An integrated active case search for skin-NTDs in yaws endemic health districts in Cameroon, Côte d’Ivoire and Ghana

Background: Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin-NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin-NTDs. Methods: From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d’Ivoire, and Ghana. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin-NTDs were then referred to a health facility for appropriate management. Results: Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d'Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections (scabies versus fungal infections) in Cameroon with 5.1% (214/4204) versus 88.7% (3730/4204), Côte d’Ivoire with 25.2% (1285/5095) versus 50.4% (2567/5095) and Ghana 20% (419/2090) versus 1.3% (28/2090). Other skin-NTDs were less common across all three countries. Conclusion: This study confirms that integrated screening allows simultaneous detection of multiple skin-NTDs, maximising use of scarce resources. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement There is only one grant that funded all the authors. This study was fully funded by the European and Developing Countries Clinical Trial Partnership (EDCTP) as part of the LAMP4yaws project. Grant number: RIA2018D-2495. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved in Cameroon by the National Ethics Committee on Research for Human Health (CNERSH) under decision N 2020/12/1327/CE/CNERSH/SP and administrative authorization of the Ministry of Public Health Number D30-308/L/MINSANTE/SG/DROS), in Cote d Ivoire by the Comite National d Ethique des Sciences de la Vie et de la Sante (IQR) through decision IQRG0075_16/09/2020, in Ghana by the Ghana Health Service of Ethical Review Committee (GHS-ERC) and Noguchi Memorial Institute for Medical Research-Institutional Review Board (NMIMR-IRB) under decisions GHS-ERC 005/12/20 and NMIMR-IRB CPS 019/20-21), and in United Kingdom through London School of Hygiene and Tropical Medicine (LSHTM) under decision Number 21633 (19 August 2021). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data of this work are available through request to the corresponding author.