Seroprevalence of Treponema pallidum antibodies and community knowledge, attitudes, and practices related to yaws in the middle belt of Ghana: A quantitative cross-sectional study

Seroprevalence of Treponema pallidum antibodies and community knowledge, attitudes, and practices related to yaws in the middle belt of Ghana: A quantitative cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Seroprevalence of Treponema pallidum antibodies and community knowledge, attitudes, and practices related to yaws in the middle belt of Ghana: A quantitative cross-sectional study Prince Nyarko, Anabel Acheampong, Prince Charles Kudzordzi, Dennis Kyei Ofori, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5416182/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The paucity of epidemiological data on yaws in Ghana hampers national eradication efforts. This study aimed to investigate the seroprevalence of T. pallidum antibodies and community knowledge, attitudes, and practices toward yaws in the middle belt of Ghana. Methods A cross-sectional, quantitative study was performed between June 2021 and October 2021. A total of 138 participants—63.8% (88) female, with a median age of 32.7 years—were recruited from five study communities. Blood samples were taken to test for antibodies against T. pallidum , and a questionnaire on knowledge, attitudes and practices toward yaws was administered. Results The overall seroprevalence of antibodies against T. pallidum was 38% (52/137) [95% CI: 30.3 − 46.3], the highest of which was 63.3% (19/30) 19/30 [95% CI: 45.5 − 78.1] in State Farms, followed by 46.8% (22/47) [95% CI: 33.3 − 60.8] in Branam and 38.5% (10/26) [95% CI: 22.4 − 57.5] in Abekwai 3. Only 54.3% (75/138) had a good level of knowledge, 40.6% (56/138) had a high level of positive attitudes, and 58.7% (81/138) had a high level of good practices toward yaws. Having a formal education significantly increased the odds of having a high level of knowledge on yaws (OR = 2.299, P = 0.045, 95% CI = 1.020–5.180). The participants with a high level of knowledge were 8 times more likely to have a high level of positive attitudes (OR = 8.407, P < .001, 95% CI = 3.702–19.090), whereas a high level of good attitudes also significantly increased the odds of having a high level of positive practices (OR = 2.870, P = .005, 95% CI = 1.379–5.970). Being ≥ 30 years old significantly increased the odds of having a high level of positive attitudes and positive practices. Conclusions Despite high seropositivity of T. pallidum antibodies, there was an inadequate level of knowledge, good attitudes, and good practices toward yaws in our study communities. We highlight the need for sustained, targeted educational and sociobehavioral change campaigns by the Ghana Yaws Eradication Program to improve community knowledge, attitudes and practices and help reduce the transmission of the disease in communities. Epidemiology Seroprevalence yaws Treponema pallidum sociobehavioral factors knowledge attitudes practices Figures Figure 1 Figure 2 Figure 3 Background Yaws is a chronic neglected tropical disease (NTD) of the skin caused by Treponema pallidum subspecies pertenue [ 1 ]. The disease remains a significant public health issue in 13 endemic countries, with Ghana, Papua New Guinea and the Solomon Islands in Africa being the most endemic [ 2 ]. Together, these countries account for approximately 85% of the global burden, with children under 15 being the most affected [ 2 ]. Transmission occurs via direct contact with an infected individual, with an incubation period ranging from 9–90 days [ 1 ]. Clinically, yaws manifest as skin lesions such as papules, macules, ulcers, and plaques and may lead to bone and granulomatous lesions in more advanced stages [ 1 ]. Ghana, one of the countries with the most yaws—endemic countries—reports over 20,000 cases annually [ 3 ]. Despite global and repeated national efforts at elimination, the prevalence of yaws, on the basis of clinical assessment, is estimated to be 0.7% of the population of Ghana [ 4 ]. All districts in Ghana apart from 9 in the Greater Accra Region report yaws cases, but the most affected are rural and deprived communities in Eastern, Volta, Central, Ashanti, Western, and the erstwhile Brong Ahafo (now Bono, Bono East and Ahafo) regions, owing to the highly humid climate of these forest areas [ 4 ]. Pilot studies in the Eastern Region in 2008 reported a prevalence between 10% and 20% in some schools [ 4 ]. According to annual routine reports, children under 15 years constitute approximately 75% of cases, with a small but consistent preponderance of males [ 4 ]. More recent mapping information from 13 districts in 4 regions revealed that 64.2% of children were DPP positive, with 22.6% testing positive for T. pallidum subsp. pertenue DNA [ 3 ]. The country’s policy to eliminate yaws is consistent with the WHO’s roadmap that targeted the eradication of yaws by 2020, which was missed [ 4 ]. The WHO’s global Morges strategy has one of its policies: the total community treatment (TCT) programme, where an entire endemic community is treated, irrespective of the number of active clinical cases in that community [ 5 ]. However, it is important that this strategy is implemented in the context of situational analysis in endemic communities to ensure that the mass drug administration (MDA) is effective and financially efficient [ 3 ]. The challenges associated with yaws eradication in Ghana include poor education, poor personal hygiene, inadequate logistics for diagnosing and tracking for MDA interventions and case management [ 4 ]. These socioeconomic, behavioral, attitudinal, and environmental factors may drive the transmission of yaws in rural and deprived communities in the country [ 4 ]. Therefore, in addition to knowing the prevalence of the disease, community knowledge, attitudes, and practices (KAPs) are important, as they may influence how individuals perceive disease transmission, symptoms, and treatment and their interactions with those affected. Thus, this study aimed to investigate the prevalence of antibodies to T. pallidum and assess the KAPs of the local population regarding the disease in the Wenchi Municipality and Tain Districts in the middle belt of Ghana. Methods Study Area This study was conducted in five rural communities: Abekwai 3 and Kokomba in the Tain District and Branam, Kwanware, and State Farms in the Wenchi Municipality (Fig. 1 ). These communities were selected because they had inadequate epidemiological data on yaws prior to our study. The Tain District has a total area of 1829.85 square kilometers and a population size of 88,104, consisting of 50.6% females and 49.4% males [ 6 ]. The Wenchi Municipality has a total area of 1296.60 square kilometers and a population of 89,739, with 50.9% females and 49.1% males [ 7 ]. Ethical considerations Ethical approval was obtained from the Committee for Human Research and Ethics at the University of Energy and Natural Resources, Sunyani, Ghana (Reference: CHRE/CA/028/022). Written informed consent was obtained from all participants or their legal guardians, and the participants were free to withdraw from the study at any time without consequence. All study procedures conformed to the principles of protection of human subjects of research embodied in the Declaration of Helsinki [ 8 ]. Study design and participant recruitment This cross-sectional study was conducted between June 2021 and October 2021. One to two weeks before the recruitment of study participants, announcements were made in the study communities via the community information centers or with the aid of a ‘gong-gong’ beater (a local means of giving information to the community residents where the ‘beater’ moves around sounding a metallic instrument ‘the gong-gong’ whereas intermittently shouting out the information). Community residents were informed to gather at chosen social centers in the community. Once they were gathered, the study was explained in English and the local ‘Twi’ language during the meeting with the village elders and community members at the designated points in the community. All individuals aged 6 years and above were invited to participate in the study and recruited once they agreed and consented, or in the case of children, their parents consented. A written informed consent form, either signed or thumb-printed and/or witnessed (when relevant), was obtained from all participants. The informed consent forms were in English, and the content was explained in ‘Twi’ to participants who could not read or write English, with a literate community resident as a witness. Data collection Blood samples were collected to test for the presence of antibodies against T. pallidum . The structured questionnaire (Additional file 1) was then administered to assess participants' KAPs related to yaws (known in the local language as the Gyator ). The questionnaire was pretested in communities with characteristics similar to those of the study area and revised to ensure clarity. Data were collected via the Kobo Collect app (version 2.022) deployed on Android Tablets and later exported as a Microsoft Excel file for analysis. Serological analysis Seropositivity against T . pallidum was determined via the Diaspot syphilis rapid diagnostic test (RDT) (Huichao Medical Co. Ltd., China) following the manufacturer’s instructions. Briefly, the finger was disinfected with alcohol pads and pricked with a needle lancet. Blood was collected with a capillary tube and placed on the RDT sample pad. Three drops of buffer were added, and the test results were read after 15–20 minutes. A positive result was indicated by the appearance of both a test line and a control line, whereas a negative result was associated with only the control line. Invalid tests displayed no lines or only a test line. Statistical analysis Data analysis was performed via Jamovi desktop software (version 2.5) and GraphPad Prism (version 10). Continuous variables were summarized using the median and interquartile ranges, and frequencies and percentages were used for categorical variables. The (crude) community prevalence of T. pallidum antibodies was calculated as the number of RDT-positive cases