Factors Associated with Yaws among Children in the Upper West Akyem and Awutu Senya West Districts

Abstract

Background: Yaws is a chronic relapsing disease caused by Treponema pallidum pertunue, which can result in severe disability and deformities. Children below the age of 15 years in socially disadvantaged and resource-poor communities are the most affected. Several non-specific factors have been demonstrated to facilitate the continuous transmission and resurgence of the disease in endemic communities. Rural communities in Ghana continue to report cases of yaws despite the roll out of several intervention strategies in the past years. Objective: The objective of this study was to determine the factors associated with the transmission of yaws among children in the Upper West Akyem and Awutu Senya West districts in the Eastern and Central Regions respectively. Methods: A community-based unmatched 1:2 case-control study was conducted among children between ages 1 – 15 years. Data on exposures (socio-demographic, environmental and behavioral factors) were collected using a structured questionnaire designed with the REDCAP software. Active case search and confirmation was done using the WHO picture guide and the Dual Path Platform (DPP) Syphilis Screen and Confirm test kit. Data were analyzed using STATA 15. Univariable and a stepwise multivariable logistic regression was done to determine the exposures that were associated with yaws infection at 0.05 significant level. Results: One hundred and eighty-six (186) participants (62 cases and 124 controls) were recruited for the study. The median ages of cases and community controls were 11 and 10 respectively. The adjusted multivariable logistic regression model showed that yaws infection was more likely among individuals who reside in overcrowded compound houses (aOR=25.42, 95%CI=6.15 - 105.09) and with poor handwashing habits (aOR=6.46, 95%CI=1.89 - 22.04). Compared to community controls, yaws cases had a threefold increased odds of sharing bathroom with more than five persons (aOR=3.25, 95%CI=1.09 - 9.71). Male sex (aOR=4.15, 95%CI=1.29-13.36) and increasing age (aOR=5.90, 95%CI=1.97 -17.67) were also significantly associated with yaws. Conclusion: Poor personal hygiene, overcrowding and lack of access to improved sanitary facilities are the factors that facilitate the transmission of yaws in the Awutu Senya West and Upper West Akyem districts. Yaws was also more common among males and school-aged children. Improving the living conditions, access to good sanitary facilities and encouraging good personal hygiene practices should be core features of eradication programs in endemic communities.