Cyril (not real name), an 11-year-old class six pupil of a basic school in the Bolgatanga East District of the Upper East Region, winces as a community health nurse gently unwraps the bandage around his leg.
The sores, raw and painful, have refused to heal despite several rounds of medication and treatment.
“For almost a month, the treatment we administered was not working because we suspected it was yaws due to the signs and symptoms he was exhibiting, but we didn’t have test kits to confirm,” Mr Edmund Awuni Anazimi, a nurse at the Zonno Community Health-based Planning Services (CHPS), admitted.
According to the enrolled nurse, each year, the Zonno CHPS treats more than 10 suspected cases of yaws.
However, there are no test kits to confirm the cases, compelling them to rely solely on clinical signs and symptoms.
“I became scared that it was a different disease other than yaws and we nearly referred him to the Zuarungu Health Centre, but after some more weeks, it worked, and he was healed,” he said.
For Cyril’s single mother, Anaamah (not real name), a petty trader who sells vegetables to feed her family, the ordeal was both exhausting and heartbreaking, as she walked 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. The nurse said it might be yaws, but she also said they didn’t have the test kits to be sure,” she recounted.
Diagnosing by sight
Early and accurate diagnosis by Rapid Diagnostic Tests has been recommended by the World Health Organisation (WHO) globally for patients with suspected yaws or any disease before they are given treatment.
This diagnosis helps to effectively and efficiently manage the disease by enabling healthcare providers to swiftly distinguish between yaws and other diseases, which helps in the overall management of the patients.
However, Cyril’s story reflects a broader problem where health workers across the Upper East Region are fighting the disease in the dark, diagnosing suspected yaws patients based on clinical signs and symptoms due to lack of test kits to confirm such cases.
Checks by the Ghana News Agency revealed that there were suspected yaws cases in almost all 15 Municipal and Districts in the Upper East Region, but due to lack of test kits, health workers diagnose these cases based solely on clinical signs and symptoms.
“Sometimes it’s difficult to tell whether a sore is caused by yaws or something else,” Mr Anazimi explained. “We were trained that the symptoms resemble those of syphilis, but without test kits, we’re only guessing.”
Ms Maria Mahama, Bolgatanga East District Director of the Ghana Health Service, said her district was the hardest hit, recording 114 suspected cases between 2023 and 2025, with most cases in Zonno and Aneeribisi communities.
She cited Kantia, Zonno-Zure, and Azuabisi communities in the district as other areas recording suspected cases but noted that the lack of diagnostic equipment or test kits was a major challenge in detecting and treating yaws in the district.
“Yaws is curable, but without test kits to confirm and the medicine to treat it, it becomes difficult,” she said.
In the Bongo District, the story is the same as healthcare workers diagnose suspected yaws cases based solely on clinical symptoms and signs due to lack of test kits.
Ms Fred Alowri, the In Charge of the Kodorogo CHPS Compound recounted several occasions she referred suspected yaws cases to the Bongo District Hospital for further examination due to lack of test kits to confirm the cases.
“Although the Bongo District Hospital also lacks test kits, it has a laboratory where further tests can be conducted when cases become critical, since the symptoms of yaws often resemble those of other diseases,” she explained.
Still endemic
Yaws, caused by Treponema pallidum pertenue, a bacterium related to the one that causes syphilis, affects the skin, bones, and joints and spreads through direct contact with fluid from the lesions of an infected person, mostly among children in poor, humid, rural communities.
The infection, which also affects adults causes chronic sores and, if left untreated, can lead to disfigurement and disability.
According to the WHO, more than 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 a total of 9,384 suspected cases reported in the West African Region in 2021, out of which Ghana recorded 3,367 suspected cases.
The other countries include Benin, Cameroon, the Central African Republic, Côte d’Ivoire, Liberia, the Republic of Congo, the Democratic Republic of Congo, and Togo.
Data from the Upper East Regional Directorate of the Ghana Health Service shows that between 2020 and 2024, about 1,190 suspected yaws cases were reported and treated in the region, alongside other Neglected Tropical Diseases (NTDs) such as elephantiasis and leprosy.
Myths, misconceptions and stigma
In rural communities like Zonno, Aneeribisi, and Kantia, myths and misconceptions about yaws and other NTDs remain strong.
“I took my daughter to a herbalist because people said it was a curse,” said Mary Abugre, a resident of Aneeribisi. “When the sore did not heal, the nurse said it might be yaws, but they couldn’t test her, so we are not sure.”
Many families still attribute some of these NTDs to witchcraft, delaying proper treatment and pushing victims to seek traditional and spiritual help instead of visiting the health facilities.
The stigma often forces children to skip school or stay away from social gatherings, deepening their emotional and physical suffering.