divided by the number examined, expressed as a percentage. The 95% CIs for prevalence values were calculated via the Wilson score interval [ 9 ]. Results Demographic characteristics and positivity of the study participants for antibodies against T. pallidum Table 1 presents the demographic characteristics of the study participants on the basis of population size, age, and sex. The total number of participants was 138; 63.8% (88) were females, with a median age of 32.7 years, from the five study communities. The overall prevalence of antibodies against T. pallidum among the study participants was 38% [52/137; 95% CI: 30.3–46.3], with the State Farms community recording the highest seropositivity of 63.3% [19/30; 95% CI: 45.5–78.1], whereas the Kokomba community recorded the lowest seropositivity of 6.7% [1/15; 95% CI: 1.2–29.8] (Table 1 ). Table 1 Demographic characteristics of the study participants NB: Serological data were available for 137 (of the 138) participants. Community Recruited/ Population (%) Sex Median age (range) (Years) Prevalence of T. pallidum antibodies Females (%) Males (%) No. negative/No. tested (%) [95% CI] No. positive/No. tested (%) Tain District Abekwai 3 36/700 (5.1%) 21 (58.3%) 15 (41.7%) 38.5 (8–71) 16/26 (61.5%) [42.5–77.6] 10/26 (38.5%) [ 22.4–57.5] Kokomba 15/120 (12.5%) 10 (66.7%) 5 (33.3%) 30 (6–75) 14/15 (93.3%) [70.2–98.8] 1/15 (6.7%) [1.2–29.8] Wenchi Municipality Branam 47/1118 (4.2%) 30 (63.8%) 17 (36.2%) 42 (9–95) 25/47 (53.2%) [39.2–66.7] 22/47 (46.8%) [33.3–60.8] Kwanware 13/150 (12.7%) 8 (61.5%) 5 (38.5%) 37 (10–90) 19/19 (100%) [83.2–100.0] 0/19 (0.0%) [0.0-16.8] State Farms 27/107 (28.0%) 19 (70.4%) 8 (29.6%) 16 (7–78) 11/30 (36.7%) [21.9–54.5] 19/30 (63.3%) [45.5–78.1] Total 138/2195 (6.3%) 88 (63.8%) 50 (36.2%) 32.7 (6–95) 85/137 (62.0%) [53.7–69.7] 52/137 (38.0%) [30.3–46.3] Distribution of positivity to T. pallidum by sex and age The distribution of seropositivity to T. pallidum antibodies by age and sex is presented in Fig. 2 . Seropositivity for T. pallidum antibodies was lowest in the 21–40 age category for both males and females. Among females, those aged ≥ 41 years had the highest seropositivity, whereas among males, those aged between 6 and 20 years had the highest seropositivity. Knowledge of yaws Table 2 shows the knowledge of the participants while they yaw. The study revealed strong awareness of yaws, with 81.9% (113/138) of the participants being familiar with the disease and 58.0% (80/138) knowing someone affected. However, significant misconceptions about transmission were noted. For example, 2.2% (3/138) of the participants believed that the disease was due to witchcraft. Additionally, although 68.8% (95/138) recognized rashes as symptoms of the disease, a significant 31.2% (43/138) did not know of any of the signs associated with the disease. Knowledge of the treatment of the disease was also limited; only 34.8% (48/138) were aware that yaws can be treated, 33.3% (46/138) believed that they could not be treated, whereas 31.8% (44/138) did not know. Awareness of preventive measures also varied, with 63.0% (87/138) identifying prophylactic drugs as a strategy, but only 21.7% (30/138) of the participants acknowledged the importance of environmental cleanliness. Despite these knowledge gaps, 73.2% (107/138) expressed confidence that yaws can be eradicated. Table 2 Community members’ knowledge of the mode of transmission of yaws, symptoms, and treatment Variables Overall (N = 138) Heard about yaws No 25 (18.1%) Yes 113 (81.9%) Know someone with yaws No 58 (42.0%) Yes 80 (58.0%) The disease is acquired through (Multiple answers possible) Food 4 (2.9%) Person to person contact 82 (59.4%) Poor personal hygiene 64 (46.4%) Hereditary 1 (0.7%) Witchcraft 3 (2.2%) Don’t know 26 (18.8%) Symptoms of the disease (Multiple answers possible) Pain in the bone 6 (4.34%) Rashes 95 (68.8%) Small bumps 42 (30.4%) Swelling of the lymph nodes 37 (26.8%) Facial disfiguration 1 (0.7%) Don’t know 43 (31.2%) The disease can be treated No 46 (33.3%) Yes 48 (34.8%) Do not know 44 (31.8%) How can the disease be prevented? (Multiple answers possible) Taking prophylactic drugs 87 (63.0%) Keeping the environment clean 30 (21.7%) Don’t know 39 (28.3%) Which group of people is mostly affected by yaws? Adults 50 (36.2%) Children 30 (21.7%) Do not know 58 (42.0%) Yaws can be eradicated Yes 101 (73.2%) No 3 (2.2%) Don’t know 34 (24.6%) Attitudes and practices toward yaws The study assessed community attitudes and practices related to yaws in the study communities, and the results are presented in Table 3 . Nearly half (44.9%, 62/138) of the study participants noted that yaws patients were stigmatized in their communities. Furthermore, 15.2% (21/138) believed that yaws were a punishment for evil doers, whereas 57.2% (79/138) indicated fear of the disease. Notably, 75.4% (104/138) of the participants expressed a willingness to support yaws control initiatives despite limited treatment availability, as only 26.8% (37/138) reported that treatment was accessible in their communities. Interaction with infected individuals varied, with 48.5% (67/138) engaging occasionally and only 19.6% (27/138) interacting very frequently with infected persons. Additionally, 48.5% (67/138) of the participants believed that infected individuals could continue their education or work. In terms of hygiene practices, 42.0% (58/138) reported maintaining good personal hygiene, and 50.7% (70/138) of the community participated in regular cleanup activities. Table 3 Attitudes and practices toward yaws in the study communities Variables Overall (N = 138) Yaws patients are stigmatized in village Yes 62 (44.9%) No 75 (54.3%) Don’t know 43 (31.1%) The disease is a punishment for evil doers Yes 21 (15.2%) No 70 (50.7%) Don’t know 47 (34.1%) Community members fear the disease Yes 79 (57.2%) No 29 (21.0%) Don’t know 30 (21.7%) Community members willing to support control efforts Yes 104 (75.4%) No 5 (3.6%) Don’t know 29 (21.0%) Infected people have access to treatment in the community Yes 37 (26.8%) No 92 (66.7%) Don’t know 9 (6.5%) Community members interact (in person) with infected persons Very frequently 27 (19.6%) Sometimes 67 (48.5%) Barely 9 (6.5%) Not all 27 (19.6%) Don’t know 8 (5.7%) Infected still persons go to school or work Yes 67 (48.5%) No 43 (31.2%) Don’t know 28 (20.3%) Maintain personal hygiene Very well 58 (42.0%) Fairly well 59 (42.7%) Not so well 21 (15.2%) Community undertakes cleanup exercises Very often 45 (32.6%) Sometimes 70 (50.7%) Barely 10 (7.2%) Not all 13 (9.4%) Figure 3 presents the percentages of participants with a high level of knowledge, a high level of good attitudes and a high level of good practices. Among the 138 participants, 54.3% had a good level of knowledge, 40.6% had positive attitudes, and 58.7% had good practices toward yaws and their control in communities. Results from bivariate analysis The results of the bivariate analysis of the effects of sociodemographic data (age, sex, education, marital status, and occupation level) on knowledge, attitudes and practices are presented in Table 4 . Compared with those who had no formal education, those who had formal education in school were twice as likely to have a high level of knowledge (OR = 2.299, P = 0.045, 95% CI = 1.020–5.180) on yaws. The participants with a high level of knowledge were 8 times more likely to have a high level of positive attitude (OR = 8.407, P < .001, 95% CI = 3.702–19.090) than those with a poor level of knowledge. A high level of good attitudes was also significantly associated with a high level of positive practices (OR = 2.870, P = .005, 95% CI = 1.379–5.970). Being ≥ 30 years old significantly increased the odds of having a high level of positive attitudes and positive practices. Additionally, farming, as an occupation, was associated with significantly greater odds of having a high level of positive attitudes (OR = 2.931, P = 0.042, 95% CI = 1.042–8.242). Table 4 Binary logistic regression of the KAP scores with different sociodemographic variables of the respondents Covariates Knowledge Attitudes Practices Odds ratio (95% CI) P value Odds ratio (95% CI) P value Odds ratio (95% CI) P value Age <30 ≥30 Reference 0.698 (0.341–1.430) 0.324 Reference 2.154 (1.028–4.512) 0.042* Reference 6.963 (3.074–15.770) < .001* Gender Female Male Reference 0.670 (0.323–1.390) 0.282 Reference 0.763 (0.358–1.625) 0.483 Reference 0.568 (0.254–1.270) 0.168 Education level Not attended school Attended school Reference 2.299 (1.020–5.180) 0.045* Reference 2.047 (0.875–4.790) 0.099 Reference 1.049 (0.430–2.560) 0.916 Marital status Non-Married Married Reference 1.121 (0.460–2.730) 0.802 Reference 0.786 (0.314–1.968) 0.607 Reference 1.301 (0.493–3.440) 0.595 Occupation Non-Farming Farming Reference 1.556 (0.587–4.120) 0.374 Reference 2.931 (1.042–8.242) 0.042* Reference 1.913 (0.662–5.530) 0.231 AIC for Knowledge = 196 AIC for Attitudes = 188 AIC for Practices = 171 Discussion This study aimed to assess the seroprevalence of antibodies against T. pallidum and explore knowledge, attitudes, and practices toward yaws in study communities. The findings provide valuable insights into the epidemiology of yaws in these areas and contribute to understanding community awareness and behaviors. The overall seroprevalence of T. pallidum antibodies was 38%, indicating a substantial burden of infection within the study population. Notably, the State Farms community recorded the highest seropositivity at 63.3%, indicating localized infection hotspots. The seroprevalence reported in our study is more than twice that of serologically confirmed cases of yaws of 26.8% (440/1643) from a study conducted in the Eastern, Western and Central regions of Ghana [ 10 ]. Our findings contrast with those of Boaitey et al. (2024) [ 11 ], who reported a 17.2% and 10.8% prevalence of T. pallidum seropositivity in individuals with yaw-like and syphilis-like lesions, respectively. The reasons for the relatively high seroprevalence in our study areas are unclear, although notably, the levels of knowledge, good attitudes and practices toward the disease were generally very low in our study communities and could be key drivers of transmission in