Yaws in Sub-Saharan Africa

Yaws, a chronic skin, bone, and cartilage treponemal infection of rural tropical communities, causes painless but stigmatizing lesions, some of which may become permanent disfiguring, crippling deformities. The palmar and plantar forms of yaws are, however, painful and pose difficulties in movement and working. For this reason, yaws, which had high clinical prevalences in some communities before the first eradication efforts which ended in the mid-1960s, caused considerable rural poverty. A global eradication effort initiated by the World Health Organization (WHO) and UNICEF in 1952 reduced the prevalence of the treponemal diseases and that of yaws in particular, in endemic countries, by over 95% by 1965. But short of eradicating it, and given the poor economies and weak health systems of many of such countries then to maintain surveillance and appropriate response, yaws started to resurge in the 1970s (Asiedu et al., PLoS Negl Trop Dis 8(9):e3016, 2014). It has since been fought successfully by only Ecuador (Anselmi et al., Trop Med Int Health 8(7):634–638, 2003) and India (Narrain et al., Indian J Med Res 141(5):608–613, 2015). Some sub-Saharan African (SSA) countries, Southeast Asian countries, and the Pacific Ocean Islands remain endemic. Children under 15 years, the most affected by yaws, continue to suffer deformities and, possibly, stigma, resulting in family and community neglect and some “dropouts” of school. Country and global goals for poverty reduction and universal education cannot be achieved if diseases like yaws continue to be neglected despite the availability of effective tools to eradicate, eliminate, or, at least, control them.