“If I knew it was yaws and curable, I would have gone straight to the hospital,” Mary said, lamenting the money she wasted seeking spiritual help.
Mr Zak Abuba, a District Disease Control Officer at the Bolgatanga East District Health Directorate, dispelled the misconceptions that yaws was caused by spiritual attacks and called for increased education to demystify the disease.
He, however, noted that there was no specific intervention in the district targeting yaws, saying that victims were usually detected during home visits by health workers or when patients visited health facilities.
“It was only in 2023 that the District Assembly supported us with some funds to purchase medicine and undertake community screening at Aneeribisi in the Gambibgo Subdistrict, where 185 people were screened, and 40 were positive and treated,” he said.
He added that the district did not have essential medicines such as Benzathine and Azithromycin to treat the disease, forcing clients to buy their own medicines for administration by health staff.
Fighting in the dark
According to Mr Eric Dakura, the Regional NTDs Coordinator, the lack of test kits for yaws and other NTDs is not limited to the Upper East Region but affects many regions across the country.
“We do not have yaws rapid diagnostic test kits. Health workers are forced to depend only on what they see, and that makes reporting incomplete and unreliable, so we continue to say ‘suspected cases,’” he explained.
The reliance on visual diagnosis, he said, often leads to underreporting and misdiagnosis, since other skin conditions mimic yaws.
“Some clinicians even treat the wrong diseases because they can’t confirm what they are seeing. The figures don’t reflect the reality on the ground. Many cases go unrecorded simply because they are never confirmed, and some patients do not report to health facilities,” he added.
In the absence of 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 say that while testing and treatment are vital, addressing Water, Sanitation and Hygiene (WASH) challenges is equally crucial in the fight against yaws.
In many communities where the disease is common, residents rely on unsafe water sources, share bathing areas, and have limited access to toilets and waste disposal facilities.
Open defecation, poor hygiene practices, and overcrowding increase the risk of skin infections and facilitate transmission through contact with wounds.
“Improving access to clean water, promoting regular handwashing, and encouraging hygiene practices can significantly reduce transmission. We tend to record more cases during the rainy season and fewer during the dry season,” Mr Dakura said.
He noted that yaws thrived in environments of poverty and poor sanitation and that health promotion campaigns on hygiene must be integrated with disease surveillance and treatment.
Funding gap and call for investment
Yaws is among the 21 Neglected Tropical Diseases that disproportionately affect the poorest populations and have been targeted by the WHO for elimination.
The WHO says about one billion people globally, approximately one-sixth of the world’s population, suffer from at least one NTD, costing families an estimated US$33 billion annually in treatment and lost income.
The United States Government’s Global Neglected Tropical Disease Effort reports that about 185,000 people die each year from NTDs.
In Africa, about 99 million people in 26 countries risk missing treatment for diseases like yaws, elephantiasis, and onchocerciasis due to limited funding (2023 WHO Africa’s Expanded Special Project for Elimination of NTDs report).
Mr Thomas Adua, the Upper East Regional Vice Chairman of the Coalition of NGOs in Health, said systematic neglect, including inadequate funding and investment to support public awareness, provision of test kits, essential medicines, and personnel, remains a major barrier to the fight.
“We cannot win the fight against NTDs when district health teams lack the basic tools to confirm and respond to cases,” he said, urging the government and development partners to prioritise investment in diagnostics, surveillance, and community sensitisation.
Mr Jonathan Adabre, Executive Director of the Development Research and Advocacy Centre (DRAC), added that without consistent funding and logistics, early detection will remain a challenge, allowing preventable diseases like yaws to cause needless pain and disability.
He also called for investment in water and hygiene facilities in schools and communities to ensure access to clean water and good sanitation, which will help reduce the spread of the disease.
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.
Health workers are doing their best under difficult circumstances, yet the disease continues to thrive quietly in poor, rural communities where access to health facilities, clean water, and accurate information is limited.
According to the WHO, NTDs have strong relevance to the Sustainable Development Goals (SDGs), particularly goal 3, which emphasises achieving equitable access to quality healthcare by 2030.
If Ghana is to achieve the WHO’s goal of eliminating yaws as a public health problem, and the SDG three which had influence on achieving the rest of the SDGs by 2030, there was the urgent need for strategic investment in the provision of rapid diagnostic test kits and essential medicines for all health facilities.
The government and civil society organisations need to also invest in the training and provision of logistical support for health workers and community volunteers to strengthen community-level surveillance and education to combat myths and misconceptions and provision of WASH facilities in rural communities to enhance hygiene practices.
By Anthony Adongo Apubeo
Source: GNA
Source: ghanabusinessnews.com