the area. However, considering that we did not confirm positive cases via polymerase chain reaction (PCR), the actual prevalence of active cases of T. pallidum infection might be lower in these communities. Our findings emphasize the urgent need for targeted, community-specific interventions to reduce transmission in the study communities. The prevalence of T. pallidum infection among males was highest in the 1–20 year age group. This finding was not surprising, as the disease is known to have a slight preponderance for males in Ghana, with children younger than 15 years being mostly affected [ 4 ]. The reasons for this association are unclear. The association with sex may reflect an earlier onset of sexual intercourse in boys than in girls, with misclassification of cases of syphilis as yaws in endemic communities [ 12 ]. Despite having awareness of yaws, the general level of good knowledge about the disease (54.3%) was far from optimal. A few of our study participants believed that yaws were caused by witchcraft and/or punishment for doing evil. The tendency to attribute illness to supernatural forces such as witchcraft and curses is a common phenomenon and is often due to a lack of knowledge about the true cause of the illness, especially when the illness is prolonged [ 13 ]. This gap in knowledge is worrying because it can delay treatment-seeking behavior, reduce disease risk perceptions and contribute to the further spread of the disease [ 12 ]. In a study by Mark et al. [ 12 ], individuals who reported a supernatural belief about causation, such as witchcraft or a curse, were more likely to report that they would not accept treatment. To remedy this situation, public health education campaigns are urgently needed to dispel myths about yaws to improve knowledge concerning the disease in our communities. The general level of good attitudes of community members (40.6%) with respect to yaws was low and a cause for concern, especially with respect to yaws eradication efforts in Ghana. Almost half of the respondents reported that yaws infected individuals are stigmatized in their communities. These findings are consistent with those of a study in the Philippines that demonstrated that stigma, discrimination, and embarrassment are commonly associated with people infected with yaws [ 14 ]. Children infected with yaws are bullied and miss school days to avoid bullying [ 14 ]. In some instances, social interaction and physical intimacy are avoided because of the fear of spreading the infection [ 14 ]. Stigma may either increase or decrease an individual’s willingness to seek treatment, depending on the sociocultural context. In some studies, stigma has been demonstrated to reduce health-seeking behavior [ 15 , 16 ], thereby contributing to further spread of the disease. However, another study by Tuwor et al. [ 17 ] in Ghana showed that the fear of stigma and experiencing stigma surprisingly motivated parents and guardians to seek and adhere to treatment, whether biomedical, traditional, or religious interventions for affected individuals. This effect of stigma, which is supported by additional evidence, encourages people to seek medical attention and stick with their treatment plans because they believe that the treatment will cure their illness and, as a result, lessen the stigma attached to it [ 18 ]. However, our study did not explore the impact of stigma on the health-seeking behavior of yaws infected individuals or their parents/guardians. Despite the phenomenon of stigmatization observed in our study, we found encouraging signs of community readiness to support yaws control efforts, with 75.4% of participants expressing a willingness to engage in eradication initiatives. However, limited access to treatment remains a barrier, as only 26.8% of respondents reported that treatment was available in their communities. This suggests that while there is a willingness to support control efforts, practical barriers such as healthcare access must be addressed to make a meaningful impact on yaw control in communities. In general, the level of positive practices (58.7%) toward yaws in the communities was low among the study participants. However, this finding was not unexpected, as the levels of knowledge and attitudes were also very low. Our findings demonstrated that participants who had a formal education in school were twice as likely to have good knowledge of yaws than were those who had no formal education. Moreover, having a high level of knowledge was significantly associated with increased odds of having a high level of positive attitudes toward the disease. Furthermore, a high level of good attitudes significantly increased the odds of having a high level of positive practices among the study participants (OR = 2.870, P = .005, 95% CI = 1.379–5.970). Globally, some studies on other disease conditions, such as COVID-19, agree with our findings that knowledge about a disease significantly affects attitudes and practices toward its control and prevention [ 19 – 22 ]. These findings suggest that health education can play a vital role in promoting preventive practices toward yaws. Interestingly, participants who were ≥ 30 years old had significantly increased odds of having a high level of positive attitudes and positive practices, whereas farming, as an occupation, was associated with significantly increased odds of having a high level of positive attitudes (OR = 2.931, P = 0.042, 95% CI = 1.042–8.242). This was not surprising, as older people in endemic communities are usually more aware of the disease because of their long stay in the community and, subsequently, could have a high level of good attitudes and good practices toward the disease. The need for targeted sociobehavioural change and educational campaigns to improve community hygiene practices among younger people is warranted on the basis of our current findings. This study has several limitations that should be addressed in future research. The study participants were not randomly selected. Therefore, the results need to be interpreted with caution, as the findings may not be representative of all the persons living in the study communities. Sample sizes to ensure a given power or precision were not calculated before the study; only people who agreed to gather at the focal point in their communities were included in the study (convenience sampling), with only 6.2% of the population participating overall (Table 1 ). This likely led to bias. Additionally, social desirability bias may have influenced the responses to the questions, although the participants were made aware that their responses had no punitive implications for them whatsoever. Owing to logistical reasons, we were unable to perform molecular confirmation of samples that were seropositive for T. pallidum ; hence, we could not confirm a diagnosis of yaws. Finally, we assessed all age groups and did not restrict our analysis to only children under 15 years of age. This implies that seropositivity may not necessarily reflect active infections. Conclusions We demonstrated that despite the high seropositivity of T. pallidum , there was an inadequate level of knowledge, good attitudes, and good practices related to yaws in our study communities. We highlight the need for sustained, targeted educational and sociobehavioral change campaigns by the Ghana Yaws Eradication Program to improve community knowledge, attitudes and practices to help reduce the transmission of the disease in communities. Abbreviations DNA Deoxyribonucleic Acid KAPs Knowledge, attitudes, and practices MDA Mass Drug Administration NTD Neglected Tropical Diseases PCR Polymerase chain reaction RDT Rapid Diagnostic Test TCT Total Community Treatment WHO World Health Organization Declarations Ethics approval and consent to participate This study was approved by the Committee for Human Research and Ethics at the University of Energy and Natural Resources, Sunyani, Ghana (Reference: CHRE/CA/028/022). Written informed consent was obtained from all participants before recruitment. All procedures in this study were in accordance with the ethical standards of the Helsinki Declaration (1964, amended most recently in 2008) of the World Medical Association. Consent for publication Not applicable Availability of data and materials As the data were collected from a small group of participants and vulnerable populations in small communities, we are unable to publicly share the dataset, as they contain indirect identifiers (such as sex, ethnicity, location, etc.) and risk the identification of study participants. However, the dataset may be requested via email ( [email protected] ) from the Committee for Human Research and Ethics at the University of Energy and Natural Resources in Sunyani, Ghana. Competing interests The authors declare that there are no competing interests regarding the publication of this article. Funding This study did not receive any specific funding. However, K.B.O acknowledges grants from the African Research Network for Neglected Tropical Diseases (ARNTD)/USAID (Grant number SGPIV/0111/241), Royal Society of Tropical Medicine and Hygiene (Small grant awarded to KBO in 2020), and International Foundation for Science (Grant Number: No. I-1-F-6681-1). The funders had no role in the design and funding of this study. Authors' contributions Conceptualization: K.B.O, P.A.O, G.Y., O.O.B; Data curation: P. N., A. A., P. C. K., K. B. O. Formal analysis: P. N., A. A., P. C. K., D. K. O., P. A. O., G. Y., O. O. B., K. B. O.; Investigation: P. N., A. A., P. C. K., E. T. B., D. K. O., P. A. O., G. Y., O. O. B., L. D., P. P. O., C. W. N., E. B. A. ; Methodology: P. N., A. A., P. C. K., P.A. O., G. Y., O. O. B., K. B. O.; Project administration: K. B. O., L. D.; Resources: K.B. O.; Supervision: K. B. O., L. D.; Visualization: P. N., L. D., A. H., K. B. O.; Writing – original draft: P. N., K. B. O.; Writing – review & editing: P. N., A. A., P. C. K., E.T. B., D. K. O., P.A.O., G. Y., O. O. B., A. H., L. D., P. P. O., C. W. N., E.B. A., F. V.D.B., K. B. O. Acknowledgments We thank all the staff and students of the Department of Biological Science and the Consortium for Neglected Tropical Diseases and One Health, who