Control Of Yaws In The Asuogyaman District. Can Community Involvement Make The Difference?

ABSTRACT

Community involvement in the control of yaws is a participatory approach to healthcare

that is organized from the perspective of the recipient. This study was prompted by the fact

that, in 1998 Addo found that community participation in the control of yaws was poor, 3.4%

of the population is infected with yaws, yaws now ranking 3rd (1997-2000) from 6th position

in 1996. This study looked at how a rural district (Asuogyaman) in the Eastern region of

Ghana perceive and manage yaws and the extent to which the communities are involved in

the control of the disease. It also looked at the health service and community factors, which

affect community participation in the district.

Focus group discussions, in-depth interviews, observations (participatory and nonparticipatory)

involving 172 participants/respondents (key informants, level B health

workers, herbalists and victims of yaws). Yaws was mainly perceived by the community

(121 out of 153) to be caused by poor personal and environmental hygiene and sanitation.

The disease was perceived by the community (74 out o f 95 respondents) to be transmitted

mainly by the sharing o f toiletries, clothing and direct contact.

The prevention of yaws was found to be by health education, avoidance of direct contact

with the lesions o f the affected person and observation of personal and environmental

hygiene and sanitation. Though these perceptions about yaws are true, this knowledge was

not reflected in their practices or treatment of the disease.

The two main forms of treatment were traditional and modem. "Blue-stone" (copper

sulphate) was found to be the most popular form of traditional treatment o f the disease by

some communities. Of the 153 respondents, 90 did not know that treatment of the disease

was available/possible at the hospitals/clinics; 63 knew, 11 had no idea and 48 gave various

answers. Health education on yaws was found to be inadequate. Yaws was perceived to

have been eradicated and accorded least importance.

The participation o f the communities in the control o f yaws was assessed by using Rifkin's

method based on 5 factors- needs assessment, management, resource mobilization, leadership

and organization. The participation of the communities was small. Presence of community

health structures and their orientation, incentives to community health agents, free treatment,

prompt response (by health workers) to reports made by community health agents and

frequent interaction between health workers and the communities promoted participation.

Knowledge about the disease enhanced participation. Conflicts, embezzlement o f funds,

failure to act on /respond to complaints made by community health agents, failure to

complement community initiatives inhibited community participation. The response rate of

the study was 91.5% (172 out of 188). Lack o f time, funds and personnel, poor road net

work, conflicts, rains, limited the study. The Rifkin method itself had limitations. Health

education and house-to-house treatment of yaws should be intensified. The study concluded

that yaws, which is endemic in the district, could be effectively controlled with community

involvement.

Key words: yaws control, community, community participation/involvement, community

health structure/agents.