3% (28/2090). Other skin-NTDs were less common across all three countries.

Conclusion

This study confirms that integrated screening allows simultaneous detection of multiple skin-NTDs, maximising use of scarce resources.

Plain English Summary

Many Neglected Tropical Diseases (NTDs) predominantly affect the skin and are referred to as skin-NTDs. The World Health Organization (WHO) has developed a number of strategies for the control, eradication and elimination of skin-NTDs and recognizes the importance of integrated approaches to mapping skin-NTDs. We conducted a study adopting integrated screening for multiple skin-NTDs and other skin conditions in Cameroon, Côte d’Ivoire, and Ghana. This ran alongside a study focused on diagnostic tests for one specific skin-NTD – yaws.

The results showed that integrated screening is a feasible and cost-effective way to detect multiple skin-NTDs in a single intervention. Of more than 60,000 individuals screened almost one in five had a skin lesion. Cases of yaws confirmed by blood tests were detected more frequently in Ghana compared to Côte d’Ivoire and Cameroon. The most common skin conditions were scabies and superficial fungal infections. Other skin-NTDs such as Buruli ulcer, leprosy, lymphatic filariasis and tungiasis were less common. Integrated screening allowed detection of skin conditions and co-endemicity of skin-NTDs and the data can guide decisions on resource mobilization to manage skin-NTDs.