An integrated active case search for skin-NTDs in yaws endemic health districts in Cameroon, Côte d’Ivoire and Ghana

Abstract

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.