The Eradication of Yaws in the Sub-District of Tongkuno, District of Muna, Indonesia: Towards A Community-Based Participative Surveillance Model

Abstract

Background: - This paper describes the findings of a research on Yaws Eradication Program in the Sub-District of Tongkuno, District of Muna, Indonesia, and to propose a Community-Based Participative Surveillance Model to improve the early detection, recording and the reporting of Yaws cases in the area. In general the study sought to explain, how aware are the people of the yaws in terms of cause, sign and symptoms, treatment, prevention and recording and reporting. The study also sought to find out the present surveillance system of the Ministry of Health in detecting, recording, and reporting of Yaws. Regarding the people belief, this study sought to find out the issues and health practices related to the spread of yaws. Finally this study proposed a community-based surveillance model that can be applied especially in the village level for early detection, monitoring, prevention and eradication of Yaws. Methods: - The study was conducted in the Sub-District of Tongkuno, District of Muna, A total of 26 individuals participated in personal communication and interview to draw their perceptions and experiences regarding Yaws. The participants were health centre personnel, elementary school teachers, parents, sub-district officials and health cadres. The researcher drew their perceptions and experiences regarding Yaws; the cause, signs and symptoms, the treatment and its preventive measures. Results: -. The poor and inconsistency recording and reporting were found in the surveillance of Yaws in Tongkuno. Personal communication and interview supported this problem. Only four out of fourteen (28.6%) of health centre personnel knew Yaws including its signs and symptoms. Seven of them (50%) identified penicillin as a treatment for Yaws. During the communication with four elementary school teachers, it found out that all of them (100%) had no idea about the cause of Yaws as well as its sign and symptoms. They also did not know its scientific treatment. One teacher (25%) mentioned personal hygiene as preventive measure for Yaws. The teachers admitted that they know Yaws in its secondary stage where the lesion filled with pus, burst, and ulcerate. All four parents (100%) being interviewed did not know the cause of Yaws but recognized and mentioned it in the local name, Kandadawa. The parents were not disturbed with the disease and in the advanced stage; they brought their infected children to traditional healers for consultation and treatment. They did not know the scientific treatment and preventive measures of Yaws. All chief district officials and their staffs being interviewed (100%) did not know the disease including its signs and symptoms. Three of them (75%) did not know its scientific treatment. One of the chief district officials (25%) mentioned penicillin as its treatment because he was a former Yaws case without realizing that he was infected with Yaws. In personal communication and interview with two health cadres, they could not explain the cause, signs and symptoms of Yaws. They also did not know the scientific treatment and its preventive measures. Conclusion: - The majority of participants in personal communication and interview did not recognize Yaws including their signs and symptoms. Most of them also did not know the scientific treatment for Yaws and its preventive measures. Health centre personnel did not pay much attention to the eradication of Yaws anymore since this disease is not a priority in communicable disease control program in the health centre. In the early stage all parents (100%) just ignore the signs and symptoms of the disease. They just let the disease grew and considered them as a sign of maturity (personal communication 2011). In this infectious stage, the parents had no intention to seek for treatment in the health centre. When the disease develops to the next stage where the lesion begins to elevate, contain pus and ulcerate, they refer their infected children to traditional healer. Traditional healer will either prepare herbal or water followed by prayer or mantra. These traditional healers also threaten the parents not to bring their children to health centre. This is the main problem why the health centre lost its control to the recording, prevention and eradication of Yaws (Munandar, personal interview, 2011). Surveillance model of Ministry of Health showed how reporting and recording activities was conducted solely by Department of Health without community participation. Poor recording and reporting result of 100% iceberg phenomenon can be partly attributed to the absence of community participation.