provided support in one way or another, to ensure the successful implementation of this research. We also appreciate the efforts of the directors and staff of the Wenchi Municipal Health Directorate and Tain District for their enormous contributions to the study. Our appreciation also goes to the chiefs, opinion leaders and people of the study communities who partnered with us in this study. References World Health Organization (2024) Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030. https://www.who.int/publications/i/item/9789240010352 . Accessed 30 WHO Global health observatory data repository: yaws. 2020. http://apps.who.int/gho/data/node.main.NTDYAWSEND?lang=en . Accessed 30 (2024) Basing LAW, Djan M, Simpson SV, Adu-Sarkodie Y (2020) Mapping of yaws endemicity in Ghana; Lessons to strengthen the planning and implementation of yaws eradication. medRxiv. ;2020.02.20.20025122. Ghana Health Service, Ghana NTD (2020) Master Plan 2021–2025. Expanded Special Project for Elimination of Neglected Tropical Diseases. https://espen.afro.who.int/system/files/content/resources/Ghana%20NTD%20Master%20Plan%202021-2025.pdf . Accessed 30 October 2024 Marks M, Kwakye-Maclean C, Doherty R, Adwere P, Aziz Abdulai A, Duah F et al (2017) Knowledge, attitudes and practices toward yaws and yaws-like skin disease in Ghana. PLoS Negl Trop Dis. 10.1371/journal.pntd.0005820 Ghana Statistical Service (2014) 2010 population and housing census. District Analytical Report. Tain District. https://www2.statsghana.gov.gh/docfiles/2010_District_Report/Brong%20Ahafo/TAIN.pdf . Accessed 30 October 2024 Ghana Statistical Service (2014) 2010 population and housing census. District Analytical Report. Wenchi Municipality. https://www2.statsghana.gov.gh/docfiles/2010_District_Report/Brong%20Ahafo/WENCHI.pdf . Accessed 30 October 2024 World Medical Association Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Participants (2024) https://www.wma.net/policies-post/wma-declaration-of-helsinki/ . Accessed 30 Brown LD, Cai TT, DasGupta A (2001) Interval estimation for a binomial proportion. Stat Sci 16:101–117 Tchatchouang S, Basing LA, Kouadio-Aboh H, Handley BL, G-Beiras C, Amanor I et al (2024) An integrated active case detection and management of skin NTDs in yaws endemic health districts in Cameroon, Côte d’Ivoire and Ghana. PLoS Negl Trop Dis. doi.org/10.1371/journal.pntd.0011790 Boaitey YA, Owusu-Ofori A, Anyogu A, Aghakhanian F, Arora N, Parr JB et al (2024) Prevalence of yaws and syphilis in the Ashanti region of Ghana and occurrence of H. ducreyi , herpes simplex virus 1 and herpes simplex virus 2 in skin lesions associated with treponematoses. PLoS ONE. doi.org/10.1371/journal.pone.0295088 Marks M, Kwakye-Maclean C, Doherty R, Adwere P, Aziz Abdulai A, Duah F et al (2017) Knowledge, attitudes and practices toward yaws and yaws-like skin disease in Ghana. PLoS Negl Trop Dis. 10.1371/journal.pntd.0005820 Ackumey MM, Gyapong M, Pappoe M, Kwakye-Maclean C, Weiss MG (2012) Illness meanings and experiences for preulcer and ulcer conditions of Buruli ulcer in the Ga-West and Ga-South Municipalities of Ghana. BMC Public Health. 10.1186/1471-2458-12-264 Dofitas BL, Kalim SP, Toledo CB, Richardus JH (2022) Stigma, psychosocial and economic effects of yaws in the Philippines: an exploratory, qualitative study. Trop Med Health. 10.1186/s41182-022-00433-4 Ribera JM, Grietens KP, Toomer E, Hausmann-Muela S (2009) A word of caution against the stigma trend in neglected tropical disease research and control. PLoS Negl Trop Dis. 10.1371/journal.pntd.0000445 Ochola EA, Elliott SJ, Karanja DM (2021) The impact of neglected tropical diseases (NTDs) on women’s health and wellbeing in sub-Saharan Africa (SSA): a case study of Kenya. Int J Environ Res Public Health. 10.3390/ijerph18042180 Tuwor RD, Mtuy TB, Amoako YA, Owusu L, Oppong MN, Agbanyo A et al (2024) SHARP collaboration. Stigma experiences, effects and coping among individuals affected by Buruli ulcer and yaws in Ghana. PLoS Negl Trop Dis. 10.1371/journal.pntd.0012093 Weiss MG (2008) Stigma and the social burden of neglected tropical diseases. PLoS Negl Trop Dis. 10.1371/journal.pntd.0000237 Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q et al (2020) Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 10.1016/j.ijid.2020.03.017 Vicerra PM (2021) Disparity between knowledge and practice regarding COVID-19 in Thailand: a cross-sectional study of older adults. PLoS ONE. 10.1371/journal.pone.0259154 Chen Y, Zhou R, Chen B, Chen H, Li Y, Chen Z et al (2020) Knowledge, perceived beliefs, and preventive behaviors related to COVID-19 among Chinese older adults: cross-sectional web-based survey. J Med Internet Res. 10.2196/23729 Akalu Y, Ayelign B, Molla MD (2020) Knowledge, attitude and practice toward COVID-19 among chronic disease patients at Addis Zemen hospital, Northwest Ethiopia. Infect Drug Resist. 10.2147/IDR.S258736 Supplementary Informations Supplementary Information is not available with this version. Additional file 1: Questionnaire on knowledge, attitudes and practices on yaws Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5416182","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":375748381,"identity":"1aac0cdb-ee1f-444e-a842-b943db585dec","order_by":0,"name":"Prince Nyarko","email":"","orcid":"https://orcid.org/0009-0008-9233-6367","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Prince","middleName":"","lastName":"Nyarko","suffix":""},{"id":375748382,"identity":"177fc68d-ce4e-4c89-8d6d-ab9d38a759c8","order_by":1,"name":"Anabel Acheampong","email":"","orcid":"https://orcid.org/0009-0008-1676-8678","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Anabel","middleName":"","lastName":"Acheampong","suffix":""},{"id":375748383,"identity":"15e379e2-2363-4806-87d3-3abb70789e7e","order_by":2,"name":"Prince Charles Kudzordzi","email":"","orcid":"https://orcid.org/0009-0008-8145-3488","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Prince","middleName":"Charles","lastName":"Kudzordzi","suffix":""},{"id":375748384,"identity":"f8d1f8b4-e72d-464b-a99f-0615649959c4","order_by":3,"name":"Dennis Kyei Ofori","email":"","orcid":"","institution":"University of Energy and Natural Resources","correspondingAuthor":false,"prefix":"","firstName":"Dennis","middleName":"Kyei","lastName":"Ofori","suffix":""},{"id":375748385,"identity":"37b6c6a6-5e97-48a6-842a-56f0317dd130","order_by":4,"name":"Edwina Twum 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Resources","correspondingAuthor":true,"prefix":"","firstName":"Kenneth","middleName":"Bentum","lastName":"Otabil","suffix":""}],"badges":[],"createdAt":"2024-11-08 11:36:17","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5416182/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5416182/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68868669,"identity":"a52e2a36-81a0-4908-beb0-dd42e5b76f8b","added_by":"auto","created_at":"2024-11-13 02:27:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":289564,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Ghana showing the location of the study communities within the Tain District and Wenchi Municipality (Bono Region)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5416182/v1/c1910af11718c2e3aae6d32a.png"},{"id":68868965,"identity":"05c35729-9316-435f-9705-e2d0d9cbbb6c","added_by":"auto","created_at":"2024-11-13 02:35:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14086,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of seropositivity to \u003cem\u003eT. pallidum\u003c/em\u003e antibodies by sex and age in the study communities in Wenchi and Tain\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5416182/v1/eda0bd243246097aff792425.png"},{"id":68868668,"identity":"0e5fc1c3-1ff8-43c8-9708-2c6747c86f44","added_by":"auto","created_at":"2024-11-13 02:27:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":12196,"visible":true,"origin":"","legend":"\u003cp\u003eLevel of community knowledge, good attitudes, and good practicestoward yaws and theircontrol in the Tain District and Wenchi Municipality. Each percentage represents a fraction of the total number of respondents who scored above the mean score within each category of the three outcomes.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5416182/v1/be0d6c38923b84fb3c33ff65.png"},{"id":68869524,"identity":"a41e1cff-19af-4bf7-b498-eefb7a60eb3d","added_by":"auto","created_at":"2024-11-13 02:43:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1329433,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5416182/v1/c43504a6-0f56-4386-a1e7-2ead7c0253a6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSeroprevalence of\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e Treponema pallidum\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e antibodies and community knowledge, attitudes, and practices related to yaws in the middle belt of Ghana: A quantitative cross-sectional study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eYaws is a chronic neglected tropical disease (NTD) of the skin caused by \u003cem\u003eTreponema pallidum\u003c/em\u003e subspecies \u003cem\u003epertenue\u003c/em\u003e [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The disease remains a significant public health issue in 13 endemic countries, with Ghana, Papua New Guinea and the Solomon Islands in Africa being the most endemic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Together, these countries account for approximately 85% of the global burden, with children under 15 being the most affected [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Transmission occurs via direct contact with an infected individual, with an incubation period ranging from 9\u0026ndash;90 days [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Clinically, yaws manifest as skin lesions such as papules, macules, ulcers, and plaques and may lead to bone and granulomatous lesions in more advanced stages [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGhana, one of the countries with the most yaws\u0026mdash;endemic countries\u0026mdash;reports over 20,000 cases annually [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite global and repeated national efforts at elimination, the prevalence