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International Notes Yaws and Yellow Fever Project -- Ghana

In January 1981, the government of Ghana and 4 major donors (USAID, WHO, UNICEF, EEC*) began a project to interrupt the precipitous increase in the prevalence of yaws and to contain the spread of yellow fever in that country. The project is intended to support the Ghanaian government's overall goal of providing the most effective health care at the most reasonable cost to the greatest number of people.

By the end of 1981, participants in the project had examined 803,437 Ghanaians (total population about 11 million) for yaws and had treated 544,469 of these persons (yaws patients and their contacts), each with a single injection of long-acting penicillin. In the project, 292,037 children were vaccinated against yellow fever, 55,791 against measles, 120,793 against tuberculosis, and 125,715 women of childbearing age were vaccinated against tetanus. In the areas surveyed, coverage of the target population with penicillin treatment and yellow fever vaccine slightly exceeded the project objective of 80%. The anti-yaws strategy included the use of mobile teams and the assurance that fixed health facilities received regular supplies of penicillin for treating patients and their contacts. However, mainly because of shortfalls in gasoline supplies, the mobile teams were only able to carry out their field activities on about 43% of the intended days of operation.

In the surveyed villages of heavily affected Ashanti, Eastern and Central Regions, the prevalence of persons with active yaws was reduced by the end of 1981 to 53/100,000 population from the 1980 level of 703/100,000. Reported by Dr EG Beausoleil, Director of Medical Svcs, Dr Yaw Aboagye-Attah, Deputy Director of Medical Svcs (PH), Dr VK Agadzi, Chief, Epidemiology Div, FK Kofi, Chief Technical Officer, Ghanaian Ministry of Health; International Health Program Office, CDC.

Editorial Note

Editorial Note: This timely project demonstrates the feasibility of halting the resurgence of yaws in Ghana, where the numbers of cases of that disease reported each year increased almost 10-fold between 1969 and 1979 (1,2). Moreover, this was accomplished while persons in the same villages were being vaccinated against other important infectious agents. In recent years several other countries, particularly in West Africa, reported large numbers of cases of yaws and/or endemic, non-venereal syphilis (1). It is hoped that the impact of this project and the methods used in it will stimulate other countries with similar public health problems to reconsider what might be accomplished in their own epidemiologic situations. Two of Ghana's neighbors, Togo and Ivory Coast, have already decided to intensify their efforts to combat yaws. The emergence of chloroquine-resistant malaria, isoniazid-resistant tuberculosis, and now dapsone-resistant leprosy (3) illustrate the risks of not acting promptly and vigorously to make maximal use of inexpensive, effective, and simple chemotherapy against an endemic disease.

References

  1. WHO. Endemic treponematoses. Wkly Epidem Rec 1981;56:241-4.

  2. WHO. Yaws--Ghana. Wkly Epidem Rec 1975;50:145-6.

  3. CDC. Increase in prevalence of leprosy caused by dapsone-resistant Mycobacterium leprae. MMWR 1982;30:637-8. *USAID (United States Agency for International Development), WHO (World Health Organization), UNICEF (United Nations Children's Emergency Fund), EEC (European Economic Community).

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