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Impact of Yaws Surveillance Programmes on Yaws Case Detection in Endemic Communities in Nigeria

Abstract

Yaws is a neglected tropical disease caused by Treponema pallidum subspecies pertenue and primarily affects children and adolescents living in tropical, humid, and underserved communities. Although yaws is targeted for global eradication, persistent challenges in case identification, surveillance, access to diagnostic services, and timely treatment may hinder progress toward interruption of transmission. In endemic or previously affected communities, limited awareness of early symptoms, geographical barriers, inadequate healthcare infrastructure, shortage of trained health workers, and weak disease surveillance systems may contribute to missed or delayed case detection. Yaws surveillance programmes provide an opportunity to strengthen disease identification through active case searches, community sensitization, household investigations, contact tracing, reporting of suspected cases, and referral for diagnostic confirmation and treatment. Against this background, this study investigates the impact of yaws surveillance programmes on yaws case detection in endemic communities in Nigeria. The study will be anchored on the Social Ecological Model, Health Belief Model, and Health Systems Framework. The Social Ecological Model emphasizes the interaction between individual, household, community, healthcare, environmental, and policy factors that influence disease recognition and access to health services. The Health Belief Model explains how perceptions of susceptibility to yaws, perceived severity, perceived benefits of early detection and treatment, perceived barriers, and cues to action may influence community participation in disease surveillance and reporting. The Health Systems Framework emphasizes surveillance systems, service delivery, health workforce, health information, medical products and technologies, financing, governance, and accessibility as important components of effective disease detection and control. Collectively, these theoretical perspectives provide a suitable framework for explaining how yaws surveillance programmes may influence case detection in endemic communities in Nigeria. The study will adopt a quantitative quasi-experimental or community-based comparative research design. The study population will comprise residents of selected endemic or historically affected communities, particularly children and adolescents who may be at increased risk of yaws, as well as community health workers and healthcare personnel involved in surveillance activities. A multistage sampling technique will be used to select states, local government areas, endemic communities, households, schools where appropriate, and eligible participants. Yaws surveillance programmes will be assessed using indicators such as surveillance coverage, frequency of active case searches, community sensitization activities, household visits, school-based case-finding where applicable, training of community health workers, contact tracing, availability of surveillance tools, suspected-case reporting, referral systems, surveillance supervision, and feedback mechanisms. Yaws case detection will be assessed using indicators such as number of suspected cases identified, number of suspected cases reported, number of persons screened, number of suspected cases referred for diagnostic assessment, laboratory-confirmed cases where diagnostic testing is available, number of newly detected cases, time from symptom recognition to detection, and treatment linkage following case identification. Data will be collected using structured questionnaires, surveillance registers, community case-finding records, healthcare facility registers, laboratory records, referral forms, treatment records, and programme monitoring documents. Descriptive statistics will be used to summarize participants' characteristics, surveillance coverage, case-finding activities, and detection outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of yaws surveillance programmes on case detection. Where a quasi-experimental design is adopted, case-detection indicators before and after implementation or strengthening of surveillance activities may be compared, or communities with enhanced surveillance may be compared with similar communities receiving routine surveillance. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that effective yaws surveillance programmes have a significant positive impact on yaws case detection in endemic communities in Nigeria. Communities with regular active case searches, community sensitization, trained surveillance personnel, household investigations, contact tracing, and effective referral systems are expected to identify more suspected and newly detected yaws cases than communities relying mainly on passive detection through health facilities. Early detection may facilitate prompt treatment and contact management, potentially reducing the duration of infectiousness and supporting interruption of transmission. However, limited diagnostic capacity, inadequate surveillance resources, geographical barriers, low community awareness, stigma, shortage of trained personnel, weak reporting systems, and limited access to treatment may reduce the effectiveness of surveillance programmes. The study therefore expects sustained, adequately resourced, community-based, and well-coordinated yaws surveillance programmes to contribute significantly to improved case detection and disease-control efforts in endemic communities in Nigeria. The study is expected to contribute to the literature on yaws surveillance, neglected tropical diseases, infectious disease case detection, community-based surveillance, rural and underserved healthcare, disease eradication, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, National Primary Health Care Development Agency, state ministries of health, local government health authorities, neglected tropical disease programmes, healthcare facilities, community health workers, schools, development partners, non-governmental organizations, and policymakers regarding strategies for strengthening yaws surveillance and detection. The study will also provide evidence-based recommendations for expanding active surveillance, strengthening community and school-based case-finding, improving training of healthcare and community health personnel, increasing community awareness of yaws symptoms, strengthening diagnostic and referral systems, improving surveillance data management, and integrating yaws surveillance into broader neglected tropical disease and primary healthcare programmes in Nigeria.

Keywords: Yaws surveillance, yaws case detection, Treponema pallidum subspecies pertenue, neglected tropical diseases, endemic communities, active case-finding, community-based surveillance, disease eradication, Nigeria, public health.