of yaws, on the basis of clinical assessment, is estimated to be 0.7% of the population of Ghana [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. All districts in Ghana apart from 9 in the Greater Accra Region report yaws cases, but the most affected are rural and deprived communities in Eastern, Volta, Central, Ashanti, Western, and the erstwhile Brong Ahafo (now Bono, Bono East and Ahafo) regions, owing to the highly humid climate of these forest areas [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Pilot studies in the Eastern Region in 2008 reported a prevalence between 10% and 20% in some schools [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to annual routine reports, children under 15 years constitute approximately 75% of cases, with a small but consistent preponderance of males [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. More recent mapping information from 13 districts in 4 regions revealed that 64.2% of children were DPP positive, with 22.6% testing positive for \u003cem\u003eT. pallidum\u003c/em\u003e subsp. \u003cem\u003epertenue\u003c/em\u003e DNA [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe country\u0026rsquo;s policy to eliminate yaws is consistent with the WHO\u0026rsquo;s roadmap that targeted the eradication of yaws by 2020, which was missed [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The WHO\u0026rsquo;s global Morges strategy has one of its policies: the total community treatment (TCT) programme, where an entire endemic community is treated, irrespective of the number of active clinical cases in that community [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, it is important that this strategy is implemented in the context of situational analysis in endemic communities to ensure that the mass drug administration (MDA) is effective and financially efficient [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe challenges associated with yaws eradication in Ghana include poor education, poor personal hygiene, inadequate logistics for diagnosing and tracking for MDA interventions and case management [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These socioeconomic, behavioral, attitudinal, and environmental factors may drive the transmission of yaws in rural and deprived communities in the country [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, in addition to knowing the prevalence of the disease, community knowledge, attitudes, and practices (KAPs) are important, as they may influence how individuals perceive disease transmission, symptoms, and treatment and their interactions with those affected. Thus, this study aimed to investigate the prevalence of antibodies to \u003cem\u003eT. pallidum\u003c/em\u003e and assess the KAPs of the local population regarding the disease in the Wenchi Municipality and Tain Districts in the middle belt of Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eThis study was conducted in five rural communities: Abekwai 3 and Kokomba in the Tain District and Branam, Kwanware, and State Farms in the Wenchi Municipality (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These communities were selected because they had inadequate epidemiological data on yaws prior to our study. The Tain District has a total area of 1829.85 square kilometers and a population size of 88,104, consisting of 50.6% females and 49.4% males [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The Wenchi Municipality has a total area of 1296.60 square kilometers and a population of 89,739, with 50.9% females and 49.1% males [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Committee for Human Research and Ethics at the University of Energy and Natural Resources, Sunyani, Ghana (Reference: CHRE/CA/028/022). Written informed consent was obtained from all participants or their legal guardians, and the participants were free to withdraw from the study at any time without consequence. All study procedures conformed to the principles of protection of human subjects of research embodied in the Declaration of Helsinki [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eStudy design and participant recruitment\u003c/h3\u003e\n\u003cp\u003eThis cross-sectional study was conducted between June 2021 and October 2021. One to two weeks before the recruitment of study participants, announcements were made in the study communities via the community information centers or with the aid of a \u0026lsquo;gong-gong\u0026rsquo; beater (a local means of giving information to the community residents where the \u0026lsquo;beater\u0026rsquo; moves around sounding a metallic instrument \u0026lsquo;the gong-gong\u0026rsquo; whereas intermittently shouting out the information). Community residents were informed to gather at chosen social centers in the community. Once they were gathered, the study was explained in English and the local \u0026lsquo;Twi\u0026rsquo; language during the meeting with the village elders and community members at the designated points in the community. All individuals aged 6 years and above were invited to participate in the study and recruited once they agreed and consented, or in the case of children, their parents consented. A written informed consent form, either signed or thumb-printed and/or witnessed (when relevant), was obtained from all participants. The informed consent forms were in English, and the content was explained in \u0026lsquo;Twi\u0026rsquo; to participants who could not read or write English, with a literate community resident as a witness.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eBlood samples were collected to test for the presence of antibodies against \u003cem\u003eT. pallidum\u003c/em\u003e. The structured questionnaire (Additional file 1) was then administered to assess participants' KAPs related to yaws (known in the local language as the \u003cem\u003eGyator\u003c/em\u003e). The questionnaire was pretested in communities with characteristics similar to those of the study area and revised to ensure clarity. Data were collected via the Kobo Collect app (version 2.022) deployed on Android Tablets and later exported as a Microsoft Excel file for analysis.\u003c/p\u003e\n\u003ch3\u003eSerological analysis\u003c/h3\u003e\n\u003cp\u003eSeropositivity against \u003cem\u003eT\u003c/em\u003e. \u003cem\u003epallidum\u003c/em\u003e was determined via the Diaspot syphilis rapid diagnostic test (RDT) (Huichao Medical Co. Ltd., China) following the manufacturer\u0026rsquo;s instructions. Briefly, the finger was disinfected with alcohol pads and pricked with a needle lancet. Blood was collected with a capillary tube and placed on the RDT sample pad. Three drops of buffer were added, and the test results were read after 15\u0026ndash;20 minutes. A positive result was indicated by the appearance of both a test line and a control line, whereas a negative result was associated with only the control line. Invalid tests displayed no lines or only a test line.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed via Jamovi desktop software (version 2.5) and GraphPad Prism (version 10). Continuous variables were summarized using the median and interquartile ranges, and frequencies and percentages were used for categorical variables. The (crude) community prevalence of \u003cem\u003eT. pallidum\u003c/em\u003e antibodies was calculated as the number of RDT-positive cases divided by the number examined, expressed as a percentage. The 95% CIs for prevalence values were calculated via the Wilson score interval [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eDemographic characteristics and positivity of the study participants for antibodies against\u003c/b\u003e \u003cb\u003eT. pallidum\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic characteristics of the study participants on the basis of population size, age, and sex. The total number of participants was 138; 63.8% (88) were females, with a median age of 32.7 years, from the five study communities.\u003c/p\u003e \u003cp\u003eThe overall prevalence of antibodies against \u003cem\u003eT. pallidum\u003c/em\u003e among the study participants was 38% [52/137; 95% CI: 30.3\u0026ndash;46.3], with the State Farms community recording the highest seropositivity of 63.3% [19/30; 95% CI: 45.5\u0026ndash;78.1], whereas the Kokomba community recorded the lowest seropositivity of 6.7% [1/15; 95% CI: 1.2\u0026ndash;29.8] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the study participants \u003cem\u003eNB: Serological data were available for 137 (of the 138) participants.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRecruited/\u003c/p\u003e \u003cp\u003ePopulation (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMedian age (range) (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c8\" namest=\"c6\" rowspan=\"2\"\u003e \u003cp\u003ePrevalence of \u003cem\u003eT. pallidum\u003c/em\u003e antibodies\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFemales (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMales (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNo. negative/No. tested (%) [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo. positive/No. tested (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTain District\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbekwai 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36/700 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.5 (8\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16/26 (61.5%) [42.5\u0026ndash;77.6]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e10/26 (38.5%) [ 22.4\u0026ndash;57.5]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKokomba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15/120 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (6\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14/15 (93.3%) [70.2\u0026ndash;98.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e1/15 (6.7%) [1.2\u0026ndash;29.8]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWenchi Municipality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBranam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47/1118 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (9\u0026ndash;95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25/47 (53.2%) [39.2\u0026ndash;66.