Community participation eliminates yaws in Ecuador

Yaws is no longer a national and international health priority for intervention, but there is still a negative perception of the disease in the few affected communities. A survey in 1988 in the northern region of Ecuador documented a prevalence of 16.5% of clinical cases and 96.3% of serological cases. A continuous, long-term community-based surveillance programme was therefore put in place focusing on yaws as one of the sentinel diseases. The results of this intervention are reported here. In 1993, a second survey showed a reduction in the prevalence of clinical cases to 1.4% and of serological cases to 4.7%. Between 1993 and 1998, no other clinical cases were detected and the serological prevalence in 1998 was 3.5%, corresponding with clinical cases of primary or congenital syphilis, latent yaws under follow-up, and individuals with low serological titres indicating a 'serological scar'. These data indicate that yaws has been eliminated. Another important outcome of the intervention is the increased self-confidence in the communities that health problems can be tackled.