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e22/47 (46.8%) [33.3\u0026ndash;60.8]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKwanware\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13/150 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (10\u0026ndash;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19/19 (100%) [83.2\u0026ndash;100.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0/19 (0.0%) [0.0-16.8]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState Farms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27/107 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (70.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (7\u0026ndash;78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11/30 (36.7%) [21.9\u0026ndash;54.5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e19/30 (63.3%) [45.5\u0026ndash;78.1]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138/2195 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.7 (6\u0026ndash;95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85/137 (62.0%) [53.7\u0026ndash;69.7]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e52/137 (38.0%) [30.3\u0026ndash;46.3]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDistribution of positivity to\u003c/b\u003e \u003cb\u003eT. pallidum\u003c/b\u003e \u003cb\u003eby sex and age\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe distribution of seropositivity to \u003cem\u003eT. pallidum\u003c/em\u003e antibodies by age and sex is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Seropositivity for \u003cem\u003eT. pallidum\u003c/em\u003e antibodies was lowest in the 21\u0026ndash;40 age category for both males and females. Among females, those aged\u0026thinsp;\u0026ge;\u0026thinsp;41 years had the highest seropositivity, whereas among males, those aged between 6 and 20 years had the highest seropositivity.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eKnowledge of yaws\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the knowledge of the participants while they yaw. The study revealed strong awareness of yaws, with 81.9% (113/138) of the participants being familiar with the disease and 58.0% (80/138) knowing someone affected. However, significant misconceptions about transmission were noted. For example, 2.2% (3/138) of the participants believed that the disease was due to witchcraft. Additionally, although 68.8% (95/138) recognized rashes as symptoms of the disease, a significant 31.2% (43/138) did not know of any of the signs associated with the disease. Knowledge of the treatment of the disease was also limited; only 34.8% (48/138) were aware that yaws can be treated, 33.3% (46/138) believed that they could not be treated, whereas 31.8% (44/138) did not know. Awareness of preventive measures also varied, with 63.0% (87/138) identifying prophylactic drugs as a strategy, but only 21.7% (30/138) of the participants acknowledged the importance of environmental cleanliness. Despite these knowledge gaps, 73.2% (107/138) expressed confidence that yaws can be eradicated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommunity members\u0026rsquo; knowledge of the mode of transmission of yaws, symptoms, and treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall (N\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeard about yaws\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (81.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnow someone with yaws\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (58.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe disease is acquired through (Multiple answers possible)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerson to person contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor personal hygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHereditary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWitchcraft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms of the disease (Multiple answers possible)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain in the bone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (4.34%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRashes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (68.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall bumps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwelling of the lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacial disfiguration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe disease can be treated\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow can the disease be prevented? (Multiple answers possible)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTaking prophylactic drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (63.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKeeping the environment clean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (28.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich group of people is mostly affected by yaws?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYaws can be eradicated\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (73.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes and practices toward yaws\u003c/h2\u003e \u003cp\u003eThe study assessed community attitudes and practices related to yaws in the study communities, and the results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Nearly half (44.9%, 62/138) of the study participants noted that yaws patients were stigmatized in their communities. Furthermore, 15.2% (21/138) believed that yaws were a punishment for evil doers, whereas 57.2% (79/138) indicated fear of the disease. Notably, 75.4% (104/138) of the participants expressed a willingness to support yaws control initiatives despite limited treatment availability, as only 26.8% (37/138) reported that treatment was accessible in their communities. Interaction with infected individuals varied, with 48.5% (67/138) engaging occasionally and only 19.6% (27/138) interacting very frequently with infected persons. Additionally, 48.5% (67/138) of the participants believed that infected individuals could continue their education or work. In terms of hygiene practices, 42.0% (58/138) reported maintaining good personal hygiene, and 50.7% (70/138) of the community participated in regular cleanup activities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAttitudes and practices toward yaws in the study communities\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall (N\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYaws patients are stigmatized in village\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe disease is a punishment for evil doers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity members fear the disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (57.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (21.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity members willing to support control efforts\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (75.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfected people have access to treatment in the community\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity members interact (in person) with infected persons\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery frequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfected still persons go to school or work\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaintain personal hygiene\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFairly well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (42.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot so well\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunity undertakes cleanup exercises\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the percentages of participants with a high level of knowledge, a high level of good attitudes and a high level of good practices. Among the 138 participants, 54.3% had a good level of knowledge, 40.6% had positive attitudes, and 58.7% had good practices toward yaws and their control in communities.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eResults from bivariate analysis\u003c/h2\u003e \u003cp\u003eThe results of the bivariate analysis of the effects of sociodemographic data (age, sex, education, marital status, and occupation level) on knowledge, attitudes and practices are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Compared with those who had no formal education, those who had formal education in school were twice as likely to have a high level of knowledge (OR\u0026thinsp;=\u0026thinsp;2.299, P\u0026thinsp;=\u0026thinsp;0.045, 95% CI\u0026thinsp;=\u0026thinsp;1.020\u0026ndash;5.180) on yaws. The participants with a high level of knowledge were 8 times more likely to have a high level of positive attitude (OR\u0026thinsp;=\u0026thinsp;8.407, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, 95% CI\u0026thinsp;=\u0026thinsp;3.702\u0026ndash;19.090) than those with a poor level of knowledge. A high level of good attitudes was also significantly associated with a high level of positive practices (OR\u0026thinsp;=\u0026thinsp;2.870, P\u0026thinsp;=\u0026thinsp;.005, 95% CI\u0026thinsp;=\u0026thinsp;1.379\u0026ndash;5.970).\u003c/p\u003e \u003cp\u003eBeing \u0026ge;\u0026thinsp;30 years old significantly increased the odds of having a high level of positive attitudes and positive practices. Additionally, farming, as an occupation, was associated with significantly greater odds of having a high level of positive attitudes (OR\u0026thinsp;=\u0026thinsp;2.931, P\u0026thinsp;=\u0026thinsp;0.042, 95% CI\u0026thinsp;=\u0026thinsp;1.042\u0026ndash;8.242).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression of the KAP scores with different sociodemographic variables of the respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCovariates\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAttitudes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003ePractices\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOdds ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOdds ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e\u0026lt;30\u003c/p\u003e \u003cp\u003e\u0026ge;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e0.698 (0.341\u0026ndash;1.430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e2.154 (1.028\u0026ndash;4.512)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e6.963 (3.074\u0026ndash;15.770)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e0.670 (0.323\u0026ndash;1.390)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e0.763 (0.358\u0026ndash;1.625)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e0.568 (0.254\u0026ndash;1.270)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003cp\u003eNot attended school\u003c/p\u003e \u003cp\u003eAttended school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e2.299 (1.020\u0026ndash;5.180)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.045*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e2.047 (0.875\u0026ndash;4.790)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e1.049 (0.430\u0026ndash;2.560)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003cp\u003eNon-Married\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e1.121 (0.460\u0026ndash;2.730)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e0.786 (0.314\u0026ndash;1.968)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e1.301 (0.493\u0026ndash;3.440)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003cp\u003eNon-Farming\u003c/p\u003e \u003cp\u003eFarming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e1.556 (0.587\u0026ndash;4.120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e2.931 (1.042\u0026ndash;8.242)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003cp\u003e1.913 (0.662\u0026ndash;5.530)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAIC for Knowledge\u0026thinsp;=\u0026thinsp;196 AIC for Attitudes\u0026thinsp;=\u0026thinsp;188 AIC for Practices\u0026thinsp;=\u0026thinsp;171\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the seroprevalence of antibodies against \u003cem\u003eT. pallidum\u003c/em\u003e and explore knowledge, attitudes, and practices toward yaws in study communities. The findings provide valuable insights into the epidemiology of yaws in these areas and contribute to understanding community awareness and behaviors.\u003c/p\u003e \u003cp\u003eThe overall seroprevalence of \u003cem\u003eT. pallidum\u003c/em\u003e antibodies was 38%, indicating a substantial burden of infection within the study population. Notably, the State Farms community recorded the highest seropositivity at 63.3%, indicating localized infection hotspots. The seroprevalence reported in our study is more than twice that of serologically confirmed cases of yaws of 26.8% (440/1643) from a study conducted in the Eastern, Western and Central regions of Ghana [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our findings contrast with those of Boaitey et al. (2024) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], who reported a 17.2% and 10.8% prevalence of \u003cem\u003eT. pallidum\u003c/em\u003e seropositivity in individuals with yaw-like and syphilis-like lesions, respectively. The reasons for the relatively high seroprevalence in our study areas are unclear, although notably, the levels of knowledge, good attitudes and practices toward the disease were generally very low in our study communities and could be key drivers of transmission in the area. However, considering that we did not confirm positive cases via polymerase chain reaction (PCR), the actual prevalence of active cases of \u003cem\u003eT. pallidum\u003c/em\u003e infection might be lower in these communities. Our findings emphasize the urgent need for targeted, community-specific interventions to reduce transmission in the study communities.\u003c/p\u003e \u003cp\u003eThe prevalence of \u003cem\u003eT. pallidum\u003c/em\u003e infection among males was highest in the 1\u0026ndash;20 year age group. This finding was not surprising, as the disease is known to have a slight preponderance for males in Ghana, with children younger than 15 years being mostly affected [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The reasons for this association are unclear. The association with sex may reflect an earlier onset of sexual intercourse in boys than in girls, with misclassification of cases of syphilis as yaws in endemic communities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite having awareness of yaws, the general level of good knowledge about the disease (54.3%) was far from optimal. A few of our study participants believed that yaws were caused by witchcraft and/or punishment for doing evil. The tendency to attribute illness to supernatural forces such as witchcraft and curses is a common phenomenon and is often due to a lack of knowledge about the true cause of the illness, especially when the illness is prolonged [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This gap in knowledge is worrying because it can delay treatment-seeking behavior, reduce disease risk perceptions and contribute to the further spread of the disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a study by Mark et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], individuals who reported a supernatural belief about causation, such as witchcraft or a curse, were more likely to report that they would not accept treatment. To remedy this situation, public health education campaigns are urgently needed to dispel myths about yaws to improve knowledge concerning the disease in our communities.\u003c/p\u003e \u003cp\u003eThe general level of good attitudes of community members (40.6%) with respect to yaws was low and a cause for concern, especially with respect to yaws eradication efforts in Ghana. Almost half of the respondents reported that yaws infected individuals are stigmatized in their communities. These findings are consistent with those of a study in the Philippines that demonstrated that stigma, discrimination, and embarrassment are commonly associated with people infected with yaws [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Children infected with yaws are bullied and miss school days to avoid bullying [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In some instances, social interaction and physical intimacy are avoided because of the fear of spreading the infection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStigma may either increase or decrease an individual\u0026rsquo;s willingness to seek treatment, depending on the sociocultural context. In some studies, stigma has been demonstrated to reduce health-seeking behavior [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], thereby contributing to further spread of the disease. However, another study by Tuwor et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in Ghana showed that the fear of stigma and experiencing stigma surprisingly motivated parents and guardians to seek and adhere to treatment, whether biomedical, traditional, or religious interventions for affected individuals. This effect of stigma, which is supported by additional evidence, encourages people to seek medical attention and stick with their treatment plans because they believe that the treatment will cure their illness and, as a result, lessen the stigma attached to it [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, our study did not explore the impact of stigma on the health-seeking behavior of yaws infected individuals or their parents/guardians. Despite the phenomenon of stigmatization observed in our study, we found encouraging signs of community readiness to support yaws control efforts, with 75.4% of participants expressing a willingness to engage in eradication initiatives. However, limited access to treatment remains a barrier, as only 26.8% of respondents reported that treatment was available in their communities. This suggests that while there is a willingness to support control efforts, practical barriers such as healthcare access must be addressed to make a meaningful impact on yaw control in communities.\u003c/p\u003e \u003cp\u003eIn general, the level of positive practices (58.7%) toward yaws in the communities was low among the study participants. However, this finding was not unexpected, as the levels of knowledge and attitudes were also very low. Our findings demonstrated that participants who had a formal education in school were twice as likely to have good knowledge of yaws than were those who had no formal education. Moreover, having a high level of knowledge was significantly associated with increased odds of having a high level of positive attitudes toward the disease. Furthermore, a high level of good attitudes significantly increased the odds of having a high level of positive practices among the study participants (OR\u0026thinsp;=\u0026thinsp;2.870, P\u0026thinsp;=\u0026thinsp;.005, 95% CI\u0026thinsp;=\u0026thinsp;1.379\u0026ndash;5.970). Globally, some studies on other disease conditions, such as COVID-19, agree with our findings that knowledge about a disease significantly affects attitudes and practices toward its control and prevention [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These findings suggest that health education can play a vital role in promoting preventive practices toward yaws.\u003c/p\u003e \u003cp\u003eInterestingly, participants who were \u0026ge;\u0026thinsp;30 years old had significantly increased odds of having a high level of positive attitudes and positive practices, whereas farming, as an occupation, was associated with significantly increased odds of having a high level of positive attitudes (OR\u0026thinsp;=\u0026thinsp;2.931, P\u0026thinsp;=\u0026thinsp;0.042, 95% CI\u0026thinsp;=\u0026thinsp;1.042\u0026ndash;8.242). This was not surprising, as older people in endemic communities are usually more aware of the disease because of their long stay in the community and, subsequently, could have a high level of good attitudes and good practices toward the disease. The need for targeted sociobehavioural change and educational campaigns to improve community hygiene practices among younger people is warranted on the basis of our current findings.\u003c/p\u003e \u003cp\u003eThis study has several limitations that should be addressed in future research. The study participants were not randomly selected. Therefore, the results need to be interpreted with caution, as the findings may not be representative of all the persons living in the study communities. Sample sizes to ensure a given power or precision were not calculated before the study; only people who agreed to gather at the focal point in their communities were included in the study (convenience sampling), with only 6.2% of the population participating overall (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This likely led to bias. Additionally, social desirability bias may have influenced the responses to the questions, although the participants were made aware that their responses had no punitive implications for them whatsoever. Owing to logistical reasons, we were unable to perform molecular confirmation of samples that were seropositive for \u003cem\u003eT. pallidum\u003c/em\u003e; hence, we could not confirm a diagnosis of yaws. Finally, we assessed all age groups and did not restrict our analysis to only children under 15 years of age. This implies that seropositivity may not necessarily reflect active infections.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe demonstrated that despite the high seropositivity of \u003cem\u003eT. pallidum\u003c/em\u003e, there was an inadequate level of knowledge, good attitudes, and good practices related to yaws in our study communities. We highlight the need for sustained, targeted educational and sociobehavioral change campaigns by the Ghana Yaws Eradication Program to improve community knowledge, attitudes and practices to help reduce the transmission of the disease in communities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDeoxyribonucleic Acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKAPs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKnowledge, attitudes, and practices\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMass Drug Administration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeglected Tropical Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolymerase chain reaction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRapid Diagnostic Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal Community Treatment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Committee for Human Research and Ethics at the University of Energy and Natural Resources, Sunyani, Ghana (Reference: CHRE/CA/028/022). Written informed consent was obtained from all participants before recruitment. All procedures in this study were in accordance with the ethical standards of the Helsinki Declaration (1964, amended most recently in 2008) of the World Medical Association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs the data were collected from a small group of participants and vulnerable populations in small communities, we are unable to publicly share the dataset, as they contain indirect identifiers (such as sex, ethnicity, location, etc.) and risk the identification of study participants. However, the dataset may be requested via email ([email protected]) from the Committee for Human Research and Ethics at the University of Energy and Natural Resources in Sunyani, Ghana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests regarding the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific funding. However, K.B.O acknowledges grants from the African Research Network for Neglected Tropical Diseases (ARNTD)/USAID (Grant number SGPIV/0111/241), Royal Society of Tropical Medicine and Hygiene (Small grant awarded to KBO in 2020), and International Foundation for Science (Grant Number: No. I-1-F-6681-1). The funders had no role in the design and funding of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e K.B.O,\u0026nbsp;P.A.O, G.Y., O.O.B;\u0026nbsp;\u003cstrong\u003eData curation:\u003c/strong\u003e P. N., A. A., P. C. K., K. B. O. \u003cstrong\u003eFormal analysis:\u003c/strong\u003e P. N., A. A., P. C. K., D. K. O., P. A. O., G. Y., O. O. B., K. B. O.; \u003cstrong\u003eInvestigation:\u003c/strong\u003e P. N., A. A., P. C. K., E. T. B., D. K. O., P. A. O., G. Y., O. O. B., L. D., P. P. O., C. W. N., E. B. A.\u0026nbsp;;\u003cstrong\u003eMethodology:\u003c/strong\u003e P. N., A. A., P. C. K.,\u0026nbsp;P.A. O., G. Y., O. O. B.,\u0026nbsp;K. B. O.; \u003cstrong\u003eProject administration:\u003c/strong\u003e K. B. O.,\u0026nbsp;L. D.; \u003cstrong\u003eResources:\u003c/strong\u003e K.B. O.; \u003cstrong\u003eSupervision:\u003c/strong\u003e K. B. O., L. D.; \u003cstrong\u003eVisualization:\u003c/strong\u003e P. N.,\u0026nbsp;L. D.,\u0026nbsp;A. H.,\u0026nbsp;K. B. O.; \u003cstrong\u003eWriting – original draft:\u003c/strong\u003e P. N., K. B. O.; \u003cstrong\u003eWriting – review \u0026amp; editing:\u003c/strong\u003e P. N., A. A., P. C. K., E.T. B., D. K. O., P.A.O., G. Y., O. O. B., A. H., L. D.,\u0026nbsp;P. P. O., C. W. N., E.B. A., F. V.D.B., K. B. O.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the staff and students of the Department of Biological Science and the Consortium for Neglected Tropical Diseases and One Health, who provided support in one way or another, to ensure the successful implementation of this research. We also appreciate the efforts of the directors and staff of the Wenchi Municipal Health Directorate and Tain District for their enormous contributions to the study. Our appreciation also goes to the chiefs, opinion leaders and people of the study communities who partnered with us in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2024) Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021\u0026ndash;2030. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789240010352\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789240010352\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Infect Drug Resist. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IDR.S258736\u003c/span\u003e\u003cspan address=\"10.2147/IDR.S258736\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Supplementary Informations","content":"\u003cp\u003eSupplementary Information is not available with this version.\u003c/p\u003e\n\u003cp\u003eAdditional file 1: Questionnaire on knowledge, attitudes and practices on yaws\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Energy and Natural Resources","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Seroprevalence, yaws, Treponema pallidum, sociobehavioral factors, knowledge, attitudes, practices","lastPublishedDoi":"10.21203/rs.3.rs-5416182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5416182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe paucity of epidemiological data on yaws in Ghana hampers national eradication efforts. This study aimed to investigate the seroprevalence of \u003cem\u003eT. pallidum\u003c/em\u003e antibodies and community knowledge, attitudes, and practices toward yaws in the middle belt of Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional, quantitative study was performed between June 2021 and October 2021. A total of 138 participants\u0026mdash;63.8% (88) female, with a median age of 32.7 years\u0026mdash;were recruited from five study communities. Blood samples were taken to test for antibodies against \u003cem\u003eT. pallidum\u003c/em\u003e, and a questionnaire on knowledge, attitudes and practices toward yaws was administered.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall seroprevalence of antibodies against \u003cem\u003eT. pallidum\u003c/em\u003e was 38% (52/137) [95% CI: 30.3 \u0026minus;\u0026thinsp;46.3], the highest of which was 63.3% (19/30) 19/30 [95% CI: 45.5 \u0026minus;\u0026thinsp;78.1] in State Farms, followed by 46.8% (22/47) [95% CI: 33.3 \u0026minus;\u0026thinsp;60.8] in Branam and 38.5% (10/26) [95% CI: 22.4 \u0026minus;\u0026thinsp;57.5] in Abekwai 3. Only 54.3% (75/138) had a good level of knowledge, 40.6% (56/138) had a high level of positive attitudes, and 58.7% (81/138) had a high level of good practices toward yaws. Having a formal education significantly increased the odds of having a high level of knowledge on yaws (OR\u0026thinsp;=\u0026thinsp;2.299, P\u0026thinsp;=\u0026thinsp;0.045, 95% CI\u0026thinsp;=\u0026thinsp;1.020\u0026ndash;5.180). The participants with a high level of knowledge were 8 times more likely to have a high level of positive attitudes (OR\u0026thinsp;=\u0026thinsp;8.407, P\u0026thinsp;\u0026lt;\u0026thinsp;.001, 95% CI\u0026thinsp;=\u0026thinsp;3.702\u0026ndash;19.090), whereas a high level of good attitudes also significantly increased the odds of having a high level of positive practices (OR\u0026thinsp;=\u0026thinsp;2.870, P\u0026thinsp;=\u0026thinsp;.005, 95% CI\u0026thinsp;=\u0026thinsp;1.379\u0026ndash;5.970). Being \u0026ge;\u0026thinsp;30 years old significantly increased the odds of having a high level of positive attitudes and positive practices.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDespite high seropositivity of \u003cem\u003eT. pallidum\u003c/em\u003e antibodies, there was an inadequate level of knowledge, good attitudes, and good practices toward yaws in our study communities. We highlight the need for sustained, targeted educational and sociobehavioral change campaigns by the Ghana Yaws Eradication Program to improve community knowledge, attitudes and practices and help reduce the transmission of the disease in communities.\u003c/p\u003e","manuscriptTitle":"Seroprevalence of Treponema pallidum antibodies and community knowledge, attitudes, and practices related to yaws in the middle belt of Ghana: A quantitative cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-13 02:27:39","doi":"10.21203/rs.3.rs-5416182/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"47d17659-b696-4dd7-a42a-50145a739e3d","owner":[],"postedDate":"November 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":40003665,"name":"Epidemiology"}],"tags":[],"updatedAt":"2024-11-13T02:27:40+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-13 02:27:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5416182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5416182","identity":"rs-5416182","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}